Benefit Errors - Basic Food Overpayments
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Benefit Errors - Basic Food Overpayments


Revised December 5, 2014



WAC 388-410-0020What happens if I receive more Basic Food or WASHCAP benefits than I am supposed to receive?
WAC 388-410-0025Am I responsible for an overpayment in my assistance unit?
WAC 388-410-0030How does the department calculate and set up my Basic Food or WASHCAP overpayment?
WAC 388-410-0033How and when does the department collect a Basic Food or WASHCAP overpayment?

WAC 388-410-0020
WAC 388-410-0020

Effective March 21, 2014

WAC 388-410-0020 What happens if I receive more Basic Food or WASHCAP benefits than I am supposed to receive?

  1. If you receive more Basic Food or WASHCAP benefits than you were supposed to receive, your assistance unit (AU) has an overpayment. There are three types of overpayments:

    1. Administrative error overpayment: When you received too many benefits because the department made a mistake. 

    2. Inadvertent household error overpayment: When you received too many benefits because you made a mistake or didn't understand what you were supposed to do.

    3. Intentional program violation (IPV) overpayment: When you received too many benefits because you broke a federal food assistance rule on purpose. If you have an IPV, you could be disqualified from receiving Basic Food or WASHCAP benefits under chapter 388-446 WAC.

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

CLARIFYING INFORMATION

  1. Examples of an Administrative Error (AE) overpayment include when we:
    1. Did not act timely on a reported or known change in circumstances;
    2. Made a mistake in determining the AU’s eligibility or benefits;
    3. Incorrectly issued duplicate benefits;
    4. Issued allotments after the end of the AU's certification period without redetermining the AU's eligibility;
    5. Did not disqualify a client for an IPV on time as required under chapter 388-446 WAC;
    6. Made an incorrect change to the case or failed to make a needed change that caused the department to make an incorrect decision on the AU's eligibility or benefit amount.
  2. Examples of an Inadvertent Household Error (IHE) include when the AU:
    1. Understand what they were required to report; or
    2. Report a change or provide accurate and complete information, but they did not do this to get more food assistance benefits than they were eligible for.
  3. Examples of an Intentional Program Violation (IPV) include when a client does any of the following on purpose:
    1. Makes an oral or written false or misleading statement that affects their benefits;
    2. Misrepresents, conceals, or withholds facts; or
    3. Violates the Food Stamp Act, Basic Food regulations, or any state laws that cover:
      1. How someone can get, have, and use Basic Food benefits or EBT cards; or
      2. The transfer of Basic Food benefits or EBT cards.

NOTE:

See chapter 388-446 WAC for information and rules on IPV disqualification hearings and penalties. WAC 388-446-0015 explains that an administrative disqualification hearing (ADH) is a formal hearing to determine if a person committed an IPV.  FSS workers cannot code an overpayment as IPV until an ADH is held and the outcome determines an IPV was committed and caused the overpayment.  See Clarifying Information #6 under WAC 388-446-0001.


4.      Date of discovery:

The Date of Discovery is the date we have adequate information to validate that the AU has an overpayment, and determine the amount overpaid. It is not the date of a system-generated BEG, because these only give enough information to identify a potential overpayment.

The date we "open" the BEG in ACES is the official date of discovery.  The exception to this rule is Basic Food errors discovered through the federal Quality Assurance review process.  The official date of discovery for a QA error is the date the Basic Food Process Preview Panel (PRP) is held where the error would be reported out as final to Food and Nutrition Services (FNS).

5.     Date of establishment:

The Date of Establishment is the date staff establishes an overpayment, send the household notification of the claim, and refer the case to the Office of Financial Recovery (OFR) for collections. The date of the overpayment letter is the official date of establishment.

