4000 General Overview

Georgia State Seal

GEORGIA DIVISION OF FAMILY AND CHILDREN SERVICES
BENEFIT RECOVERY POLICY MANUAL

Chapter:

4000

Effective Date:

December 2019

Policy Title:

General Overview

Reviewed or Updated in:

MT-11

Policy Number:

4000

Previous Update:

MT-10

Requirements

Benefit errors must be corrected either by recovering valid overpayments or issuing benefits for valid underpayments.

Basic Considerations

An overpayment (OP) exists when an assistance unit (AU) receives more benefits than it is eligible to receive.

An underpayment (UP) exists when an AU does not receive all benefits for which it is entitled. Benefits lost more than 12 months prior to the date of establishment shall not be restored. Underpayments must be processed within 60 days of the date the underpayment is established in active and inactive cases. The 60-day SOP does not apply to reinstated benefits.

A claim is a debt that the state must collect regardless of the claim type.

Repayment of debt is the responsibility of the following:

  • The Head of Household and all members of the household who were 18 years of age and older, regardless of the status at the time the overpayment or trafficking occurred.

  • A sponsor of an alien AU member if the sponsor is at fault.

  • A person connected to the AU, such as an authorized representative, who is trafficking or otherwise causes an overpayment or trafficking.

Claim Types

An overpayment is the result of one of the following:

  • An Agency Error (AE)

  • An Inadvertent Household Error (IHE)

  • An Intentional Program Violation, including trafficking (IPV)

AE and IHE overpayments must be processed within 60 days from the date that you become aware of the pending overpayment.

Invalidating Claims

Overpayments established for closed cases, which are of the same type and total $125 or less, are invalidated.

Overpayments established for active cases, which are of the same type and total $100 or less, are invalidated.

Overpayments and underpayments discovered by a QC reviewer in the process of a quality control investigation, regardless of the amount, must be established into claims and scheduled for collection within 60 days of notification unless fraud is suspected.

Potential overpayments for suspected fraud claims are sent to the Office of Inspector General (OIG) as a Request for Case Review. These requests must be processed, and a claim established within 12 months of the request.

Claim Notification

Documentation of the overpayment and proper notification to the AU are essential. Before any collection activity, the AU must be notified of the debt. For AE and IHE claims, the notice must include the rights to a fair hearing and an attached Repayment Agreement.

  • The initial notice of overpayment for AE, IHE and IPV claims is generated and mailed via Georgia Gateway. If a system notice is not generated, a manual notice is required. The initial notice must include a Repayment Agreement for non-fraud claims.

  • If there is no response to the initial notification of debt, manual follow-up is required.

  • Additional notices are mailed by Georgia Gateway if payments are not made regularly.

  • Mail sent through the US Postal Service is considered received unless returned to the DFCS office as undeliverable.

A file must be created for every valid claim authorized in Georgia Gateway. Any claim denied prior to payment activity does not require a claim file. Underpayments do not require a claim file. Multiple claims on a single AU may be filed together if separated by claim number.

Claim files must be available for program and fiscal audits.

Food Stamp claims may be transferred out of state.

TANF claims may not be transferred out of state.

Procedures

The county office determines if a benefit error exists, investigates reports or other indications of a possible overpayment of benefits.

Possible information sources:

  • Inconsistencies in the case record or inconsistent information from the AU

  • Clearinghouse

  • IEVS matches

  • Information from agency employees

  • Gateway screening on adult AU members (for claims on other AU numbers).

  • Information from other individuals or agencies

  • Information from a whistleblower referral (from a federal agency)

  • Information from a hotline referral (from the state toll-free number)

This list may not be all-inclusive.

Determine the potential cause of the error.

Process the claim according to policy if the overpayment is caused by agency error (AE) or inadvertent household error (IHE).

Refer the case to OIG if the overpayment is caused by a suspected Intentional Program Violation.

Document the benefit error as appropriate in case notes in Georgia Gateway as follows:

  • IHE and AE – Document the reason for the OP, the date of establishment and date and method of discovery, the amount, the months included in the OP, the results of discussions with the AU and other pertinent information.

  • IPV – Document the date and method of discovery and reason for request for investigation to OIG.

  • Underpayment (UP) – Document the reason for the underpayment, the date of establishment, date, and method of discovery, the amount, the months included in the underpayments and other pertinent information. No claim file is required.

  • Invalid benefit errors (OP and UP) - Document the error month(s) and amount(s), and the reason the benefit error is determined to be invalid.

Create a claim file containing the following information:

  • Initial documentation including liability for repayment

  • Budgets for each month

  • Verification used to establish claim

  • Verification of receipt of benefits

  • Verification of initial notification of overpayment

  • Verification of Intentional Program Violation Disqualification Notice

Claim Maintenance

Retaining claim files:

  • All claims in open or suspended status in Georgia Gateway must have a file.

  • Closed claim files must be retained for 3 years and through one county fiscal audit.

IPV disqualification documents must be kept permanently. Documents include:

  • Disposition information

  • Court order/consent agreement

  • Hearing decision/WDH

OIG claim information other than the disqualification documents may be purged according to program policy.

Retain claim management reports as needed for county purposes.

Retain fiscal reports as required by administrative regulations.