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Indiana Health Coverage Program Policy Manual Chapter 4600 BENEFIT RECOVERY Sections 4600.00.00 – 4650.20.05 Contents 4600.00.00 BENEFIT RECOVERY ................................................................................................2 4605.00.00 IDENTIFYING OVER ISSUANCES ...............................................................................2 4605.05.00 STAFF RECOVERY RESPONSIBILITIES ............................................................3 4605.05.05 ELIGIBILITY WORKER RESPONSIBILITIES ......................................................3 4605.05.10 BENEFIT RECOVERY WORKER RESPONSIBILITIES .........................................4 4605.05.15 FRAUD REFERRAL COORDINATOR/BENEFIT RECOVERY CODY USER RESPONSIBILITIES 4 4610.00.00 TYPES OF OVER ISSUANCES ....................................................................................5 4610.05.00 AGENCY ERROR DEFINITION .......................................................................5 4610.10.00 CLIENT ERROR DEFINITION .........................................................................5 4610.15.00 SUSPECTED FRAUD DEFINITION ..................................................................6 4610.15.10 DETERRENTS AGAINST FRAUDULENT ACTIVITY ...........................................6 4610.15.15 ESTABLISHMENT AND INVESTIGATION OF POSSIBLE FRAUD .......................7 4610.15.20 INVESTIGATION OF POSSIBLE FRAUD ..........................................................7 4610.15.25 REPORT OF FRAUD INVESTIGATIONS AND ADJUDICATIONS ........................8 4610.15.30 REFERRAL TO COUNTY PROSECUTOR ..........................................................8 4610.20.00 EVIDENCE USED TO SUBSTANTIATE FRAUD.................................................9 4610.25.00 COURT DETERMINATION OF FRAUD ...........................................................9 4620.00.00 COMPLETING THE BENEFIT RECOVERY REFERRAL .................................................10 4620.05.00 ASSIGNING THE REFERRAL TO THE BENEFIT RECOVERY WORKER ..............10 4620.05.10 TOTAL INELIGIBILITY .................................................................................10