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Working Connections Child Care (WCCC) Manual
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overpayments

NOTICE:   ITEMS SHADED IN BLUE ARE A RESULT OF THE COLLECTIVE BARGAINING AGREEMENT (CBA) WITH STATE AND THE UNION REPRESENTING THE FAMILY HOME AND IN-HOME/RELATIVE PROVIDERS EFFECTIVE 7/1/07.

B.  Establishing an overpayment
Revised:  July 1, 2007

Overpayments to providers will not include errors caused by parent mistakes.

The Division of Finance, Office of Financial Recovery (OFR), is responsible for the collection of debts owed to the department.

Time frames for consumer overpayments

There is no time limit for how far back a consumer overpayment can cover.

Time frames for provider overpayments

Effective November 15, 2005, under DSHS direction, provider child care overpayment time frames were limited to three-years. The three-years applies to the first of the month after establishing the overpayment in WCAP. The three-years does not apply to provider self-reported overpayments or overpayments determined FRAUD by DFI. The time limit applies to the date the overpayment is first established in WCAP.

Effective July 1, 2007 the time frames for provider overpayments will be different for Centers, Family Homes and In-home/relative providers.

  • Center overpayment time frames continue to follow the three-year process effective November 15, 2005

  • Family Home overpayments have a:

    • Two-year time frame maximum for incorrect rates paid by age or region, unless discovered by a federal audit*, or

    • Three-year time frame maximum for any other reason, including those discovered through a federal audit*.

  • In-Home/Relative overpayments have a three-year time frame maximum, including those discovered through a federal audit.*

TYPE OF OVERPAYMENT REASON 2 years maximum 3 years maximum 5 years maximum
Center General   X  
Center Reported by provider or determined fraud by DFI     X
Center Found by an audit (any audit by worker, supervisor, state auditor, etc)   X  
Family Home General Rates X (except for rates)  
Family Home Reported by provider or determined fraud by DFI Rates X (except for rates)  
Family Home Found by an auditor (either federal or on behalf of a federal audit*) Rates X (except for rates)  
In-Home/Relative General   X  
In-Home/Relative Reported by provider or determined fraud by DFI   X  
In-Home/Relative Found by an auditor (either federal or on behalf of a federal audit*)   X  

*A federal audit is done by either a federal agency or by the State Auditor's Office (SAO) on behalf of a federal agency.

worker responsibilities

  1. Review the potential overpayment for possible fraud elements and follow the Working Connections Child Care Manual Fraud section for DFI referrals as necessary.

  2. Apply the appropriate time frame to the overpayment, using the first day of the month following the month the overpayment is established in WCAP. The overpayment established date is the date the required overpayment forms (see #1 from "Steps for Completing Overpayments" below) are completed in WCAP and sent to OFR (via DMS).

  3. Document actions in WCAP. Include the appropriate time frame if applied.

EXAMPLE 1:

You find an overpayment for incorrect billing of hours or days January 2006.

  1. The provider billed incorrectly December 1, 2000 through June 30, 2005

  2. You establish the overpayment in WCAP May 10, 2006.

  3. Based on the overpayment establishment date in WCAP of May 10, 2006, apply the three-year look-back period to June 2006. The overpayment covers June 1, 2003 through June 30, 2005.

  4. No overpayment for December 1, 2000 through May 31, 2003 is established.

  5. Document the overpayment, including the use of the three-year time period.

The overpayment was established in WCAP prior to July 1, 2007. Apply the time frame effective November 15, 2005 for all providers.

EXAMPLE 2:

An auditor finds an overpayment in July 2007.

  1. The potential overpayment covers September 2003.

  2. On the date of discovery, the overpayment is outside the time frame for any provider overpayment unless it is determined fraud.

  3. No overpayment is established.

  4. Document no overpayment was established due to the appropriate time frame.

EXAMPLE 3:

A supervisor or SAO auditor finds a Family Home overpayment in June 2007. The provider was paid the incorrect rate based on the region.

