Okla. Admin. Code § 340:65-9-1

Current through Vol. 42, No. 4, November 1, 2024

Section 340:65-9-1 - Scope and applicability

(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.

Okla. Admin. Code § 340:65-9-1

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

Amended by Oklahoma Register, Volume 35, Issue 24, September 4, 2018, eff. 9/17/2018

Amended by Oklahoma Register, Volume 39, Issue 24, September 1, 2022, eff. 9/15/2022