Library: Policy

340:65-9-1. Scope and applicability

Revised 9-15-22

(a) Scope and applicability. The scope and applicability of overpayment procedures contained in this Subchapter apply to Temporary Assistance for Needy Families (TANF) and State Supplemental Payment (SSP) recipients.

(b) Overpayment claim definition. An overpayment claim occurs when a household receives more benefits than it is entitled to receive. Overpayments may be classified as inadvertent household errors (IHE), agency error (AE), willful misrepresentation, intentional program violation, or fraud.

(c) Overpayment referral. When Oklahoma Human Services (OKDHS) staff suspects an overpayment occurred, he or she sends an overpayment referral to the Adult and Family Services (AFS) Benefit Integrity and Recovery (BIR) Unit for an overpayment determination and claim establishment.

(1) Reasons OKDHS staff may send an overpayment referral to the AFS BIR Unit for an overpayment determination include, but are not limited to, when the:

(A) household:

(i) failed to provide OKDHS with correct or complete information;

(ii) failed to report changes in its circumstances; or

(iii) elected to receive benefits pending a fair hearing decision that subsequently found the family ineligible or eligible for fewer benefits;

(B) worker:

(i) failed to take prompt action on a change reported by the household;

(ii) incorrectly computed the household's income, deductions, or both; or

(iii) incorrectly authorized benefit issuance to a household; or

(2) The worker includes in the overpayment referral, the circumstances leading to the overpayment, if the overpayment occurred because of household or agency error, and how he or she computed the overpayment amount. • 1 When applicable, the overpayment referral may cover up to six years prior to the date the worker discovers the over-issuance.

(A) For TANF, when an overpayment occurs because the client does not report earned income within 10-calendar days, per Oklahoma Administrative Code (OAC) 340:65-5-1, the worker calculates the overpayment based on the client's gross earned income without the earned income deduction, per OAC 340:10-3-33.

(B) For SSP, the client is allowed the earned income deduction, per OAC 317:35-5-42(d) even when the earned income is reported untimely.

(d) Overpayment claim establishment. AFS BIR Unit staff evaluates overpayment referrals, establishes overpayment claims, and refers overpayment claims to the OKDHS Office of the Inspector General (OIG) when appropriate, per OAC 340:65-9-2 and OAC 340:65-9-4. An overpayment claim is considered established on the date AFS BIR Unit staff sends the overpayment notice to the household.

(1) When AFS BIR Unit staff determines an OIG referral is not appropriate, AFS BIR Unit staff:

(A) establishes the overpayment claim;

(B) classifies the overpayment claim as an IHE, AE, or willful misrepresentation, per OAC 340:65-9-2;

(i) Notification of Overpayment, Form 08OP011E, Repayment Agreement and, when appropriate, Form 08OP025E, Chart of Temporary Assistance for Needy Families and State Supplemental Payment Overpayments, to the debtor(s); and

(ii) Notification of Overpayment with supporting documentation to the OKDHS county office; and

(D) assigns overpayment recoupment, per OAC 340:65-9-6.

(2) When the worker suspects fraudulent intent, but has insufficient information to complete an overpayment referral, he or she sends Form 19MP001E, Referral Form, to OIG.

(A) When OIG staff suspects an overpayment occurred, but a fraud determination is not needed, OIG staff sends the findings to the AFS BIR Unit to calculate and establish the claim. • 2

(B) When OIG staff determines fraud occurred, OIG staff may:

(i) refer a TANF or SSP overpayment claim for a court decision regarding fraud, per OAC 340:65-9-4;

(ii) for TANF overpayment claims, make a referral to the Legal Services Appeals Unit for an administrative disqualification hearing instead of a court referral; or

(iii) for SSP, send the findings to the AFS BIR Unit calculate and establish the overpayment based on willful misrepresentation.

(e) Right to appeal. When the household disagrees with the overpayment decision, the household may request a fair hearing within 30-calendar days of the date on the Notification of Overpayment. An OKDHS mailed item is presumed received on the second day mail is delivered following the date on the notice, per OAC 340:2-5-63. • 3

(f) Case record retention. OKDHS is mandated to retain case records containing overpayments for three years from the date: • 4

(1) the overpayment debt is paid in full; or

(2) AFS BIR Unit staff determines the debt to be uncollectable. This may occur when the debtor(s) dies or files bankruptcy and discharges the debt.

INSTRUCTIONS TO STAFF 340:65-9-1

Revised 9-15-22

1. (a) The overpayment referral consists of a memo with supporting documentation that may include, but is not limited to:

(1) Form 08OP025E, Chart of Temporary Assistance for Needy Families and State Supplemental Payment Overpayments;

(2) pay stubs;

(3) an employer statement;

(4) an award letter;

(5) financial institution records;

(6) a deed;

(7) a vehicle title; or

(8) data exchange screen.

(b) The worker submits the overpayment referral to the Adult and Family Services (AFS) Benefit Integrity and Recovery (BIR) Unit by interoffice mail, email to overpayments@okdhs.org, or faxes it to 405-522-0952 within 30-calendar days of discovery, when possible.

(c) The worker includes in the memo the:

(1) circumstances that caused the overpayment including if the:

(A) client reported changes within 10-calendar days; and

(B) overpayment is due to a household or agency error, per Oklahoma Administrative Code (OAC) 340:65-9-2;

(2) date the worker discovered an overpayment may have occurred;

(3) dates and months the worker believes the household was completely or partially ineligible for benefits;

(4) gross earned and unearned income and deduction calculations used to determine the correct benefit amount, when the overpayment is due to income or deductions. When the income is from a new source, the worker includes the:

(A) date employment began and receipt date of first check; and

(B) receipt date of the first payment for unearned income; and

(5) resource amount and the date resources exceeded allowable standards, when the overpayment is due to excess resources.

2. Office of Inspector General (OIG) staff documents the circumstances leading to the overpayment, including income, resources, or other necessary verification, and sends the information to AFS BIR Unit staff to compute the over-issuance amount.

3. When the debtor(s) disputes the overpayment decision, the client and worker complete Form 13MP001E, Request for a Fair Hearing, and the worker sends the form to the Legal Services Appeals Unit. Prior to the hearing, the worker completes Form 13MP002E, Hearing Summary, and sends the form and applicable documentation to the Legal Services Appeals Unit and the debtor(s). AFS BIR Unit staff is available for consultation as needed. Refer to OAC 340:2-5 for fair hearing procedures.

4. To ensure Oklahoma Human Services meets the federal requirement, county office staff must image to the client's case record all overpayment documents submitted to the AFS BIR Unit and all documents AFS BIR Unit staff returns to the county office and annotate within the imaging record details OVERPAYMENTS/DO NOT DELETE.

(1) Examples of documents the worker images to the case record and submits to the AFS BIR Unit in the overpayment packet include, but are not limited to:

(A) Form 08OP025E;

(B) Form 08TW013E, Time and Progress Report; or

(C) paystubs and resource information used to calculate the overpayment.

(2) Examples of documents AFS BIR Unit staff images and returns to the county office in the overpayment packet include, but are not limited to:

(A) Form 08AD019E, Program Penalty/Disqualification Notice;

(B) Notification of Overpayment; or

(C) Form 08OP025E when AFS BIR Unit staff makes changes to the form.

(3) OKDHS AFS maintains the case for at least three years after the overpayment is fully repaid or deemed uncollectable. The worker checks with AFS BIR Unit staff before destroying a case to make sure these requirements are met.