Phase II Findings: Error Rate Methodology Pilot
Executive Summary, I. Introduction, II. Methodology, III. Measuring Improper Payments in Nine States, IV. Findings and Next Steps, V. Recommendations, Appendices: Appendix A: Arkansas, Appendix B: Colorado, Appendix C: Illinois, Appendix D: Ohio, Appendix E: Record Review Worksheet, Appendix F: Data Entry Form, Appendix G: Telephone Discussion Guide, Appendix H: Arizona, Appendix I: California, Appendix J: Kansas, Appendix K: Nebraska, Appendix L: New Hampshire
Appendix K: Nebrasksa
Nebraska is State-administered and has 93 counties. Some Resource and Referral agencies exist in Nebraska, but they do not receive State funds. Nebraska has approximately 6,000 child care providers with contracts to provide care; however, the State does not pay for slots, but arranges for care on a case by case basis.
Improper Payments Process
Nebraska does not define improper payments in statute or policy. Nebraska revised statute, 81–3109, defines intentional program violations as:
Any action by an individual to intentionally make a statement either verbally or in writing to obtain benefits to which they are not entitled, to conceal information to obtain benefits to which they are not entitled, to alter one or more documents to obtain benefits to which they are not entitled.
Nebraska identifies improper payments primarily through monthly exception reports, including computer generated lists of top-paid providers in the State, copay lists, and lists of high daily and hourly rates. The Issuance and Collection Center Unit is responsible for auditing Temporary Assistance for Needy Families (TANF), Food Stamps, child care, and foster care. Four auditors conduct the child care audits. Most audit referrals fall into one of two categories:
- Overcapacity—Providers identified as serving more children than their licensed capacity. Auditors identify providers by compiling a spreadsheet for the provider’s daily attendance for both title XX billings and the food program. From these data, they are able to determine if the provider is caring for more children than allowed.
- Inaccurate Billings—Providers identified as billing out of the authorization, padding billings with additional attendance, making inaccurate calculations, or other regulation violations. Auditors identify problems by compiling monthly charts that provide an easy comparison between attendance billed by the provider and the authorized days of care.
Following an investigation, the State determines the amount of the overpayment and who is responsible for the overpayment. For each overpayment, the auditor will write a report of audit findings that summarizes the details of the case, how the amount was determined, and who was responsible for the overpayment. The overpayments will either be internal, which are charged to the billing documents, or external, where the overpayment may go to civil court. Clients and providers have 45 days to appeal an audit decision. Nebraska takes action on every improper payment and has no threshold.
The agency attempts to develop a repayment agreement of up to 50 percent. If the case is active, the agency can deduct from the next payment. The State has had better success at recouping overpayments by pursuing civil suits rather than criminal suits. The letters requesting repayment are issued by the attorney assigned to Child Care and sent to the clients and providers. The State believes that letters coming from the legal office are more effective than other types of communication.
Automation
The Nebraska system, developed approximately 5–8 years ago, uses a home-grown, mainframe-based automated system that serves TANF, Food Stamps, and Child Care. Because all of the major programs use the same system, the automated system determines if the client is receiving the service and where. Child care eligibility is not automated and the eligibility must be performed manually and entered into the system.
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