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West Virginia Income Maintenance Manual Chapter 11

West Virginia Income Maintenance Manual

Page iii Chapter 11 Benefit Repayment

11.3.5.C Collection Procedures ......................................................................................23 11.3.6 DETERMINING THE REPAYMENT AMOUNT ........................................................23 11.3.6.A Active Recipients ..............................................................................................23 11.3.6.B Former Recipients ............................................................................................24 11.3.6.B.1 Lump-Sum Payment ...................................................................................24 11.3.6.B.2 Installment Payments .................................................................................24 11.3.6.B.3 Use of EBT Cash Account Benefits ............................................................24 11.3.7 RIGHT TO A FAIR HEARING ..................................................................................25 11.3.8 MAINTENANCE OF THE CASH ASSISTANCE CLAIM ..........................................25 11.3.8.A Notification of Delinquent Payments .................................................................25 11.3.8.B Receipts ...........................................................................................................25 11.3.8.C Action Required When a Client Moves .............................................................26 11.3.8.D Repayment of an Overpaid Claim .....................................................................26 11.3.8.E Effect of Bankruptcy .........................................................................................26 11.3.8.F Effect of Expunged EBT Cash Accounts ..........................................................26 11.3.8.G Months Removed from the Lifetime Limit .........................................................27 11.4 MEDICAID CLAIMS AND REPAYMENT PROCEDURES ..........................................28 11.4.1 REPAYMENT OF CORRECTLY PAID BENEFITS – ESTATE RECOVERY ...........28 11.4.2 REPAYMENT OF BENEFITS FOR WHICH CLIENT WAS INELIGIBLE ..................28 11.4.2.A Intentional Misrepresentation ...........................................................................28 11.4.2.B Unintentional Misrepresentation or Worker Error ..............................................29 11.4.3 PROVIDER FRAUD ................................................................................................29 11.5 REFERRALS TO THE FRONT-END FRAUD UNIT (FEFU) .......................................30 11.5.1 REFERRAL CRITERIA ............................................................................................30 11.5.1.A Identification .....................................................................................................30 11.5.1.B Residency ........................................................................................................31 11.5.1.C Household Composition ...................................................................................31 11.5.1.D Assets ..............................................................................................................31 11.5.1.E Earned Income .................................................................................................31 11.5.1.F Unearned Income .............................................................................................32