IMA POLICY MANUAL
PART VIII: CASE MAINTENANCE
Chapter 6: Overpayment and Underpayment
This chapter provides information on TANF and FS overpayment policy and underpayment policy in TANF, FS, GC, and IDA programs. An overpayment occurs when a recipient receives benefits for which s/he is ineligible to receive. Similarly, an underpayment occurs when a recipient receives fewer benefits than s/he is eligible to receive.
In this chapter, when the term "All" or "Both" is used, it applies to the respective programs that are being discussed.
The overpayment section outlines when to charge a TANF or FS overpayment and pursue overpayment recovery. In cases in which an overpayment has been charged and the group continues to receive TANF or FS, a portion of the group’s benefits are withheld to repay the overpayment. In cases in which the group no longer receives benefits, the Office of Chief Financial Officer, Payment and Collections Division, is responsible for pursuing overpayment recovery. Overpayments are not charged in the GC or the IDA programs.
The underpayment section outlines when to provide supplemental benefits to adjust for an underpayment in TANF, FS, GC, or IDA.
This chapter does not apply to MA. However, the Department of Health (DOH) may seek to collect funds expended on behalf of individuals ineligible for health benefits or medical expenses paid to providers not eligible for Medicaid reimbursement.
| Overpayments |
TANF: D.C. Code 4-210.19;
3-218.1; 29 DCMR 5816 |
FS: 7 USC(2022); 7 CFR
273.18 |
| Underpayment |
TANF: D.C. Code 4-208.3;
29 DCMR 5817
GC: See TANF and D.C.
Code 4-205.5a |
FS: 7 USC 2020(b); 7 USC
2020(e)(10)-(11); 7 CFR 273.18 |
Types of Overpayments 6.3.1
| TANF |
Persons are overpaid when they receive benefits for which they are not eligible. There are three types of overpayments:
- Error overpayments resulting from DHS failure to take action on known or reported information: This includes miscalculation of a budget or failure to make a timely reduction in benefits based on information fully and timely reported by the recipient.
Two examples of agency error are:
- failure to take prompt action on a change the unit reported
- miscalculation of the unit's income or deductions which results in an overpayment of benefits.
- Applicant/recipient error overpayments: These overpayments may be due to inadvertent household error or suspected fraud. Inadvertent household errors are caused by misunderstanding or unintentional errors by the household.
Some examples of inadvertent household error overpayments are:
- failure to report a change between recertifications, unless there is documentation of contact with the customer during which he failed to report the change; for example, calling the Change Center to report an address change and not reporting new employment that is later discovered
- failure to report a change promptly
- failure to report the absence of a child who has unexpectedly not returned home within 90 days.
Errors due to suspected fraud are caused by documented incidents of false or misleading statements, misrepresentation, concealment or withholding of facts. Errors for which DHS suspects fraud, but for which there is no documentation of intentional misrepresentation, shall be treated as an inadvertent error when calculating the overpayment. Cases suspected of fraud or intentional program violation (IPV) are considered to be applicant/recipient error overpayments until a determination of fraud or IPV is made (see Section 1.5.2: Intentional Program Violation in Part IV.)
Some examples of suspected intentional program violation overpayments are:
- failure to give correct or complete information at application
- failure to report an income change at recertification
- failure to report a change in household size at recertification
- providing false verification at application or recertification.
- Fraud overpayments: Cases suspected of fraud are considered to be applicant/recipient error overpayments until the court makes a determination of fraud, a determination of IPV has been made, or the customer has signed a waiver to an administrative disqualification hearing. An SSR can only make an allegation of fraud; the actual determination of fraud is made by the court or through an IPV disqualification proceeding.
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| FS |
See TANF. In addition, an applicant/recipient error overpayment is further defined as:
- an error that is the result of a group erroneously being categorized as categorically eligible, provided the erroneous categorization is due to a household error
- a FS error that is the result of a group erroneously being categorized as categorically eligible due to an error on the part of SSA.
Department error is further defined as errors that result when:
- DHS fails to reduce the unit's benefits when its cash assistance benefits change
- the department issues the group’s FS benefits after their certification period expired
- the department fails to verify that nonexempt group members completed a current work registration form
- the department erroneously classifies a group as categorically eligible and this mistaken classification is the fault of the department (not the fault of SSA or the recipient).
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