CWES Overpayment & Underpayment Definitions

 [EAS 44-350.2]

Administrative Overpayment

An overpayment caused by the Agency or CWES staff when all the information necessary to determine the correct payment was in the possession of the county. This generally occurs when the client reports the change but appropriate action is not taken, or when the EC makes an incorrect payment computation.

Collect

To recover Supportive Services funds which are overpaid to a person by using collection methods other than grant adjustment.

Corrective Payment

A payment made to a client/provider when it is determined that the client/provider has been underpaid. This usually occurs as the result of a retroactive court order, delayed implementation of regulations, the correction of a misinterpretation of regulations, prior months underpayments, or miscalculation.

Date of Discovery

The date in which the EC discovered enough information sufficient to support a determination of the occurrence and amount of the overpayment/underpayment.

Deferral

A deferral is a temporary postponement of recovery and collection of a supportive service overpayment. The EC determines if an overpayment referral to Collections should be deferred. A referral to Collections is NOT made when the overpayment is deferred. Deferral provisions apply only to Responsible Party - Person (client) overpayments. Deferral provisions do NOT apply to Responsible Party - Resource (provider) overpayments.

Demand for Repayment

A notice sent by the Department of Tax and Collections (DTAC) to the client/provider, stating that an overpayment has occurred and that the client/provider must repay these funds. This may be sent at the same time as any other notices of overpayment and/or adjustment.

Fraud

Fraud exists when a person, on behalf of himself or others, has:

• Knowingly and with the intent to deceive or defraud made a false statement or representation in order to obtain benefits, continue or gain an increase in benefits, or avoid a reduction of benefits.
• Knowingly and with intent to defraud failed to disclose a fact which could have resulted in denial, reduction, or discontinuance of benefits.
• Accepted benefits knowing that there was no eligibility for those benefits, or accepted any amount of benefits knowing that this was greater than the amount to which entitled.
• Made statements which that individual did not know to be true for the purpose of obtaining, continuing, or avoiding a reduction or denial of benefits.

Grant Adjustment

A method of recovering an overpayment by reducing the CalWORKs grant of a currently eligible individual or Assistance Unit (AU), provided that the client chooses this method of recovery and agrees with the amount of the CalWORKs grant adjustment.

Intentional Program Violation (IPV)

A determination made by a state or federal court, or pursuant to an Administrative disqualification hearing, that an individual has intentionally:

• Made a false or misleading statement or misrepresented, concealed, or withheld facts, or
• Committed any act intended to mislead, misrepresent, conceal, or withhold facts, and
• Committed these acts to establish or maintain CalWORKs or supportive services eligibility, or to increase or prevent a reduction in the amount of the CalWORKs grant or supportive services payments.

Whenever there is a fraud overpayment, the District Attorney (DA) makes an evaluation whether to pursue the case for an IPV conviction or not.

Responsible Party - Persons

In CalSAWS, on the Recovery Account Detail page, under the Responsible Party section, Persons refer to the client overpayment (administrative or client caused) for the following types of supportive service overpayments:

• Ancillary
• Child Care
• Transportation.

Note: When establishing the overpayment, it is important to select the Person as the Responsible Party. Do not select both Person and Resource for the same overpayment.

Responsible Party - Resources

In CalSAWS, on the Recovery Account Detail page, under the Responsible Party section, Resources refers to the child care provider for either provider or administrative caused overpayments or to a vendor when an ancillary overpayment applies to a vendor (e.g., erroneous book voucher payment made to the vendor and it was not a client caused overpayment).

Note: When establishing the overpayment, it is important to select the Resource as the Responsible Party. Do not select both Person and Resource for the same overpayment.

Offsetting

A method for recovering all or part of an overpayment by applying it against a payable underpayment.

Other Overpayment

An overpayment which does not meet the criteria to be considered an Administrative overpayment. This may be a client-caused or a provider-caused overpayment. This also includes overpayments as a result of fraud.

Overpayment

Any amount of supportive service payments an individual has received to which he/she is not eligible. This may be all or a portion of the supportive service payment received.

Recoupment/Recovery

Any method of collecting Supportive Services payments which were overpaid. Methods of recovery include grant adjustment (recoupment), voluntary cash recovery, demand for repayment, action for civil judgment and offsetting.

Supplemental Payment

It is a payment issued to an individual for the current month when the EC has recomputed the current payment and determined that the client is eligible for a larger amount of payment than what was actually issued for the month.

Underpayment

A situation that occurred in the prior months when the individual receives less than the amount to which the individual is entitled in a given month(s). If an underpayment comes to the attention of the EC, reasonable steps to correct the underpayment must be taken.

Voluntary Cash Recovery

A repayment voluntarily made to the county by an individual who has incurred an overpayment.