Overpayments

Created on: 
Jun 07 2016

Table of Contents

Related WACs and Clarifying Information

Child Care Subsidy

Seasonal Child Care

DEL Clarifying Information (published February 1, 2017)

WAC 170-290-0271

Determining Consumer Income When Calculating an Overpayment

WAC 170-290-0065 allows staff to choose the method in calculating income. When an overpayment is processed, Office of Fraud and Accountability (OFA) should use the same method as chosen and documented by the worker.

Consumers will not receive an overpayment for care used or billed during the 10 day advance notice period when changes are reported and processed timely.

Additional Information

What causes an overpayment?

Overpayments are when clients or providers receive more benefits than those for which they are eligible.

For providers: please see WAC 170-290-0268 (1).

The Department looks for the following patterns when determining when a provider overpayment may have occurred. 

  • Licensed/certified providers who consistently claim the maximum number of units authorized, (i.e., 23 full-days, 23 to 30 half days per month).
  • Family/Friend & Neighbor (FFN) providers who consistently bill for the maximum authorized units per month.
  • FFN providers who claim for more than 6 children for the same time period (overlapping days and hours).
  • FFN providers who claim payment for non-school/holiday hours (contingency hours) for which they are not eligible. 
  • Authorized payment rates that exceed the DSHS rate for the child's age or geographic area.
  • A child age 13 years or older being authorized for care.  Only children age 13 and older who have special needs or who are under court supervision can be authorized for child care. If the provider is licensed/certified, they must have a waiver to provide this care.
  • Duplicate authorizations and payments for a child.

For clients: please see WAC 170-290-0271 (1).

The Department looks for the following patterns when determining when a client overpayment may have occurred. 

  • The need for child care was not clearly supported in the case file based on factors such as household composition and approvable activities.
  • The amount of care authorized was more than the client was eligible to receive. 
  • The monthly household income was determined incorrectly.
  • The copayment was applied incorrectly.
  • The client did not disclose all income sources, or the Department did not calculate the monthly income correctly.
  • The client failed to notify the Department of a reportable change and continued using childcare while no longer eligible.

 

What if an overpayment is caused by a departmental error?

If the Department commits an error that causes an overpayment, the client or provider will still have to repay the debt.  This is because they received payment for more benefits than they were eligible for.

In some cases if certain elements are met, and the client disputes the overpayment through the Administrative Hearing process, they could be eligible for Equitable Estoppel and have the debt removed or reduced to prevent a manifest injustice.

How long do clients and providers have to provide requested information regarding an overpayment?

Clients have 14 days to provide any information the Department requests. Effective July 1, 2017 child care providers have 28 days to return attendance records when requested.  Providing the information may reduce the amount that they would be required to pay otherwise. Failure to provide the information may mean that they will be required to pay for all benefits received during the overpayment’s timeframe.