  1. The potential overpayment is for December 2003 through May 2007.

  2. On the date of discovery, some of the overpayment is outside the two-year time frame allowed for Family Home overpayments due to incorrect rates due to age or region.

  3. A worker establishes the overpayment in WCAP July 10, 2007.

  4. Apply the two-year time frame beginning August 2007. The overpayment covers August 2005 through May 2007.

  5. Document the overpayment, including the use of the two-year time frame.

The overpayment was established in WCAP after July 1, 2007. Apply the appropriate time frame effective July 1, 2007 for Family Home providers.

EXAMPLE 4:

An SAO audit finds an In-Home/Relative overpayment for incorrect rates in July 2007.

  1. The potential overpayment covers December 2003 through May 2007.

  2. On the date of discovery, the some of the overpayment is outside the three-year time frame allowed for In-Home/Relative providers.

  3. The overpayment is established in WCAP July 2007. The overpayment covers August 2004 through May 2007.

  4. Document the overpayment, including the use of the three-year time frame.

EXAMPLE 5:

You find an In-Home/Relative overpayment in July 2007.

  1. The potential overpayment covers December 2003 through May 2007.

  2. The case is referred to DEL for possible fraud. DEL reviews the information and makes a DFI referral. DFI determines the provider is fraudulent.

  3. On the date of discovery, the some of the overpayment is outside the three-year time frame allowed for In-Home/Relative providers. Even with the fraud determination by DFI, the overpayment cannot go back more than three-years from establishment.

  4. The overpayment is established in WCAP July 2007. The overpayment covers August 2004 through May 2007.

  5. Document the overpayment, including the use of the three-year time frame.

The overpayment was established in WCAP after July 1, 2007. Apply the appropriate time frame effective July 1, 2007 for In-Home/Relative providers. The overpayment cannot exceed the three-year time frame.

Steps for Completing Overpayments

Take the following steps once you have all the information needed to determine an overpayment:

  1. Complete the following OFR required forms in the WCAP:

    1. DSHS 18-399 Social Service Incorrect Payment Computation and either:

    2. DSHS 18-398 Client Overpayment Notice for consumer overpayments; Or

    3. DSHS 18-398(A) Vendor Overpayment Notice for provider overpayments.

  2. Save the forms in WCAP. All overpayment forms are automatically sent to OFR through the Document Management System (DMS), when processed in the WCAP. Do not send a copy of the forms to OFR by mail.

  3. DO NOT forward a copy of the overpayment notices to the consumer or to the provider. OFR will forward overpayment notices.

  4. Document your actions in the WCAP.

OFR notifies the DSHS Tax Desk or Accounting of consumer overpayments.

Overpayment Disputes

  1. If a consumer or provider objects to the department's overpayment decision, they may file a fair hearing request per WAC 170-290-0260.

  2. Overpayment disputes resulting from Payment Review Program (PRP) overpayments are handled by PRP. Refer the provider to the number on their overpayment notice.

Editing overpayments

Once an overpayment is saved it is an established overpayment and receives an overpayment tracking number on the bottom right corner of the forms. This tracking number identifies one overpayment from another. To correct a previously established overpayment take the following steps:

  1. Access the original overpayment from the WCAP edit overpayment option.

  2. Check the modification box on the overpayment notice (found on the top left of the notice).

  3. Edit both the computation form and the notice if needed. On the overpayment forms, clearly state the reason for the modification whether it is a change in dates, amount, reason, removal of the entire overpayment, etc.

  4. Resend the forms to OFR through DMS by using the Save/Print/DMS button.

  5. Document the reasons for the changes in the WCAP notes screen.

The modified overpayment forms retain the same overpayment tracking number from the original overpayment. OFR can track the overpayments and subsequent modifications with this number. Once an overpayment is saved, it cannot be deleted from WCAP or removed from DMS.

 

 

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