Revised 6-1-10

1.  (a) The worker and supervisor process overpayments using the Oklahoma Program Integrity (OPI) System.  OPI interfaces with EPPIC to retrieve paid benefit information.  OPI has the capability to access databases in IMS and calculates the overpayment automatically using this information. Household information, current addresses, aliases, and benefit information are automatically retrieved from the IMS system.  All documentation and circumstances leading to the overpayment must be thoroughly explained by the worker in OPI Case Comments.  The Case Comments must include:

(1) a short summary of the circumstances which led to the possible overpayment claim including the original and new family share co-payment amounts, if applicable; and

(2) the contract number of the child care provider.

(b) Office of Inspector General (OIG) auditors and investigators submit a summary of their findings and supporting documentation to the Family Support Services Division (FSSD) Benefit Integrity and Recovery Section and/or the Finance Division upon completion of an audit or investigation.  Auditors give child care providers a copy of the audit report.

2.   (a) An example of a plan of service error is when the worker approves the client for the weekly unit type and the client's work hours show only  12 days per month are needed.  The overpayment occurs when the client actually uses any additional care for a non-work reason.

(b) Examples of agency error overpayments are when:

(1) the worker inappropriately approves a child for a blended, weekly, or special needs authorization; and

(2) the provider receives a rate for which he or she is not entitled.  The overpayment is the difference between the correct rate of payment and the actual amount received by the provider.

3.   (a) Due diligence by human services center (HSC) staff includes:

(1) processing child care benefits timely and accurately;

(2) taking action on reported changes within ten days;

(3) correctly approving the days and hours care is needed, based on the client's need for child care;

(4) informing the client and/or provider of Oklahoma Department of Human Services (OKDHS) policy and procedures; and

(5) arranging provider training for initial child care contracts.

(b) Due diligence by FSSD Child Care Subsidy Section staff includes:

(1) informing the client and/or provider of OKDHS policy and procedures;

(2) providing ongoing provider training and/or training materials such as the "Contracting with OKDHS for Child Care Subsidy Payments Handbook" to keep providers informed of child care subsidy rules; and

(3) updating providers on changes in OKDHS policy and procedure.  This includes informing providers about how a child qualifies for different rates in the "Contracting with OKDHS for Child Care Subsidy Payments Handbook, " on OKDHS Appendix C-4, Child Care Provider Rate Schedule.

(c) Due diligence by Finance Division staff includes correctly processing child care claims.

4.   The provider is responsible for maintaining accurate records for three years or until the resolution of pending legal issues, whichever is later. The provider must:

(1) check the accuracy of the attendance swiped by the client and accurately complete Form 10AD121E, Child Care Claim.  If the client swipes inaccurate attendance, the provider must void out incorrect swipes and ask the client to swipe again; and

(2) maintain copies of any manual claim forms, Form 10AD121E, submitted to the Finance Division.

5.   Prior to completion, the overpayment is shown in pending status in OPI.

(1) The worker and supervisor establish overpayment claims under $500 due to inadvertent client error and any agency error overpayment regardless of the amount.

(2) Prior to establishment of all overpayment claims that are due to inadvertent household error or willful misrepresentation and are $500 and over, these overpayment claims are automatically transmitted by the OPI system to the FSSD Benefit Integrity and Recovery Section for review.

(A) If, after review, it is determined that the overpayment claim is the result of inadvertent household error or willful misrepresentation, the claim is referred for investigation to OIG.  After investigation, OIG releases the overpayment claim back to the FSSD Benefit Integrity and Recovery Section for establishment of the claim or other action as determined by the investigation.

(B) All claims against clients not referred to OIG are established by the FSSD Benefit Integrity and Recovery Section staff through the OPI system.

6.  (a) A notice titled Notification of Overpayment and Form 08OP011E, Repayment Agreement, are issued by OPI to the client for each incident of overpayment at the time the HSC staff or FSSD Benefit Integrity and Recovery Section staff establishes the overpayment claim.  This notice includes:

(1) how the debt occurred, who was at fault, and the time period of the debt; and

(2) an explanation of the client's appeal rights.  Clients must request an appeal through their local HSC.  See OAC 340:2-5 for hearing procedures.

(b) The overpayment notice Finance Division staff sends to providers includes:

(1) how the debt occurred;

(2) the time period covered;

(3) the method of repayment of the debt; and

(4) when the Finance Division will begin recoupment from future OKDHS payments.

7.  At the time the Notification of Overpayment notice is mailed to the client, Form  08OP011E, is also sent.  Form 08OP011E must be signed by the client and returned to the FSSD Benefit Integrity and Recovery Section.

8.   Finance Division staff sends a copy of the notice to the FSSD Child Care Subsidy Section staff and OIG.

9.   If a provider is not receiving payment from OKDHS, the provider is still required to set up a monthly repayment plan with the Finance Division.