SECTION 340:40-15-1. Overpayments

(a)   Overpayment claim definition. A client or child care provider overpayment claim may occur as a result of agency, client, or provider error when a household received more child care benefits than it is entitled to receive or a provider was paid in error per (b)(1)(B) or (3) of this Section.

(b)   Overpayment referral. Oklahoma Department of Human Services (DHS) staff including, but not limited to, Adult and Family Services (AFS) or Child Welfare Services (CWS) staff, Office of Inspector General (OIG) auditors or investigators, or Financial Services (FS) Electronic Payment Systems (EPS) staff may identify a possible overpayment. When DHS staff suspects an overpayment occurred, he or she sends a client overpayment referral to AFS Benefit Integrity and Recovery (BIR) and a provider overpayment referral to FS EPS for an overpayment determination and claim establishment.

(c)   Overpayment determination and claim establishment. AFS BIR staff determines if a client overpayment occurred, when it occurred, and if it is due to an agency or client error. When the overpayment is due to a client error, AFS BIR staff establishes the overpayment as an inadvertent client error, willful misrepresentation, or fraud. FS EPS staff determine and establish provider overpayments. An overpayment claim is considered established on the date AFS BIR staff sends the overpayment notice to the household or FS EPS staff sends a letter to the child care provider.

(1)   Agency error overpayment claim. An agency error overpayment claim may be established against the client or the child care provider depending on the circumstances. An agency error overpayment occurs when DHS staff did not exercise due diligence.

(A)   When AFS staff incorrectly calculates countable income and/or deductions resulting in an incorrect family share copayment or complete ineligibility, or AFS or CWS staff approves more care than the household is entitled to receive, AFS BIR staff establishes the agency error overpayment against the client.

(B)   FS EPS staff establishes agency error overpayments against the provider for child care plan errors when DHS pays an incorrect rate.

(2)   Client error overpayment claim. AFS BIR staff establishes an overpayment claim against the client when the client:

(A)   provides incorrect information at the time of application or renewal;

(B)   fails to report any change that affects eligibility per Oklahoma Administrative Code (OAC) 340:40-9-2; or

(C)   uses child care for days and hours the client is not eligible for child care.

(3)   Provider error overpayment claim. FS EPS establishes an overpayment claim against the provider when the provider:

(A)   submits incorrect claims;

(B)   fails to timely void inaccurate attendance entered in the point-of-service (POS) machine by the client;

(C)   receives payment for care the provider did not provide and is not entitled to receive. This can occur when the provider has possession of the client's electronic benefit transfer (EBT) card and swipes attendance for a day a child did not attend or facility staff requests that a parent do so;

(D)   receives payment for care from DHS that was provided after the date his or her child care license was revoked or contract was cancelled; or

(E)   moves a POS machine to a different location prior to obtaining written approval from AFS Child Care Subsidy staff and payment was made for care during that period.

(4)   Liquidated damages. Per OAC 340:2-11-150, FS EPS staff may assess liquidated damages in addition to a provider overpayment when the provider:

(A)   is in possession of the client's EBT card;

(B)   swipes the card through the POS machine; or

(C)   knows the client's personal identification number (PIN).

(d)   Overpayment notice. Following claim establishment, AFS BIR staff sends the client an overpayment notice and FS EPS staff sends an overpayment notice to the provider.

(e)   Appeal rights. Only a client has the right to appeal all or part of any overpayment claim established against him or her.

(f)   Repayment of an overpayment claim. DHS requires repayment of all established overpayments.

(1)   AFS BIR staff sends the client Form 08OP011E, Repayment Agreement, with the overpayment notice and begins sending a monthly account statement the following month that reflects all payment and account information.

(2)   FS EPS staff sends a letter to the provider that explains the repayment process for vendor overpayments. When the provider:

(A)   receives subsidy payments, a portion of his or her weekly payments are retained to repay the overpayment; or

(B)   does not receive subsidy payments, he or she must set up a repayment plan with FS EPS staff.

[Source: Added at 17 Ok Reg 25, eff 10-1-99 (emergency); Added at 17 Ok Reg 1244, eff 6-1-00; Amended at 17 Ok Reg 3583, eff 10-1-00 (emergency); Amended at 18 Ok Reg 1236, eff 5-11-01; Amended at 22 Ok Reg 1948, eff 7-1-05; Amended at 25 Ok Reg 920, eff 6-1-08; Amended at 27 Ok Reg 1220, eff 6-1-10; Amended at 35 Ok Reg 36, eff 10-1-17 (emergency); Amended at 35 Ok Reg 1647, eff 9-17-18]