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2 4600.00.00 BENEFIT RECOVERY This chapter presents policies and procedures on the following topics: · Identifying Over Issuances (Section 4605) · Types of Over Issuances (Section 4610) · Over Issuance Calculation (Section 4620) · Initiating Collection Action (Section 4630) · Recovery Methods (Section 4635) · Transmittal of Repayment (Section 4640) · Claim Against Estate (Section 4650). 4605.00.00 IDENTIFYING OVER ISSUANCES An over issuance exists when an AG received benefits when it was not eligible to receive benefits, or in the case of spend down or liability, when the AG received benefits in an amount greater than it was eligible to receive. Benefit Recovery will not be pursued if the correct information would only have affected the amount of monthly premiums or POWER Account contributions. Benefit Recovery will be pursued for assistance groups where the member failed to report or falsified information which would have made them completely ineligible for the assistance they received. This means that income reporting would not affect categories such as MA X, MAGP, MASI, MAMA, MA 4, MA 8, MA 15, and MA Q. The claims process begins with the identification of an over issuance. This occurs when the eligibility worker receives or discovers information which appears to contradict information previously used to determine eligibility. The worker may receive information that an over issuance has occurred because of any of the following scenarios: · An untimely reported change · Information from individuals inside/outside the AG · Fair hearing decision found unfavorable to client · Transfer penalties · Quality Control (QC) referral · Management Evaluation (ME) review · Office of Inspector General (OIG) investigation/audit report (referred through Central Office) · Central Office referral. The source reporting information may have already conducted a case review and obtained documentation to resolve the discrepancy and determine the time and amount of any over issuance.