1850 Claim Disposition Options for Fraud Claims

Georgia State Seal

Department of Human Services
Policy and Manual Management System

Index:

POL 1850

Revised:

01/27/2023

Next Review:

01/26/2025

Policy

One of the primary goals of the Office of Inspector General (OIG) is to seek final adjudication and disposition of intentional program violation claims by judicial or administrative means.

Options for adjudication through the judicial process:

  • Criminal prosecution

  • Consent Agreement

Options for adjudication through the administrative process:

Adjudication through administrative processes allows recipients who have intentionally obtained excess benefits to be administratively adjudicated and make restitution without going through the court system. Currently, there are two mechanisms for administrative adjudications:

  • Administrative disqualification hearing

  • Waiver of disqualification hearing

Non-adjudications:

Recovery of overpayments through administrative means allows recipients who have obtained excess benefits to make restitution without adjudication. Currently, there is one mechanism:

  • Non-fraud claim

Authority

O.C.G.A. § 49-4-15

References

7 U.S.C. §§ 2011, et seq.
7 C.F.R. § 273.16

Applicability

This policy applies to the legal adjudication of a claim.

Definitions

A claim is a debt that the state must collect regardless of the claim type. Claims are created when an assistance unit receives more benefits than it is eligible for or does not receive all the benefits it is entitled to. A claim is not considered complete until it is brought to a final claim disposition and the claim is authorized.

Responsibilities

  1. The OIG Fraud Prevention and Recovery Unit Director (FPRU) oversees POL 1850.

  2. The FPRU State Operations Unit updates procedures to implement this policy.

History

Evaluation

The OIG/FPRU evaluates this policy by:

  1. Monitoring and completing an annual review to confirm the accuracy of claim disposition options.

  2. Passing any audit(s) with no findings.