Current through Register Vol. 54, No. 45, November 9, 2024
Section 255.4 - Procedures(a)Determination of overpayment. The Department is responsible for identifying overpayments and recovering incorrectly paid assistance. (1)County Assistance Office. The County Assistance Office has the basic responsibility for determining and redetermining eligibility for assistance and, therefore, for discovering ineligibility. County Assistance Office duties are: (i) To explore possible overpayments on active and closed cases.(ii) To determine whether an overpayment has occurred.(iii) To determine the cause or causes of the overpayment.(iv) To collect verification of the resource or resources which caused the overpayment.(v) To recommend the nature of the action to be taken on referred overpayments.(vi) To furnish Bureau of Claim Settlement with current information which may affect action on the overpayment.(2)Quality control. The Department's Division of Evaluation, Quality Control Branch, informs the County Assistance Office of unreported resource or circumstance discovered during their review process. The County Assistance Office has the responsibility to review the case and determine whether an overpayment has occurred.(3)Complaints from community residents. The County Assistance Office may receive complaints from identified persons or from anonymous callers who want to report what they believe to be incorrect public assistance payments. The complaint is referred to the appropriate County Assistance Office worker to investigate the complaint and determine whether an overpayment has occurred. The confidentiality of the informant must be ensured.(4)The Treasury Department. The Treasury Department may investigate and prosecute cases involving replacement of assistance checks, duplicate receipt of assistance checks or altered assistance checks. Treasury may collect funds resulting from the investigations and prosecutions. See Chapter 231 (relating to checks requiring special handling) for procedures relating to duplicate or altered assistance checks.(b)Exploring overpayments. The methods of exploring overpayments must be appropriate to the particular situation and to the different eligibility factors. These methods must not infringe on the civil liberties of individuals nor interfere with the due process of law. (1) Specifically prohibited activities are: (i) Forcible entrance to a home, entering a home under false pretenses, searching the home, questioning based on a presumption of guilt or other practices that violate personal dignity or privacy or that constitute harassment of the individual.(ii) Making home visits during normal sleeping hours, generally 10 p.m. to 7 a.m. The County Assistance Office worker shall not visit the client before or after normal working hours or on weekends unless the visits have been previously scheduled with the individual.(2) The County Assistance Office worker explores the overpayment in the same way as any other determination of eligibility for assistance. The usual sources of information and verification are used, such as, but not limited to, the recipient, the case record, banks and employers.(3) When the County Assistance Office worker determines that an overpayment has occurred, the worker sufficiently establishes the facts of the overpayment to support final action on the case.(4) Whenever possible, the overpayment is discussed with the client unless such discussion might interfere with the recovery of unreported personal property. The County Assistance Office worker should not compute the amount of the overpayment claim. The Bureau of Claim Settlement will contact the client and arrange repayment.(5) If the overpayment resulted from unreported personal property that is currently available for repayment, the County Assistance Office should report the situation to Bureau of Claim Settlement immediately, by telephone if necessary. The usual overpayment referral will be prepared later. The County Assistance Office should also report immediately to Bureau of Claim Settlement whenever the County Assistance Office discovers that a person who had a previous overpayment has a liquid asset which can be used for repayment.(c)Overpayment referral. The overpayment referrals are as follows:(1)Overpayment investigation control card. The purpose of the overpayment control card is to provide the County Assistance Office with a control over the process of investigating and referring overpayments. The County Assistance Office worker prepares an overpayment control card for each possible overpayment.(2)Overpayment referral. The County Assistance Office prepares an overpayment referral for an overpayment within 30 days from the date the County Assistance Office verifies the overpayment. The referral is prepared according to directions printed on the form.(i)Cash overpayments. The County Assistance Office submits the overpayment referral to the Bureau of Claim Settlement along with supporting documents needed to substantiate the overpayment. The County Assistance Office recommends on the overpayment referral whether to consider the overpayment suspected fraud or nonfraud. The Bureau of Claim Settlement makes the final decision on whether the overpayment is fraud or nonfraud, and whether prosecution is appropriate.