CLAIMS HANDBOOK - Department of Human Services

BENEFIT RECOVERY (CLAIMS) HANDBOOK
PROCESSING NON FRAUD CLAIMS SCREENED OUT BY OPIC
OPIC will return referrals when Intentional Program Violation cannot be determined or
when an agency error is discovered.
A claim must be processed as Agency Error if any employee had or had access to
information that was not acted on, including Services files, alerts, and clearinghouse
information.
A claim must be processed as Inadvertent Household Error if OPIC determines that
there was no intent to commit fraud, or if intent cannot be supported because necessary
forms cannot be located to prove that the customer’s responsibility to report changes
was explained. IHE claims must be processed with actual circumstances and without
earned income deductions. Signed forms are not required to process non fraud claims.
Consider SRR / Timely Notice and Statute of Limitations Policies to determine first
month of overpayment when processing AE and IHE Claims.
Statute of Limitations:
From the date of the disposition letter from OPIC, DFCS can correct the current month,
and the 12 months immediately prior only. Any overpaid months prior to that date must
be forgiven. Assure that ongoing budget is correct when appropriate.
Example:
Disposition letter dated 8/15/07 reports AE claim beginning 1/06 and ending 10/06.
DFCS is limited to correcting budgets and creating overpayment for 8/06-10/06 only.
Standard of Promptness:
Claims must be processed and the customer notified of a debt within 60 days of the
date on the OPIC disposition letter or within 1 year of the original referral date,
whichever date is sooner.
Example:
Disposition letter date is 8/15/07; original referral (5667) date is 9/2/06. SOP for claim
establishment is 9/1/07.
Rev December ‘10 20