4005 Claim Types | FPRU-3450-MANUAL

The Division of Family and Children Services (DFCS) and the Office of Inspector General (OIG) are responsible for calculating and establishing agency error (AE) and inadvertent household error (IHE claims), requesting case reviews for suspected fraud claims, monitoring for compliance and managing and collecting all claims, including intentional program violations (IPV).

An Agency Error exits if one of the following occurs:

This list is not inclusive.

An Inadvertent Household Error exists if one of the following occurs:

This list may not be all-inclusive.

An Intentional Program Violation exists if one of the following occurs:

This list may not be all-inclusive.

Agency error claims are calculated back to the month the overpayment should have been effective but no more than twelve months prior to the date of discovery.

Inadvertent household error and suspected fraud overpayments may be established for any amount that occurred up to six years before the discovery date. Suspected fraud overpayments are referred to OIG within 30 days of discovery.

Inadvertent household and agency error overpayments are the result of historical changes made because of AU circumstances. Changes may be made in Georgia Gateway or computed and entered manually.

Georgia Gateway processing may create benefit errors that are invalid. Consider program policy before establishing overpayments into claims or releasing underpayments.

Food Stamp claims are valid only for changes the AU is required to report.

Refer to Section 3720, Reporting Requirements, in the Food Stamp Program manual for more specific instructions on reporting requirements for simplified reporting households.

TANF claims exist if a financial change which results in a decrease in benefits or total ineligibility is not made the month after the change occurs, or the second month, depending on when the action is taken, and timely notice expires.

Changes resulting in a decrease in benefits or ineligibility due to non-cooperation / non-compliance require timely notice from the date of notification of closure. An overpayment exists if the change is not made the month after the month timely notice expires.

An overpayment exists if a non-financial change results in a decrease in benefits or total ineligibility and is not made for the month after the change occurs.

Overpayments exist if TANF benefits are issued and the customer also receives other public assistance benefits during the same month.

Refer to TANF policy for more specific instructions.

If the AU refuses without good cause to cooperate in providing this information, consider the AU totally ineligible for the months involved. Use the best information available and document.

For closed cases, deny the claim if the total loss is $125 or less.

For active cases, deny the claim if the total loss is $100 or less.

Process any benefit error regardless of the amount, if found during a Quality Control review. The OIG worker must schedule any benefit error within 60 days of notification from QC unless fraud is suspected.

All claim types in active cases, except criminal prosecution, are automatically recouped via benefit reduction. The customer may request to have an amount in addition to the formula amount recouped each month.

Payments for claims coded as criminal prosecution are made directly to the Probation Office during the period of probation assigned by the court system. For claims with this IPV disposition type, review the payment history at least quarterly. If payments are not being received from the probation office, contact to verify if regular payments are being received by that agency. Change to claim type to consent agreement and verify the correct recoupment mode when the probationary period ends if a balance remains.

Document Case Notes in Georgia Gateway and ensure proper notification is sent to the assistance unit. Before any collection activity, the assistance unit must be notified of the debt. For AE and IHE claims, the assistance unit must be notified of the right to a Fair Hearing. If a system notice is not generated, a manual notice is required. A repayment agreement must be included for AE and IHE claims.

Attempt to discuss the Georgia Gateway generated notices, which include information about the claim and a Repayment Agreement with the AU. Attempt to obtain a signed Repayment Agreement. The customer’s signature indicates evidence of notification of the debt. Automatic recoupment and tax offset occur even if the customer does not respond to attempts to contact or sign a repayment agreement.

Maintain claim files and manage collection of the debt.

The TANF AU has 30 days and the FS AU has 90 days in which to request a hearing on the fact of the claim or the amount of the debt. These time frames reflect federal and state policies and are specified on the notices.

Suspend collection immediately if a hearing is requested regarding the fact of the claim or the amount of the debt.

Do not suspend the claim if the hearing request involves collection, including the amount calculated for formula recoupment.

Terminate the original balance after any payments have been returned if the claim is not supported. Notify the customer.

If the hearing decision supports the debt, the household must be re-notified of the claim balance due and a new due date must be assigned. Future delinquency will be based on the new due date.

An OIG representative must attend any hearing involving an IPV claim or program disqualification.