1142.020.00 Claims Referral Procedures and Determination of Date of Discovery – DSS Manuals

IM-65 July 12, 2023 ; IM-50 May 15, 2020 ; IM-142 December 2, 2005

The Claims and Restitution System (CARS) is divided into two areas:

the discovery tracking system and

the claim tracking system.

A discovery claim referral is tracked from date of discovery through notification to the household that an overpayment has occurred by generation of a demand letter (see 1142.045.00 Demand Letters ) or rejection of the referral. Once a claim is established, the claim tracking system is used to monitor collection activity.

A Program Integrity Unit (PIU) staff member registers a discovery claim referral in CARS using the Discovery Add (OVAD) screen to begin the discovery tracking process when:

a potential overpayment exceeds the threshold,

is a result of a quality control review, or

suspected fraud is identified.

Enter the date the potential claim is verified as the date of discovery. A discovery identifier is assigned, which includes the 10-digit DCN, the date of the discovery, and a sequence number to track the number of SNAP claims discovered for the DCN on that day.

CARS uses the date of discovery to determine that the claim was established in an appropriate time frame. When a claim referral is registered, CARS calculates the due date of the claim. The discovery claim referral must be acted on and the claim established or rejected by the last day of the quarter following the quarter in which the potential claim was discovered.

A Weekly Pending Discovery Claim Referral Report (FCLWK500-01) shows three days prior to the end of the quarter as the due date to act on the claim referral for management purposes.

Claim referral procedures vary according to how the potential claim is discovered.

If staff discover potential overpayments that exceed the threshold or that appears to be fraud, then staff send a claim referral. PIU staff registers the discovery claim referral in CARS on the OVAD screen. The date of discovery is the date the PIU staff obtains the verification that is used to calculate the over-issuance.

Quality control staff register the discovery claim referral in CARS if a potential overpayment is discovered because of a quality control review. The date of discovery is the date the supervisor signs off on quality control review findings.

The Welfare Investigation Unit (WIU) establishes trafficking of SNAP benefits; and WIU notifies the PIU staff that trafficking occurred, the amount of the claim, and the period of the claim. The PIU staff registers the discovery claim referral in CARS for trafficking of SNAP benefits. The date of discovery is the date the PIU staff receives notice of trafficking from WIU.

When WIU, SNAP Program and Policy Unit, or another source discovers a potential overpayment, PIU staff are notified and register the discovery claim referral in CARS. The date of discovery is the date the PIU staff obtains the verification used to calculate the overpayment.