6.     Timeframes to set up overpayments :

We must process at least 90% of all overpayments by the end of the calendar quarter after the quarter we discover an overpayment. A claim is not timely if we sent the AU an overpayment letter later than the last day of the quarter after the quarter in which we "opened" the overpayment BEG.  Even though we can set up a valid overpayment after the timely processing period, federal rules require the department to meet this timeframe.  For information on processing a BEG, see the ACES User Manual. 

 


NOTE:

Potential overpayments discovered by the Basic Food quality assurance (QA) process must be considered "priority" and every attempt must be made to establish these overpayments within federal time limits, but only after the payment errors associated with these overpayments have been reviewed and finalized by the Basic Food Process Review Panel (PRP).

To ensure that staff review potential overpayments and promptly act on this information, the department monitors Benefit Error Group (BEG) lists.

To measure if we are meeting federal timeliness standards for establishing overpayments, staff compares the dates an overpayment BEG was "opened" to the date we sent the overpayment letter.


EXAMPLE

  1. If we discover an overpayment on February 6th (1st quarter) we must set up the overpayment by June 30th (2nd quarter).
  2. If we discover an overpayment on June 28th (2nd quarter) we must set up the overpayment by September 30th (3rd quarter).


 7.   Other program reporting requirements and Basic Food overpayments:

If someone does not report a change in circumstances required under WAC 388-418-0005, we determine if a client has an overpayment for each program based on that program’s reporting requirements.

  • For Basic Food, the household must report changes as required under WAC 388-418-0005(2).
  • If a Basic Food assistance unit would not have to report the change based on the AU's circumstances, we do not set up an overpayment even if the household had to report a change for another department program.

 

 


EXAMPLE

Julie, Spencer, and their two children receive TANF and Basic Food. They fail to report that Spencer got a job Earning $900 monthly. Spencer received his first paycheck on August 25th. We discover this information in November. 

TANF:

The family was required to report getting a job for TANF. We determine amount of TANF benefits the family was eligible for if they reported the change timely on September 10th and set up an overpayment for October and November.

Basic Food:

The new job did not cause the family to go over the income limit for a family of four. Since they did not have to report this change for Basic Food, we do not set up an overpayment.


EXAMPLE

Diane receives TANF and Basic Food for herself and her daughter. Diane doesn't report she has switched to full-time status at work and now earns $2,500 monthly. Her paycheck on April 30th puts her over the income limit for Basic Food. We discover this information in July.

TANF:

Diane was required to report the change in employment status and going over the earned income limit for TANF. We treat this change as if Diane had reported it timely on May 10th. We would set up an overpayment for the TANF benefits the AU received in June and July.

Basic Food:

Diane’s $2,500 monthly income is over the income limit for a two-person AU. Since she was required to report this change for Basic Food, we set up a Basic Food overpayment for benefits the AU received in June and July.


WORKER RESPONSIBILITIES

  1. Timely processing of overpayments:

When you learn of a potential overpayment through an interface, alert, client contact, or other source, take all needed actions as appropriate to validate that an overpayment occurred and determine the amount of the overpayment. This may include requesting additional information or proof of someone's circumstances.

  1. When you have adequate information to determine that the AU was overpaid and determine the amount they were overpaid, this is the date of discovery for the overpayment. The date of discovery is recorded as the date you "open" the overpayment BEG in ACES.
  2. After you have established the date of discovery, finish processing the overpayment by sending the client an overpayment letter including the calculation and refer the case to the Office of Financial Recovery for collections. This is the date of establishment for the overpayment. The date of establishment is recorded as the date you generate the overpayment letter to refer the case to OFR.

Claims Establishment Timeline

 

1st Quarter

2nd Quarter

3rd Quarter

4th Quarter

If your date of discovery is in:

January;
February; or
March

April;
May; or
June

July;
August;
September

October;
November; or
December

You must establish the claim by:

June 30th

September 30th

December 31st

March 31st


NOTE:

There is a federal requirement to establish a minimum of 90% of valid overpayments by the end of the calendar quarter after the quarter we discovered the overpayment.  This is especially important for overpayments validated by the federal SNAP (Basic Food) QC process.