(ii)Food Stamp overpayments. The County Assistance Office submits the overpayment referral to the Bureau of Claim Settlement according to Chapter 561 (reserved).(d)Claim computation. The Bureau of Claim Settlement is responsible for computing cash overpayment claims. Food stamp overpayment claims are computed according to Chapter 561. (1) The Bureau of Claim Settlement verifies the amount of assistance received and computes the claim as follows: (i) Assistance received means assistance granted to the client, to the client's spouse and to the minor children in the same grant group during the overpayment claim period. The claim period begins with the first assistance check the grant group receives after an unreported change of circumstances in the grant group has occurred or an unreported resource has been received.(ii) If the overpayment was caused by a resource owned by a specific person in the grant group, which resource did not affect the eligibility of others in the grant group, the assistance received is the fractional share of the grant for that specific person.(iii) Available resources are computed using the same disregard, work expense deductions and income incentives as in determining eligibility with the following exceptions:(A) The 10-day appeal period after advance notice, as set forth in § 133.4(b)(2) (relating to procedures), does not apply to the receipt of resource.(B) When an AFDC or GA client fails to report earned income on a timely basis as defined in § 125.24(d) (relating to procedures), no deductions are allowed from the earned income unless there is good cause as set forth in § 183.97(3) (relating to ineligibility for disregards from earned income for TANF and GA). If good cause does not apply, the net resource is the gross earned income.(iv) The amount of the claim is the total net resource or the total amount of assistance received during the overpayment period, whichever is less.(v) If the overpayment results from an unreported decrease or overstatement of the family size, the amount of the claim is the difference between the assistance received and that which should have been received if the correct family size allowance has been used. If the overpayment results from an unreported decrease or overstatement of special needs, the amount of the claim is the difference between the assistance received and that which should have been received if the correct needs were known.(e)Collection activities. The Bureau of Claim Settlement is responsible for collecting and settling overpayments referred by the County Assistance Office, except for specific cases referred to the Bureau of Special Investigations. (1)Collection principles for overpayments. Collection efforts continue until the claim is paid in full or until the Bureau of Claim Settlement determines that full payment cannot be collected.(i) The Bureau of Claim Settlement is responsible for collecting and settling claims.(ii) The County Assistance Office should not compute claims nor attempt to settle claims. However, if a debtor or his representative offers payment to the County Assistance Office the payment may be accepted "on account" except when the Bureau of Claim Settlement is considering prosecution. If the County Assistance Office accepts payment, the payor must be provided with a receipt.(iii) The Bureau of Claim Settlement collects from the debtor. The debtor usually is the payment name of the overpaid grant group, but may be any adult of the grant group or the sponsor of the alien.(2)Collection principles for prosecution cases. The Bureau of Claim Settlement reviews every overpayment referral coded suspected fraud, computes the claim, and decides whether or not to prosecute the case. Prosecution procedures are as follows:(i) The Bureau of Claim Settlement initiates prosecution through the proper judicial channels. The County Assistance Office employes may be called upon to testify before district justices, judges, juries and grand juries as part of their responsibilities.(ii) The Bureau of Claim Settlement advises the County Assistance Office when prosecution is initiated. No advance written notification is given to the client by the Bureau of Claim Settlement. Under no circumstances does the client have the right to appeal under Chapter 275 (relating to appeal and fair hearing and administrative disqualification hearings).(iii) If the client is found guilty, the court orders the method and terms of restitution. Repayment is made through the court.(3)Collection principles for nonprosecution cases. The method the Bureau of Claim Settlement uses to collect restitution depends on whether or not the debtor is receiving cash assistance. (i)Debtors receiving AFDC or GA. If the debtor is receiving a cash grant, the collection method is as follows:(A) The Bureau of Claim Settlement notifies the debtor by letter of the amount of the claim and gives the debtor three options of repayment:(I) Repayment of the total claim in one payment.