Current through Register Vol. 35, No. 18, September 24, 2024
The department shall initiate collection action by sending
the eligibility determination group an overpayment notice.
A.
Adverse action notice: If
the amount of the claim was not established by a fair hearing decision, the
eligibility determination group will be provided with an adverse action notice.
The adverse action notice is sent on all claims established after March 26,
1990 and on any preexisting claims if at any time after March 26, 1990 a
follow-up demand letter is sent on the claim. A one-time adverse action notice
that informs the eligibility determination group that it has ninety (90) days
to appeal the amount of the claim will satisfy notice requirements.
B.
Demand letter: Collection
action is initiated by sending the eligibility determination group a demand
letter. The demand letter informs the eligibility determination group of the
claim amount, the reason for the claim, time period for which there is a claim,
any offset that reduces the claim and how the eligibility determination group
may pay the claim. The first demand letter to a participating eligibility
determination group shall inform the eligibility determination group:
(1) that unless the eligibility determination
group selects an acceptable method of payment and informs the department within
the specified time limit, or timely requests a fair hearing and continued
benefits, their SNAP benefit amount will be reduced;
(2) that benefit reduction will affect the
eligibility determination group's monthly benefits, only if the department has
not otherwise informed the eligibility determination group;
(3) that if the eligibility determination
group timely selects an acceptable benefit reduction amount, the reduction will
begin with the first benefit month that is issued after the
selection;
(4) that if the
eligibility determination group fails to make a timely selection or fails to
request a fair hearing and continued benefits, the benefit reduction will be
effective with the first benefit issued after timely notice of such selection
or request for hearing is due to the department; and
(5) advise the eligibility determination
group of any individual or organization that provides free legal
representation.
C.
Collection action:
(1)
Initiating action: The department shall initiate collection action on
all claims unless the claim is collected through an offset or one of the
following conditions applies:
(a) the total
amount of the claim is less than the established claims threshold outlined in
Subsection G of 8.100.640.11 NMAC, and the claim cannot be recovered by
reducing the eligibility determination group's SNAP benefit amount;
or
(b) the department has
documentation that establishes the eligibility determination group cannot be
located.
(2)
Postponing action: Collection action will be postponed on claims where
an eligibility determination group is being referred for possible prosecution
or for administrative disqualification, and the determination is made that
collection action will prejudice the case.
(3)
Collection action:
Restitution bureau shall pursue collection as specified in 8.100.640.13
NMAC.
D.
SNAP
Intentional program violation (IPV):
(1)
Initiating collection: If
an eligibility determination group member is found to have committed an IPV or
has signed either a waiver or a disqualification consent agreement, the
department shall initiate collection action against the individual's
eligibility determination group. Personal contact with the eligibility
determination group is made, if possible. The department is required to
initiate such collection unless:
(a) the
eligibility determination group has repaid the overpayment already;
or
(b) the department has
documentation establishing that the eligibility determination group cannot be
located; or
(c) the department
determines that collection action will prejudice the case against an
eligibility determination group member referred for prosecution.
(2)
Partially paid
claim: The department shall initiate collection action for an unpaid or
partially paid claim, even if collection action was previously initiated while
the claim was being handled as an IHE claim.
(3) In cases where an eligibility
determination group member has been found guilty of misrepresentation or fraud
by a court or has signed a disqualification consent agreement in a case
referred for prosecution, the department shall request that the matter of
restitution be brought before the court or be addressed in the agreement
reached between the prosecutor and the accused individual.
(4)
Changes in eligibility
determination group composition:(a)
Collection action will be initiated by the restitution bureau against the
eligibility determination group containing the member found to have committed
an IPV.
(b) If a change in
eligibility determination group composition occurs, collection action is
pursued against any or all of the adult members of an eligibility determination
group at the time an overpayment occurred.
(c) Collection action is pursued against any
eligibility determination group which has a member who was an adult member of
the eligibility determination group that received the overpayment.
E.
Fraud
exception: Notice of overpayment and administrative hearings rights
shall not be given if the department has decided to pursue criminal prosecution
for fraud. In such cases, the participant's notice of rights are limited to
those afforded by state criminal statutes. No attempt shall be made by
department staff to recover overpayments in such cases, nor shall any offers to
refund the overpayment be accepted by the county office.
F.
Recovery action:
(1)
Overpayments of less than
$1,000: Overpayments of less than one thousand dollars ($1,000) to
currently eligible cases shall be immediately processed by the department for
recoupment.
(2)
Overpayments
over $1,000: Overpayments of more than one thousand dollars ($1,000) to
currently eligible cases shall be referred to the office of inspector general
(OIG) for a fraud action decision.
(3)
Response to referral:
(a) The department shall be notified by the
OIG within thirty (30) days whether fraud action has or will be taken on an
open case. If no fraud action is contemplated, the case shall be immediately
processed for either recoupment or cash recovery.
(b) If a response is not received from the
OIG within thirty (30) days of referral, the county will initiate recoupment
from currently eligible cases.
G.
Fraud referral:
(1)
Fraud elements:
(a) By state statute, Section
30-16-6, NMSA
1978, fraud is the intentional misappropriation or taking of anything of value
that belongs to another by means of fraudulent conduct, practices or
representations.
(b) Fraud exists
when:
(i) a person, by words or conduct,
misrepresents facts to the department with the intention to deceive the
department; and
(ii) because of the
misrepresentation and the department's reliance upon it, the eligibility
benefit group has obtained benefits from the department to which they were not
entitled.
(2)
Referral for investigation: If the department decides that fraud
may exist, the case is referred to the OIG for further investigation or
possible prosecution.
