Current through Register Vol. 42, No. 5, February 29, 2024
(1) In general,
an erroneous payment means an underpayment, overpayment, delayed payment, or a
payment for a period of ineligibility. The following definitions are
applicable:
(a) A delayed payment is defined
as a payment that has been properly authorized but the issue of a check has
been improperly delayed. Corrective action will consist of a special payment
processed for the period for which the individual or family had accrual rights
regardless of current eligibility as soon as possible after identification of
the failure to issue the check.
(b)
An underpayment is defined as either a payment received by or for an assistance
unit for the payment month which is less than the amount for which the
assistance unit was eligible or failure to issue a payment for a payment month
to an eligible assistance unit. The Department will not correct underpayments
resulting from a client's failure to report information or the
incorrect/incomplete reporting of information. The Department will not correct
other underpayments occurring more than 12 months prior to:
1. The date the county department receives a
request for correction from a member of the underpaid unit or
2. The date the county department discovers
that a loss to an assistance unit has occurred.
Corrective action will involve either the issuance of a special
payment or reinstatement of eligibility. The period of the special payment is
from the first month of error on the 12th month
prior to (1) or (2) above whichever is later, to the month in which the payment
is correct.
(c)
An overpayment is defined as a situation when an assistance payment received by
or for an assistance unit for the payment month exceeds the amount to which the
assistance unit was eligible. Recovery of all overpayments will be sought by
the Department by methods described in (2) below. Corrective action will depend
on the causal reason for the overpayment, the current recipient status of the
assistance unit, and whether the erroneous payment is defined as non-fraud or
suspected fraud as below:
1. A non-fraud
overpayment is defined as an overpayment due to continued or unreduced benefits
when a request for a fair hearing is submitted during the advance notice
period; or due to administrative (or agency) error caused by an active or
passive error on the part of a Departmental agent although the client made full
disclosure of facts; or due to a payment during the advance notice period to
which the assistance unit is entitled but not eligible; or due to client error
when the applicant/recipient fails to disclose facts regarding his situation,
but there is no demonstrable intent to defraud.
2. A suspected fraud overpayment occurs when
a recipient has received an overpayment occasioned or caused by his willful
withholding of information concerning any household circumstances which would
affect the amount of payment. To sustain an allegation of suspected fraud, the
following elements must be present: documented evidence to substantiate the
facts upon which the overpayment has been determined, an actual overpayment,
and evidence that the individual intentionally committed the action or inaction
which has prompted the overpayment.
(2) Corrective action for overpayments should
generally consist of one or more of the following recovery activities depending
on the type of claim (i.e., non-fraud, suspected fraud, or fraud confirmed by
court action), on the amount of the overpayment, on whether the client
currently receives financial assistance, on what steps may have already been
taken to collect the overpayment, on whether civil or criminal legal action is
permitted under the laws or on the age of the overpayment:
(a) Recoupment of 15% of the payment standard
based on the current family size.
(b) Monthly cash repayment based on a
negotiated repayment agreement; the monthly amount of the repayment shall be
based on the household's current ability to repay with a suggested minimum of
$10 per month. The repayment agreement may be renegotiated at any time the
household's situation changes.
(c)
Civil or criminal legal action as permitted to the Department under applicable
state law, including claims against the estate of a deceased person through
filing of a claim with the court of appropriate jurisdiction.
(d) State income tax refund intercept as
permitted under the Code of Ala. 1975 for collection
of debts owed to the Department and Federal income tax refund intercept as
permitted for collection of debts owed to the Department.
(3) The Department shall also operate a fraud
control program which will disqualify intentional program violators from
participation in the Family Assistance program as described below:
(a) For this purpose, the appropriate
disqualification penalty shall be imposed against an individual who is a member
of a family applying for or receiving assistance who is found on the basis of a
plea of guilty or nolo contendre or otherwise by a state or federal court or by
a department administrative disqualification hearing and to have intentionally
made a false or misleading statement or misrepresented, concealed, or withheld
facts, or to have committed any act intended to mislead, misrepresent, conceal,
or withhold facts or profound a falsity, for the purpose of establishing the
family's eligibility for benefits or of increasing (or preventing a reduction
in) the amount of the grant.
(b)
The disqualification penalty shall be the removal of the needs of the
individual found to have intentionally committed a program violation as
described above in the following manner: for a period of 6 months upon the
first occasion of any such offense; for a period of 12 months upon the second
occasion of any such offense; and permanently upon the third or a subsequent
occasion of any such offense.
Author: Jeri Farrior
Statutory Authority: Social Security Act, Title
IV-A;
45 C.F.R.
233.20; P.L. 98-369, effective October 1,
1984; State Plan for Title IV-A; Code of Ala. 1975,
Title 38.
