An overpayment exists and the CAO will complete an overpayment referral when: ESA 16542-135 Sanctions and SPAL Overpayments (Linked February 25, 2013)
The individual used assistance benefits and received assistance he/she was not eligible to receive. The CAO should establish an overpayment. The OIG will determine if it is referred for collections or prosecution. The CAO should not accept any payments from recipients to repay a prosecution claim;
NOTE: If there is an LIHEAP overpayment because of suspected fraud, a client mistake or client misrepresentation, DPW must refer the overpayment for collection to the OIG by completing an OIG-189 form (see LIHEAP Forms and Publications). Keep one copy in the LIHEAP record and send all other copies to the OIG. See Chapter 910, Appendix A, for details. If the person or agency that received the funds returns an uncashed check, there is no overpayment and an OIG-189 is not required.
The individual used an electronic authorization card [Electronic Benefit Transfer (EBT) or ACCESS card] to receive assistance for which he/she was not eligible;
The Cash Assistance or SNAP individual received a special allowance which was not used for its intended purpose;
Example: A special allowance is issued to an individual for car repairs to obtain employment. The individual does not have the car repaired and uses the special allowance for another purpose.
Exception: An overpayment does not exist when a special allowance is issued to an individual for a service which the individual obtained, but the individual did not use the allowance to pay the service provider. (See Section 910.22, An Overpayment Will Not Be Established or Referred).
Example: A special allowance is issued to an individual for car repairs to obtain employment. The repairs are completed; however, the individual does not use the special allowance to pay for the repairs. (See Section 910.22, An Overpayment Will Not Be Established or Referred).
The TANF individual used the special allowance for its intended purpose but was later found ineligible for TANF benefits in the month the special allowance was issued;
The actual cost of a service was less than the estimated cost of the service for which a special allowance was issued.
The individual provided falsified documentation to obtain a special allowance;
The individual received an ongoing special allowance when the need no longer existed;
The individual obtained MA Program Services, including LTC, for which he/she was not eligible;
The individual loaned his/her Pennsylvania ACCESS card to a person who was not eligible to use it;
The individual received TANF cash assistance for a period covered by a diversion benefit;
An individual receives a check inadvertently sent due to a systems error to make payment to a child care provider who is enrolled in OIM Direct Pay and the individual fails to make payment to the provider, the CAO will make direct payment to a provider. An overpayment exists and a referral will be submitted for the payment received by the individual;
There is a duplicate issuance of the SSP benefit by the Pennsylvania Treasury Department (Treasury);
The SSP individual was ineligible for Supplemental Security Income (SSI) and, consequently, the SSP;
The individual was found to be ineligible for SSP-Only payments.
NOTE: For overpayments caused by the receipt of assigned support payments beginning the second month of assistance, see Chapter 131, Support Appendix E, of the Cash Assistance Handbook. There are no SNAP overpayments in these situations.
An overpayment will not be established or referred in the following situations:
The CAO did not require the SNAP individual to sign the Application for Benefits;
The CAO did not certify the individual for SNAP in the correct county;
A SNAP individual did not provide a Social Security Number (SSN) because the CAO failed to advise the individual of the SSN requirement for all household members;
When a SNAP employment and training special allowance is used for its intended purpose, even if the individual is later found ineligible for the SNAP benefits in the month of authorization; and
A special allowance issued to an individual for a service which the individual obtained but the individual did not use the allowance to pay the service provider.
Example: An individual was determined eligible for a childcare allowance, took the children to the babysitter, but did not pay the babysitter for the service.
Exception: If there is an error in the system and a check is inadvertently sent to an individual to make payment to a child care provider who is enrolled in OIM Direct Pay and the individual fails to make payment to the provider, the CAO will make direct payment to a provider. An overpayment exists and a referral will be submitted for the payment received by the individual. See Cash Assistance Handbook Section, 183.8, “Restitution,” and Supplemental Handbook section 910.21 An Overpayment Exists and the CAO Will Complete an Overpayment Referral.
When a LIHEAP overpayment is not caused by the client’s misrepresentation, fraud or error, the overpayment must be considered an administrative error and no restitution is required. The client must not be held responsible for repayment of administrative errors, and no referral should be made to the OIG.
When a Medical Assistance or Buy-In overpayment is not caused by the client’s intentional misrepresentation or fraud, the overpayment is considered administrative error and no restitution is required. Since the client is not required to make restitution no referral should be made to the OIG.
Reissued October 23, 2013, replacing August 13, 2013