55 Pa. Code § 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.
(2)
[Reserved].
(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.
Notes
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).
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