By working the potential overpayment immediately to validate and process the overpayment, we ensure that we meet the federal requirement.


  1. Review client-caused errors for potential IPVs:
    • Consider what appears to be the AU's intent or lack of intent to decide if an overpayment is an IHE or a suspected IPV.
    • Set up a suspected IPV overpayment as an IHE overpayment until an administrative disqualification hearing or a court determines the client's intent.
  2. Modifying an overpayment:

If the department determines that an assistance unit’s overpayment amount needs to be modified because of an error, the worker should refer to the ACES manual, Benefit Error Group (BEG) - Modify a BEG – Overpayment or Underpayment.


ACES PROCEDURES

See Benefit Error Group (BEG) – Modify a BEG – Overpayment or Underpayment


WAC 388-410-0025
WAC 388-410-0025

Effective March 21, 2014

WAC 388-410-0025 Am I responsible for an overpayment in my assistance unit?

If your assistance unit (AU) received more Basic Food or WASHCAP benefits than it was supposed to receive, your AU has an overpayment. If you have an overpayment, we determine the amount you were overpaid and set up a claim to recover this overpayment.

  1. We set up an overpayment for the full amount your AU was overpaid for every adult AU member at the time your AU was overpaid.

  2. Each adult member is responsible for the whole overpayment until we recover the entire amount of the overpayment.  We do not collect more than the amount your AU was overpaid.

  3. If we determine you are responsible for an overpayment, you are responsible for the overpayment even if you are now in a different AU than you were when you had the overpayment.

  4. You may be responsible for a Basic Food or WASHCAP overpayment even if it was the department's fault you were overpaid.

  5. We do not apply equitable estoppel, as described under WAC 388-02-0495, to Basic Food or WASHCAP overpayments.

  6. We may reduce all or part of an overpayment if we determine you are unable to repay the balance or that doing so would be a hardship.  See WAC 388-410-0033.

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

CLARIFYING INFORMATION

Even though all adult members of an AU with an overpayment are liable for the full overpayment, the Office of Financial Recovery (OFR) tracks payments to ensure that we do not collect more than the amount of the overpayment.


WORKER RESPONSIBILITIES

Overpayment Liability

  1. Set up the overpayment in the name of every adult who was a member of the AU at the time the AU was overpaid.
  2. Create a separate Basic Food overpayment letter for each responsible member for the entire amount of the overpayment.
  3. Make sure each overpayment letter states the name of the primary payee and the total overpayment amount.

NOTE:

If the only responsible members are a husband and wife who are living in the same residence, send just one overpayment letter. List one spouse as the primary payee and the other spouse as the secondary payee.


ACES PROCEDURES

See Benefit Error Group (BEG) - Confirm a BEG - Overpayment


WAC 388-410-0030
WAC 388-410-0030

Effective March 21, 2014

WAC 388-410-0030 How does the department calculate and set up my Basic Food or WASHCAP overpayment?

  1. We calculate the amount of your Basic Food or WASHCAP overpayment by counting the difference between:

    1. The benefits your assistance unit (AU) received; and

    2. The benefits your AU should have received.

  2. To calculate the benefits your AU should have received, we determine what we would have authorized if we:

    1. Had correct and complete information; and

    2. Followed all the necessary procedures to determine your AU's eligibility and benefits.

  3. If you did not report your earned income as required under WAC 388-418-0005 and WAC 388-418-0007, you do not receive the earned income deduction under WAC 388-450-0185 when we calculate your overpayment amount.

  4. If we paid you too few Basic Food or WASHCAP benefits for a period of time, we will use the amount we underpaid your AU to reduce your overpayment if:

    1. We have not already issued you benefits to replace what you were underpaid; and

    2. We have not used this amount to reduce another overpayment.

  5. We must set up an inadvertent household error or administrative error overpayment if:

    1. We discovered the overpayment through the federal quality control process;

    2. You currently receive Basic Food or WASHCAP benefits; or

    3. The overpayment is over one hundred twenty-five dollars and you do not currently receive Basic Food or WASHCAP benefits.

