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Chapter 10: Overpayment Procedures & Investigations 1 Chapter 10: Overpayment Procedures & Investigations

(A) Agency Error If an overpayment is due to agency error, a claim will be filed. Rather than filing the claim against the client, the amount of the overpayment will be paid from the state’s general fund.

Caseworker Overpayment Procedure-Agency Error 1. Quality Control determines a benefit level to be incorrect and notifies the caseworker and the Program Specialist 2. Caseworker will put case in a temporary INA status and enter 9’s in the begin date field • Caseworker will contact client within 5 days to notify of overpayment and to see if they would be eligible at this point 3. Administrator and Program Specialist will determine if the overpayment was the result of agency error 4. If determined to be a agency error the Program Specialist will track the overpayments

(B) Client Error

Overpayments resulting from client error must be referred to the Office of Recoveries and Fraud Investigations (ORFI). ORFI will determine if the client error was intentional or inadvertent. An overpayment has NOT occurred, and a overpayment referral will not be completed if the total amount paid by the agency on the client’s behalf DOES NOT exceed the benefit level the client would have received had the income been accurately reported at the time of eligibility determination.

Example: John Smith was approved for $500 of assistance and it is later discovered that he should have only been approved for $300 of assistance due to the client failing to report all income, household members with income, etc. If, at the close of the heating season: (a) The department has paid the full $500. An overpayment will be done against the client for the full $200 difference. (b) The department paid more than $300, but less than $500. An overpayment will be done for the difference between what was actually paid and the amount the client should have been eligible for. (c) The department paid less than $300. No overpayment will need to be calculated.

Caseworker Overpayment Procedure-Client Error 1. Quality Control determines a benefit level to be incorrect and notifies the caseworker and the Program Specialist 2. Caseworker will put case in a temporary INA status and enter 9’s in the begin date field • Caseworker will contact client within 5 days to notify of overpayment and to see if they would be eligible at this point