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728 Chapter 3:Processes and procedures • Section 5: Program integrity (07/2026)
Paid to an ineligible provider or
The payment exceeds the amount for which a provider is eligible, or
Paid to a provider who does not submit attendance logs upon request. PF “possible fraud” overpayment occurs when an individual or provider is suspected of intentionally causing an overpayment to occur in order to receive or increase payments or benefits they are not eligible to receive. PI “provider intentional” overpayment occurs when there is clear and convincing evidence the provider intended to mislead, misrepresent, conceal or withhold facts. Provider intentional overpayment occurs when the provider intentionally does any of the following: • Bills ODHS|OHA for more care than actually provided, including duplicate billings • Collects payment directly from an individual after ODHS|OHA’s payment for the services has been garnished or after overpayment recovery actions have reduced the amount paid • Fails to comply with the agreements of the Child Care Provider Listing (7494) form, including failing to list required individuals for the record check, or • Establishes eligibility for payment for another person. Note: When an overpayment is caused by both an administrative and participant error in the same month, ODHS|OHA determines the primary cause of the overpayment and assigns as either an administrative or “client error” overpayment. Overpayment thresholds ODHS|OHA establishes an overpayment when the following thresholds are exceeded: Administrative Error overpayments in: • Cash and child care programs, when the amount is greater than $200 • SNAP open case, when the amount is greater than $100 • SNAP closed case, when the amount is greater than $200 • Medical programs, do not establish AE overpayments. Client Error overpayments in: • Cash and child care programs, when the amount is greater than $200 • SNAP open case, when the amount is greater than $100 • SNAP closed case, when the amount is greater than $200 • Medical programs, do not establish CE overpayments. Provider Error overpayments in: • Cash, adult care, and child care programs, when the amount is greater than $200 • SNAP open case, when the amount is greater than $100 • SNAP closed case, when the amount is greater than $200.