  6. If you have an inadvertent household error that we referred for prosecution or an administrative disqualification hearing, we will not set up and start collecting the overpayment if doing so could negatively impact this process.

  7. We set up an intentional program violation overpayment based on the results of an administrative disqualification hearing (chapter 388-02 WAC) unless:

    1. Your AU has repaid the overpayment; or

    2. We have referred your inadvertent household error for prosecution and collecting the overpayment could negatively impact this process.

  8. We must calculate the overpayment amount:

    1. For an administrative error overpayment - up to twelve months prior to when we became aware of the overpayment;

    2. For an inadvertent household error overpayment - for no more than twenty-four months before we became aware of the overpayment; and

    3. For intentional program violation (IPV) overpayments - from the month the act of IPV first occurred but no more than six years before we became aware of the overpayment.

 

 

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

NOTE:

When the overpayment involves food assistance, current policy states that only a court of law or an Administrative Disqualification Hearing can determine an Intentional Program Violation (IPV).

The FSS establishes an unintentional overpayment, called Inadvertent Household Error, and refers the food and any related cash overpayment to OFA for investigation and potential prosecution.


CLARIFYING INFORMATION

  1. Calculating the Overpayment
    1. The overpayment amount is the difference between what the client received and what they were eligible to receive.
    2. When determining an overpayment amount, you may subtract an under payment, if not already issued, from an overpayment to get the net overpayment amount.
  2. Overpayments discovered by QC Reviews: 

If the department discovered an overpayment through the federal QC process or the QC process reports the case as ineligible for benefits, we must set up an overpayment regardless of the amount.

  1. Overpayments discovered outside the QC Review process

If we didn't discover the overpayment through the federal QC process, we set up an overpayment if:

a.    The responsible household members still receive Basic Food or WASHCAP benefits; or

b.    The overpayments total more than $125.

 


NOTE:

Overpayments discovered through internal audits, Management Evaluation reviews, or any payment accuracy initiatives are not considered as discovered through the federal QC process.


    4.    OFR collects on established debts regardless of the amount.

The $125 rule applies to whether or not we establish an overpayment for Basic Food or WASHCAP. OFR will collect on established overpayments regardless of the amount. This includes when we:

·         Set up an overpayment for an AU who no longer receives Basic Food; or

·         Modify an existing overpayment to $125 or less.

OFR is the point of contact for compromising (reducing) overpayment balances or making decisions on waiving overpayment collections. Clients must be referred to OFR for these requests.


WAC 388-410-0033
WAC 388-410-0033

Effective March 21, 2014

WAC 388-410-0033 How and when does the department collect a Basic Food or WASHCAP overpayment?

  1. When we set up an overpayment because you received more Basic Food or WASHCAP benefits than you were supposed to receive, we start to collect the benefits you were overpaid. This includes when we:

    1. Modify an established overpayment to an amount we would not have to set up under WAC 388-410-0030 (5); or

    2. Set up an overpayment that we do not have to set up under WAC 388-410-0030(5).

  2. You can repay your overpayment by:

    1. Paying the entire amount at once;

    2. Having us take the amount of your overpayment out of your EBT account;

    3. Making regular payments under a scheduled repayment agreement as described in subsection (4) of this section; or

    4. Having your current Basic Food or WASHCAP benefits reduced.

  3. If you have an inactive EBT account and we cancelled Basic Food or WASCHAP benefits in the account under WAC 388-412-0025, we use the cancelled benefits to reduce the amount of your overpayment.

  4. If your AU currently receives Basic Food or WASHCAP benefits, you can repay your overpayment by making monthly payments. The payments must be more than we would recover through us reducing your benefits. Your AU or the department can request a change to the agreement if necessary.