(II) Partial repayment with grant reduction until the claim is fully recouped.(III) Grant reduction alone until the claim is fully recouped.(B) If the debtor does not select one of the options, the Bureau of Claim Settlement will implement grant reduction until the claim is fully recouped. The Bureau of Claim Settlement will notify the debtor by a second letter of the amount of the grant reduction and the number of checks to be reduced.(C) For overpayments, the grant reduction shall not reduce the income and resources in the grant group to less than 90% of the family size allowance, as specified in § 175.23(a) (relating to requirements).(D) The debtor may elect a larger amount of recoupment to repay the claim in a shorter period of time.(E) In cases where the recoupment reduces the semimonthly assistance payment to less than $5.00, the minimum grant requirements specified in § 225.24(b)(1)(i) (relating to procedures) do not apply. If recoupment eliminates the assistance payment entirely, the client continues to receive categorically needy medical assistance benefits.(F) The Department provides the client with an Advance Notice form according to § 133.4 (relating to procedures) before taking action to reduce the grant. Chapter 275 applies if the client wishes to appeal.(G) The Department may collect a claim by recoupment while the Bureau of Claim Settlement is seeking restitution by court action as long as the amount of the overpayment claim is reduced by the amount collected through recoupment.(H) The County Assistance Office is responsible for establishing controls to ensure recoupment is removed when the claim is fully paid.(I) When the claim cannot be fully recouped because of a discontinuance of the entire grant group, the County Assistance Office notifies BCS of the date of discontinuance and the amount recouped.(J) After discontinuance, the County Assistance Office documents the case record to alert the worker making future assistance authorizations that a claim is pending so that recoupment can be resumed.(K) When the debtor is no longer receiving assistance, or moves to another grant group, the collection method may be:(I) Repayment from the debtor.(II) Grant reduction of the grant group which was overpaid or of any grant group which subsequently includes a member of the overpaid grant group.(III) Repayment from any individual members of the overpaid grant group no longer receiving cash assistance.(ii)Debtors not receiving AFDC or GA. The Bureau of Claim Settlement pursues repayment for every overpayment not referred for prosecution through the repayment letter system as follows:(A) The Bureau of Claim Settlement notifies the debtor of the amount of the overpayment claim by a computer-generated letter which requests full repayment.(B) If the debtor does not respond to the first letter, the Bureau of Claim Settlement computer system automatically sends a second letter requesting repayment and notifying the client of the minimum repayment amount.(C) Criminal prosecution is not appropriate to collect nonfraud overpayments. However, the Bureau of Claim Settlement may institute civil proceedings if the debtor refuses to acknowledge the claim, refuses to make repayment, or fails to fulfill the Bureau of Claim Settlement repayment agreement. If legal action is initiated, the Bureau of Claim Settlement will notify the County Assistance Office.(f)Exchange of information. Effective collection of overpayment claims depends on prompt and accurate communication between the Bureau of Claim Settlement and the County Assistance Office.(1)County Assistance Office to claim settlement. The County Assistance Office is the primary source of information for the Bureau of Claim Settlement and Bureau of Special Investigations. The County Assistance Office may assist collection activity by providing current information as requested, including the case record.(2)Bureau of Claim Settlement to County Assistance Office. The Bureau of Claim Settlement notifies the County Assistance Office of the final disposition of the overpayment referral by returning to the CAO the last copy of the overpayment referral form.The provisions of this §255.4 adopted August 4, 1977, effective 8/5/1977, 7 Pa.B. 2180; amended July 21, 1978, effective 8/28/1978, 8 Pa.B. 2065; amended December 4, 1981, effective 12/5/1981, 11 Pa.B. 4192; amended January 14, 1983, effective 1/15/1983, 13 Pa.B. 464; amended August 26, 1988, effective 11/1/1988, 18 Pa.B. 3921.The provisions of this §255.4 issued under sections 201(2) and 403(b) of the Public Welfare Code (62 P. S. §§ 201(2) and 403(b)).
This section cited in 55 Pa. Code § 121.3 (relating to requirements); 55 Pa. Code § 142.23 (relating to requirements); 55 Pa. Code § 147.24 (relating to procedure); 55 Pa. Code § 255.2 (relating to definitions); 55 Pa. Code § 255.84 (relating to procedures); 55 Pa. Code § 275.1 (relating to policy); 55 Pa. Code § 275.4 (relating to procedures); 55 Pa. Code § 275.32 (relating to finding of an intentional program violation); and 55 Pa. Code § 275.33 (relating to finding that no intentional program violation occurred).