55 Pa. Code § 255.2 - Definitions

The following words and terms, when used in this section and §§ 255.1, 255.3, 255.4 and 255.71, have the following meanings, unless the context clearly indicates otherwise:

Found by a State or Federal court-The term includes one of the following:

(i) A verdict of guilty, a plea of guilty or a plea of nolo contendere.

(ii) Receiving probation without verdict, disposition in lieu of trial, an accelerated rehabilitative disposition or a similar deferred adjudication process in lieu of trial, including a process in which the accused recipient signs a voluntary consent disqualification agreement which is approved by the court.

Intentional program violation-An action by an individual applying for or receiving AFDC or GA for himself or others for the purpose of establishing or maintaining his own, his household's or his family's eligibility for AFDC or GA or for the purpose of increasing or preventing a reduction in the amount of the grant, which involves one of the following:

(i) An intentionally made false or misleading statement or misrepresentation or concealment or withholding of a fact.

(ii) An act intended to mislead, misrepresent, conceal or withhold a fact or propound a falsity.

Overpayments-Classified either as suspected fraud, or as nonfraud will be made by relating the case facts nonfraud for purposes of administrative action. The decision as to whether or not the overpayment is suspected fraud will be made by relating the case facts to the following definitions and criteria.

(i) Causes of overpayment. There are two basic causes of overpayment: fraudulent misrepresentation by the client and error on the part of the agency or the client.

(ii) Fraud. Suspected if the overpayment was caused by what appears to be willful withholding of information on the part of the client.

(iii) Nonfraud. An overpayment resulting from the client's misunderstanding of eligibility requirements or of his responsibility for providing the county office with information, from the innocent concealment of facts, or from county office omission or administrative error in securing or acting on information.

(iv) Suspicion of fraud. When a person is believed to have knowingly and deliberately withheld information or provided incorrect information to obtain assistance for which he would otherwise not be eligible, a suspicion of fraud will exist. Only the court will have jurisdiction to convict for fraud. Under the Public Welfare Code (62 P. S. §§ 101-1503), obtaining, or aiding or abetting a person in obtaining assistance by means of a willfully false statement or misrepresentation, or by impersonation, or other fraudulent means, is a misdemeanor. A person convicted of fraud under this statute will be sentenced to make restitution of the money received by virtue of his fraudulent acts and, in addition, will be subject to fine or imprisonment.

(v) Willful withholding. The person had in fact been told by the CAO, knew and understood what was required and the consequences of any action or lack of action. It further means that noncompliance with known requirements was planned for the express purpose of getting assistance that would not otherwise have been granted.

Restitution-Recovery of assistance from a recipient who has been overpaid. Overpayment will exist when a person receives assistance for which he was not eligible.

State-The states of the United States and the District of Columbia, the Commonwealth of Puerto Rico, the Virgin Islands and Guam.

Notes

55 Pa. Code § 255.2

The provisions of this § 255.2 adopted August 4, 1977, effective 8/5/1977, 7 Pa.B. 2180; amended April 12, 1991, effective 5/1/1991, 21 Pa.B. 1557.

The amendment made to § 255.2 at 21 Pa.B. 1557 (April 13, 1991) was promulgated under section 6(b) of the Regulatory Review Act (71 P. S. § 745.6(b)).

The provisions of this § 255.2 amended under sections 201 and 403(b) of the Public Welfare Code (62 P. S. §§ 201 and 403(b)).

This section cited in 55 Pa. Code § 275.11 (relating to general policy); and 55 Pa. Code § 275.12 (relating to definitions).