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FOOD AND NUTRITION SERVICES CERTIFICATION CLAIMS Agency Error (AE) Claims

1 Section 810 Change #3 2017 September 20, 2017 FNS 810 Agency Error (AE) Claims Change #3-2017 September 20, 2017

810.01 GENERAL POLICY

Agency Error claims are federal debts and must be collected. The issue is not who made the mistake, but rather who used the benefits. A Fair Hearing or subsequent State Level Hearing cannot override the Federal laws that require recipients to repay Agency Error Claims. The DSS- 8554, Letter of Overissuance, states the only reasons to request a Fair Hearing are if the household disagrees with the amount of the claim established or the amount of recoupment, or the household states the claim has been previously paid in full.

A. A claim must be established within 12 months from the date the referral was created in Enterprise Program Integrity Control System (EPICS).

Date of Discovery means that the agency is aware of sufficient facts to suspect that an overissuance occurred by completing a DSS-1682.

B. Establish a claim for any months of overissuance which occurred within six years prior to the Date of Discovery. Do not include in the claim calculation any amount of the overissuance which occurred in a month more than six years from the date the overissuance was discovered.

C. Use policy in effect at the time the overissuance occurred.

D. Regardless of the detection source, all potential FNS overissuances must be reviewed timely to determine if referral to local agency Program Integrity staff is required. The referral must be investigated and if appropriate, a claim established, within required time frames.

Enter established claims in EPICS before the 180th day or close unsubstantiated referrals in EPICS before the 180th day to prevent an untimely referral. All potential overissuances must be investigated even if the timeliness standards cannot be met.

If the process of establishing a claim is not completed within the time frames listed in 810.01 D,1-5, the case is considered overdue. Federal regulations require that time frames be tracked and corrective action implemented when more than 10% of referrals in a local agency are more than 180 days old. Counties should monitor monthly the following reports FRD-407 Timeliness Report and FRD-420 Caseload Details By Investigator to ensure counties are within the 10% timeliness requirement.

1. Create a referral in the Enterprise Program Integrity Control System (EPICS) within 10 business days of detection of a potential overissuance. This establishes a file in EPICS to track the claim and establishes the referral’s Creation Date.

2. Request all necessary verifications within 30 calendar days of the receipt of the referral if possible.

3. Allow 30 calendar days for the return of the requested verification.