CLAIMS HANDBOOK - Department of Human Services
CLAIMS HANDBOOK - Department of Human Services
CLAIMS HANDBOOK - Department of Human Services
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BENEFIT RECOVERY (<strong>CLAIMS</strong>) <strong>HANDBOOK</strong><br />
To refer suspected cases <strong>of</strong> IPV, the case manager should:<br />
1. Correct the benefits for the ongoing month, only. Do not change data for any<br />
historical month unless the change is unrelated to the suspected IPV. Invalidate<br />
errors caused by related case changes.<br />
2. Complete Form 5667 as soon as the suspected fraud is discovered. A sample <strong>of</strong><br />
Form 5667 and instructions for completion are located in the forms section.<br />
3. Enter on County Log and indicate log number on Form 5667. A sample County<br />
Log and instructions for monitoring are located in the forms section.<br />
4. Within 10 days <strong>of</strong> completing the 5667, forward to the OPIC agent or the OPIC<br />
regional <strong>of</strong>fice. Refer to Appendix A for OPIC regions and Region Office<br />
Addresses.<br />
5. Referrals made by the Call Center, Maximus, OPIC Agents, Etc. should be<br />
added to the log as they are discovered. EBT trafficking claims identified by<br />
OPIC without a referral from another source are not included on the 5667 log.<br />
6. A claim should be established in SUCCESS within 12 months <strong>of</strong> the discovery <strong>of</strong><br />
the suspected fraud. Monitor referrals and indicate the date <strong>of</strong> acknowledgement<br />
<strong>of</strong> receipt by OPIC, and the return dates <strong>of</strong> the initial and final disposition letters<br />
on the log. A sample <strong>of</strong> the disposition letter is located in the forms section.<br />
7. Complete the appropriate case action requested by OPIC including<br />
disqualification <strong>of</strong> recipient.<br />
To refer suspected vendor abuse:<br />
FS Vendor Abuse<br />
Allegations are referred via memorandum. Include<br />
the name and address <strong>of</strong> the vendor, along with<br />
specific details <strong>of</strong> the allegation.<br />
Mail to :<br />
Office <strong>of</strong> Program Integrity and Compliance<br />
2 Peachtree St, NW Suite 30.449<br />
Atlanta, GA 30303<br />
Child Care Vendor Abuse<br />
Allegations are referred via Form 5667-B.<br />
Complete form and mail electronically to:<br />
lahendrix@dhr.state.ga.us<br />
or:<br />
Office <strong>of</strong> Program Integrity and Compliance –<br />
CAPS Unit<br />
125 Henry Parkway<br />
McDonough, GA 30253<br />
Maintain 5667 log to monitor outstanding referrals. Pages <strong>of</strong> the log may be<br />
purged after all referrals contained on that page are dispositioned.<br />
Rev December ‘10 19