  5. If you are responsible for repaying an administrative or inadvertent household error overpayment, we automatically reduce your monthly benefits unless you:

    1. Pay the overpayment all at once;

    2. Set up a repayment agreement with us;

    3. Arrange with us to compromise (reduce) or waive all or part of your overpayment under section (13) below; or 

    4. Request a hearing and continued benefits within ninety days of the date you received your collection action notice.

  6. If you are responsible for an intentional program violation (IPV) overpayment, you must tell us how you want to repay this overpayment within ten days of the date you receive your collection action notice. If you do not do this, we will reduce your current monthly benefits.

  7. If you receive ongoing Basic Food or WASHCAP benefits, we can reduce your monthly benefits to repay the overpayment. We do not reduce your first Basic Food or WASHCAP allotment when we first approve your application for benefits.

    1. If you have an administrative or inadvertent household error overpayment, we reduce your benefits by the greater of:

      1. Ten percent of your monthly benefits; or

      2. Ten dollars per month.

    2. If you have an IPV overpayment, we reduce your benefits by the greater of:

      1. Twenty percent of your monthly benefits; or

      2. Twenty dollars per month.

  8. If you do not meet the terms of a repayment agreement with the department, we automatically reduce your current benefits unless you:

    1. Pay all overdue payments to bring your repayment agreement current; or

    2. Ask us to consider a change to the repayment schedule.

  9. If your overpayment claim is past due for one hundred eighty or more days, we refer your overpayment for federal collection. A federal collection includes reducing your income tax refund, social security benefits, or federal wages. We do not count your overpayment as past due if you:

    1. Repay the entire overpayment by the due date;

    2. Have your monthly benefits reduced to repay the overpayment;

    3. Arrange with us to compromise (reduce) or waive all or part of your overpayment under section (13) below; or

    4. Meet the requirements of your scheduled repayment agreement.

  10. If you no longer receive Basic Food or WASHCAP benefits, we can garnish your wages, file a lien against your personal or real property, attach other benefits, or otherwise access your property to collect the overpayment amount.

  11. We suspend collection on an overpayment if:

    1. We cannot find the responsible AU members; or

    2. The cost of collecting the overpayment would likely be more than the amount we would recover.

  12. We can  compromise (reduce) all or part of any unpaid claim when:

    1. The amount you offer to repay is close to what we could expect to receive from you before we can no longer legally collect the overpayment from you; or

    2. We determine that you are unable to repay the balance or that doing so would be a hardship.

  13. We write off unpaid overpayments and release any related liens when:

    1. The claim is invalid;

    2. All adult household members die;

    3. The claim balance is less than twenty-five dollars and has been delinquent for ninety days or more;

    4. We determine it is not cost effective to pursue the claim further;

    5. We agreed to accept a partial payment that left an unpaid balance after this payment;

    6. You have paid ten percent of your monthly benefits or ten dollars, whichever is greater, on an adminstrative or inadvertent household error overpayment for at least thirty-six months;

    7. The claim has been delinquent for three years or more unless we plan to pursue the claim through the Treasury Offset Program; or

    8. An administrative law judge orders us to do so.

  14. If your AU has an overpayment from another state, we can collect this overpayment if the state where you were overpaid does not plan to collect it and they give us the following:

    1. A copy of the overpayment calculation and overpayment notice made for the client; and

    2. Proof that you received the overpayment notice.

  15. You can ask for a hearing to contest whether you owe an overpayment, whether we calculated the overpayment correctly, or whether we should have waived an overpayment.

