Situations when an overpayment exists and the CAO will complete an overpayment referral include but are not limited to the following:
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;
Exception: If a LIHEAP or MA overpayment is caused by an Administrative error, it cannot be collected and will not be referred to the OIG. LIHEAP and MA overpayments will only be referred to the OIG if they are caused by an individual error.
Reminder: MA Includes Buy-In and LTC unless otherwise noted.
NOTE: If there is an LIHEAP overpayment caused by an individual error, DHS will refer the overpayment for collection to the OIG by completing an OIG-189 form. The CAO will keep one copy in the LIHEAP record and send all other copies to the OIG. See Appendix A. 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).
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).
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 except when the receipt of these services is caused by an administrative error;
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 Cash Assistance Handbook Chapter 131) There are no SNAP overpayments in these situations.
PO-17659-910; Individual and Administrative Errors and Overpayments; August 17, 2015
Situations when an overpayment will not be established or referred include, but are not limited to, the following:
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 and Supplemental Handbook section 910.21).
A Medical Assistance or LIHEAP overpayment is caused by an administrative error (See Section 910.45 for the definition of administrative error).
NOTE: If an overpayment is caused by individual error, intentional or unintentional, the overpayment is not administrative and will be referred to the OIG.
Reissued August 20, 2015, replacing October 23, 2013