Library: Policy

340:50-15-3. Overpayment claim procedures

Revised 9-15-17

(a) Overpayment determination.Overpayments are calculated by Adult and Family Services (AFS) local county office or support center staff and are referred to AFS Benefit Integrity and Recovery (BIR) for final determination.

(1) When the household failed to report earned income in a timely manner 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 county office or support center staff documents the circumstances causing the overpayment and the calculations used to determine the over-issuance amount on Form 08OP005E, Report of Food Benefit (FB) Overissuance, and sends Form 08OP005E and supporting documentation to AFS BIR staff for claim establishment.  • 1

(3) When 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's 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.  • 2

(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) When AFS BIR classifies an overpayment as an inadvertent household error or agency error, the established overpayment claim does not cover more than 12 months prior to the month in which the overpayment was discovered unless a court orders the household to pay restitution for an additional time period.

(2) When an intentional program violation is determined, the established overpayment time frame may cover up to six years prior to the date the overpayment was discovered.

(d) Household notification.AFS BIR staff sends the household:

(1) the Notification of Food Benefit Overpayment notice;

(2) page 1 of Form 08OP005E showing the overpayment over-issuance amount; and

(3) Form 08OP118E, Food Benefit Repayment Agreement.

(e) County office notification.After claim establishment, AFS BIR staff sends the county 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.

Revised 9-15-17

1.(a) The worker uses the FSCALC transaction to calculate the over-issuance amount.

(b) Supporting documents may include, but are not limited to:

(1) pay stubs and FSCALC transaction screens showing the income used in correct benefit calculation;

(2) bank statements, property deeds, or other resource documentation;

(3) a marriage license; or

(4) a collateral statement.

(c) The worker sends the overpayment referral to Adult and Family Services (AFS) Benefit Integrity and Recovery (BIR) by:

(1) email to overpayments@okdhs.org;

(2) fax to 405-522-0952; or

(3) inter-office mail.

2.To be considered timely per Section 273.18(d) of Title 7 of the Code of Federal Regulations, all food benefit overpayment claims must be established within 180-calendar days following the discovery date.In order to meet this time frame, it is important for staff to send overpayment referrals to AFS BIR within 30-calendar days of discovery.The worker sends the overpayment regardless of timeliness.