340:50-15-3 Overpayment claim procedures

(a) Overpayment determination. Adult and Family Services (AFS) local office staff calculates overpayments and refers it to AFS Benefit Integrity and Recovery (BIR) for final determination. (1) When the household failed to report earned income timely, per Oklahoma Administrative Code (OAC) 340:50-9-5, the worker does not subtract an earned income deduction from gross earnings when calculating the overpayment amount. (2) AFS local office staff documents the circumstances causing the overpayment and the calculations used to determine the over-issuance amount on Form 08OP005E, Report of Supplemental Nutrition Assistance Program Overissuance and sends Form 08OP005E and supporting documentation to AFS BIR staff for claim establishment. (3) If Office of Inspector General (OIG) staff determines a trafficking-related offense occurred, AFS BIR staff bases the overpayment amount on the value of the trafficked benefits. Per Section 273.18(c) of Title 7 of the Code of Federal Regulations, the value of the trafficked benefits is determined by: (A) the household member or authorized representative's admission; (B) adjudication; or (C) OIG documentation that formed the basis for the trafficking determination. (b) Overpayment claim establishment. AFS BIR staff is responsible for evaluating overpayment referrals, establishing overpayment claims, and referring overpayment claims to OIG when fraudulent intent is suspected. An overpayment claim is considered established on the date AFS BIR staff sends the overpayment notice to the household. (1) When fraudulent intent is not suspected, AFS BIR staff: (A) establishes the overpayment claim and classifies it as an inadvertent household or agency error, per OAC 340:50-15-4; (B) notifies the household and worker, per (d) and (e) of this Section; and (C) sets up a repayment plan with the household, per OAC 340:50-15-6. (2) When fraudulent intent is suspected, AFS BIR staff sends the overpayment referral to OIG to determine whether fraudulent intent occurred. The overpayment claim is not established and notices are not sent until OIG completes its investigation and releases the claim back to AFS BIR. Refer to OAC 340:50-15-25 for procedures when overpayments are referred for an intentional program violation determination. (c) Claim establishment time frame. The amount of time included in an overpayment claim varies. (1) From when Oklahoma Human Services (OKDHS) learned of the overpayment AFS BIRS calculates all overpayment claims back at least 12 months but no more than six years. (2) When AFS BIR classifies an overpayment as an intentional program violation, the overpayment claim begins with the month the first intentional program violation occurred, subject to paragraph (1). (3) OKDHS complies with court orders that require a household to pay restitution. (d) Household notification. AFS BIR staff sends the household: (1) the Notification of Food Benefit Overpayment notice; (2) Form 08OP005E showing the overpayment over-issuance amount; and (3) Form 08OP118E, Food Benefit Repayment Agreement. (e) Local office notification. After claim establishment, AFS BIR staff sends the local office: (1) a copy of the Notification of Food Benefit Overpayment notice sent to the client; (2) the completed Form 08OP005E; and (3) the County Notification of Overpayment notice.