Library: Policy

340:40-15-1. Overpayments

Revised 10-1-17

(a) Overpayment claim definition.A client or child care provider overpayment claim may occur as a result of agency, client, or provider error when a household received more child care benefits than it is entitled to receive or a provider was paid in error per (b)(1)(B) or (3) of this Section.

(b) Overpayment referral.Oklahoma Department of Human Services (DHS) staff including, but not limited to, Adult and Family Services (AFS) or Child Welfare Services (CWS) staff, Office of Inspector General (OIG) auditors or investigators, or Financial Services (FS) Electronic Payment Systems (EPS) staff may identify a possible overpayment.When DHS staff suspects an overpayment occurred, he or she sends a client overpayment referral to AFS Benefit Integrity and Recovery (BIR) and a provider overpayment referral to FS EPS for an overpayment determination and claim establishment.   • 1

(c) Overpayment determination and claim establishment.AFS BIR staff determines if a client overpayment occurred, when it occurred, and if it is due to an agency or client error.When the overpayment is due to a client error, AFS BIR staff establishes the overpayment as an inadvertent client error, willful misrepresentation, or fraud.FS EPS staff determine and establish provider overpayments.An overpayment claim is considered established on the date AFS BIR staff sends the overpayment notice to the household or FS EPS staff sends a letter to the child care provider.

(1) Agency error overpayment claim.An agency error overpayment claim may be established against the client or the child care provider depending on the circumstances.An agency error overpayment occurs when DHS staff did not exercise due diligence. • 2

(A) When AFS staff incorrectly calculates countable income and/or deductions resulting in an incorrect family share copayment or complete ineligibility, or AFS or CWS staff approves more care than the household is entitled to receive, AFS BIR staff establishes the agency error overpayment against the client.

(B) FS EPS staff establishes agency error overpayments against the provider for child care plan errors when DHS pays an incorrect rate.

(2) Client error overpayment claim.AFS BIR staff establishes an overpayment claim against the client when the client:

(A) provides incorrect information at the time of application or renewal;

(B) fails to report any change that affects eligibility per Oklahoma Administrative Code (OAC) 340:40-9-2; or

(C) uses child care for days and hours the client is not eligible for child care.

(3) Provider error overpayment claim.FS EPS establishes an overpayment claim against the provider when the provider: • 3

(A) submits incorrect claims;

(B) fails to timely void inaccurate attendance entered in the point-of-service (POS) machine by the client;

(C) receives payment for care the provider did not provide and is not entitled to receive.This can occur when the provider has possession of the client's electronic benefit transfer (EBT) card and swipes attendance for a day a child did not attend or facility staff requests that a parent do so;

(D) receives payment for care from DHS that was provided after the date his or her child care license was revoked or contract was cancelled; or

(E) moves a POS machine to a different location prior to obtaining written approval from AFS Child Care Subsidy staff and payment was made for care during that period.

(4) Liquidated damages.Per OAC 340:2-11-150, FS EPS staff may assess liquidated damages in addition to a provider overpayment when the provider:

(A) is in possession of the client's EBT card;

(B) swipes the card through the POS machine; or

(C) knows the client's personal identification number (PIN).

(d) Overpayment notice.Following claim establishment, AFS BIR staff sends the client an overpayment notice and FS EPS staff sends an overpayment notice to the provider.   • 4

(e) Appeal rights.Only a client has the right to appeal all or part of any overpayment claim established against him or her.

(f) Repayment of an overpayment claim.DHS requires repayment of all established overpayments.

(1) AFS BIR staff sends the client Form 08OP011E, Repayment Agreement, with the overpayment notice and begins sending a monthly account statement the following month that reflects all payment and account information.

(2) FS EPS staff sends a letter to the provider that explains the repayment process for vendor overpayments.   • 5When the provider:

(A) receives subsidy payments, a portion of his or her weekly payments are retained to repay the overpayment; or

(B) does not receive subsidy payments, he or she must set up a repayment plan with FS EPS staff.

INSTRUCTIONS TO STAFF 340:40-15-1

1.(a) The overpayment referral consists of a memo and supporting documentation. The memo must include:

(1) a short summary of the circumstances that led to the possible overpayment claim including the original and new family share copayment amounts, when applicable;

(2) if the overpayment is due to a household or agency error; and

(3) the contract number of the child care provider.

(b) Supporting documentation may include, but is not limited to:

(1) pay stubs;

(2) an employer statement;

(3) a school or training schedule; or

(4) a data exchange screen.

(c) Office of Inspector General (OIG) auditors and investigators submit a summary of their findings and supporting documentation to Adult and Family Services (AFS) Benefit Integrity and Recovery (BIR) and/or Financial Services Electronic Payment Systems (EPS) upon completion of an audit or investigation.Auditors give child care providers a copy of the audit report.

2.(a) A client overpayment due to an agency error may occur when, based on the client's work schedule, staff incorrectly approves the client for the weekly unit type and only 12 days per month are needed.The client overpayment occurs when the client actually uses more than 12 days of care for a non-work reason.

(b) Examples of agency error provider overpayments are, when the:

(1) worker inappropriately approves a child for a blended, weekly, or special needs authorization; and

(2) provider receives a rate for which he or she is not entitled.When this occurs, the difference between the correct payment rate and the actual amount the provider received is the overpayment.

(c) Due diligence by AFS staff includes:

(1) processing child care benefits timely and accurately;

(2) taking action on reported changes per Oklahoma Administrative Code (OAC) 340:40-9-2 rules regarding case changes, closures, and reopens;

(3) correctly approving the days and hours care is needed; and

(4) informing the client and/or provider of Oklahoma Department of Human Services (DHS) policy and procedures.

(d) Due diligence by AFS Child Care Subsidy staff includes:

(1) informing the client and/or provider of DHS policy and procedures;

(2) providing ongoing provider training and/or training materials, such as the online "Orientation to Child Care Subsidy Contracts" and the "Contracting with OKDHS for Child Care Subsidy Payments" online handbook to keep providers informed of child care subsidy rules; and

(3) updating providers on DHS policy and procedure changes as they occur.

(e) Due diligence by Financial Services (FS) EPS staff includes correctly processing child care claims and Form 08EB004E, Report of Electronic Benefits Transfer (EBT) Child Care Payment Adjustments, requests.

3.The provider is responsible for checking the accuracy of the attendance swiped by the client and accurately completing Form 10AD121E, Child Care Claim, when needed.When the client swipes inaccurate attendance, the provider must void out incorrect swipes and ask the client to swipe again.

4.(a) AFS BIR staff issues the client notice titled Notification of Overpayment and Form 08OP011E, Repayment Agreement, after establishing the overpayment claim.The notice includes:

(1) information regarding how the debt occurred, who was at fault, and the time period of the debt; and

(2) an explanation of the client's appeal rights.Clients must request an appeal through their local county office.Refer to OAC 340:2-5 for hearing procedures.

(b) The provider overpayment notice sent by FS EPS staff includes information regarding:

(1) how the debt occurred;

(2) the time period covered;

(3) how the provider may repay the debt; and

(4) when FS will begin recoupment from future provider payments.

5.FS EPS staff sends a copy of the provider overpayment notice to AFS Child Care Subsidy and OIG.