Current through Vol. 42, No. 1, September 16, 2024
(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
(C)
overpayment is discovered during an audit or benefit renewal.
(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. 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;
(C) sends the:
(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.
(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.
(f)
Case record retention. OKDHS
is mandated to retain case records containing overpayments for three years from
the date:
(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.
Added at 20 Ok Reg 2059,
eff 7-1-03; Amended at 25 Ok Reg 958, eff 6-1-08; Amended at 28 Ok Reg 880, eff
6-1-11