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

CLARIFYING INFORMATION

  1. Who has to repay an overpayment:
    1. The Department collects from the client by reducing Basic Food benefits. Clients can also repay an overpayment by paying the Office of Financial Recovery directly.
    2. The adults in the overpayment assistance unit share the responsibility for repaying an overpayment even if they later belong to different assistance units.
    3. We consider a person who receives Basic Food or WASHCAP benefits as having the ability to repay an overpayment.
  2. When we can reduce an overpayment for a client who receives benefits:
    1. The CSO can reduce an overpayment debt only if the overpayment was incorrectly calculated for an amount larger than is actually owed.
    2. An Administrative Law Judge can order an overpayment debt waived or reduced to correct an overpayment that was calculated in error.  An ALJ does not have the authority to reduce or waive an overpayment based on hardship. 
  3. When the Office of Financial Recovery can reduce an established overpayment:

A person responsible for an overpayment may be able to negotiate a reduction of the debt with the Office of Financial Recovery. OFR is the secretary's designee for the department under RCW 43.20A.110 and uses criteria under RCW 43.20B.030 to determine if an overpayment should be reduced or dismissed  as allowed under Title 7 CFR §273.18(c)(7)  

    • OFR determines if a reduction of the debt would be cost effective for the department instead of continuing collections through other means.
    • Normally, reducing the debt is cost effective only if the person is willing to pay the remaining debt off in full.
    • People can contact OFR to negotiate a reduction in the overpayment by calling OFR at 800-562-6114.
  1. The first month's allotment of a newly approved application:

We do not recover an existing overpayment from the first month's benefits of a newly-approved application for WASHCAP or Basic Food. We do recover an overpayment from the first month of an AU's certification period if we recertified the AU with no break in eligibility.

    5.  Collecting overpayments:

OFR takes the necessary steps to collect the overpayment. This includes allotment reduction, installment payments, and lump sums, as well as other means of collection.


NOTE:

If we have removed Basic Food benefits from a client's EBT account through the expungement process, OFR will reduce the client's overpayment by the amount we expunged from the client's EBT account.


WORKER RESPONSIBILITIES

ACES is programmed to calculate the overpayment and generate the correct letter and computation sheet.  However, you must review the letters and make sure they are complete and correct.

  1. Work potential overpayments when you are alerted to a discrepancy:

Set up all overpayments as soon as possible.  Make sure that you set up the overpayment by the end of the calendar quarter after the quarter you discover the overpayment.

  1. Send an overpayment letter:
  1. Send an overpayment letter for every responsible person for the full amount of the overpayment.  Use either:
    1. 0045-05, Food Assistance Overpayment - Inadvertent Error; or
    2. 0045-06, Food Assistance Overpayment - Administrative Error.
  2. ACES sends the overpayment letter and claim determination report from state office by certified mail, return receipt requested.
  3. The overpayment letter will contain information about the conditions for compromising or waiving overpayment claims and contact information for OFR to make these requests.
  1. When an overpayment appears to be an Intentional Program Violation:
  1. Set up suspected IPV overpayments as an inadvertent household error (IHE) overpayment and follow the Administrative Disqualification Hearing (ADH) process described under WAC 388-446-0015.
  2. If the client is found by a court or ADH to have an IPV, change the IHE overpayment to an IPV.
    1. Do not create a new BEG.
    2. Modify the existing overpayment by creating 0045-09, Overpayment Modification letter in aces.online.
    3. In the letter, select the box for "The type of overpayment has changed."
    4. Add text notifying the client that the overpayment changed from an IHE to an IPV due to an ADH or court decision.
    5. Send the client a Disqualification Notice; 0056-010056-02, or 0056-03.
  3. Let OFR know when the overpayment had been determined to be an IPV, even if the overpayment was paid in full.  OFR will need IPV documentation and will change the overpayment coding for federal funding purposes.  Send OFR:
    1. The Overpayment Modification letter;
    2. The Disqualification Notice; and
    3. Copy of the final hearing decision, court order, or diversion agreement and disqualification consent agreement.
  1. Potential Fraud:

If you suspect a client has committed fraud, see FRAUD for instructions.

Modification Date: December 5, 2014