<?xml version='1.0' encoding='utf-8'?>
<chapter num="14" heading="Correction of Payment Irregularities" title_num="07" subtitle_num="03">
  <regulation prefix="Regulation" num=".01" heading="Definitions.">
    <paragraph num="A.">
      <text>In this chapter, the following terms have the meanings indicated.</text>
    </paragraph>
    <paragraph num="B.">
      <text>Terms Defined.</text>
      <paragraph num="(1)">
        <text>“Agency error” means an error caused by the local department's action or failure to act.</text>
      </paragraph>
      <paragraph num="(2)">
        <text>“Assistance unit” means a group of eligible individuals living together for whom cash assistance has been authorized.</text>
      </paragraph>
      <paragraph num="(3)">
        <text>“Client error” means failure by the recipient to correctly, promptly, or adequately report information which would have:</text>
        <paragraph num="(a)">
          <text>Reduced the amount of the continuing benefits payments; or</text>
        </paragraph>
        <paragraph num="(b)">
          <text>Resulted in total ineligibility.</text>
        </paragraph>
      </paragraph>
      <paragraph num="(4)">
        <text>“Department” means the Department of Human Services.</text>
      </paragraph>
      <paragraph num="(5)">
        <text>“Fraud” means:</text>
        <paragraph num="(a)">
          <text>Willfully making a false statement or representation, willfully failing to disclose a material change in household or financial condition, impersonating another person to obtain, or attempting to obtain, benefits to which the individual is not entitled; or</text>
        </paragraph>
        <paragraph num="(b)">
          <text>An intentional program violation as described in COMAR 07.03.10.</text>
        </paragraph>
      </paragraph>
      <paragraph num="(6)">
        <text>“Local department” means a department of social services in a county or Baltimore City and the Montgomery County Department of Health and Human Services.</text>
      </paragraph>
      <paragraph num="(7)">
        <text>Overpayment.</text>
        <paragraph num="(a)">
          <text>“Overpayment” means the amount by which a benefit payment received by or for an assistance unit exceeds the amount it was eligible to receive.</text>
        </paragraph>
        <paragraph num="(b)">
          <text>“Overpayment” may result from:</text>
          <paragraph num="(i)">
            <text>Agency error;</text>
          </paragraph>
          <paragraph num="(ii)">
            <text>Client error; or</text>
          </paragraph>
          <paragraph num="(iii)">
            <text>Fraud.</text>
          </paragraph>
        </paragraph>
      </paragraph>
      <paragraph num="(8)">
        <text>“Recoupment” means a process used by a local department to recover an overpayment from the continuing benefit payment of a recipient by withholding an amount determined appropriate, as described in Regulation .05 of this chapter.</text>
      </paragraph>
      <paragraph num="(9)">
        <text>“Recovery” means a process used by a local department to recover an overpayment from an individual whose case is closed.</text>
      </paragraph>
      <paragraph num="(10)">
        <text>Underpayment.</text>
        <paragraph num="(a)">
          <text>“Underpayment” means a payment received by or for an assistance unit which is less than the proper amount allowable to the assistance unit.</text>
        </paragraph>
        <paragraph num="(b)">
          <text>“Underpayment” occurs when the local department has a properly completed application and all information needed for an eligibility decision but does not:</text>
          <paragraph num="(i)">
            <text>Act upon a reported change;</text>
          </paragraph>
          <paragraph num="(ii)">
            <text>Act upon a policy change;</text>
          </paragraph>
          <paragraph num="(iii)">
            <text>Correctly interpret policy;</text>
          </paragraph>
          <paragraph num="(iv)">
            <text>Correctly compute a benefit; or</text>
          </paragraph>
          <paragraph num="(v)">
            <text>Act promptly on information.</text>
          </paragraph>
        </paragraph>
      </paragraph>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".02" heading="Underpayment Procedures.">
    <paragraph num="A.">
      <text>To correct an underpayment, the local department shall:</text>
      <paragraph num="(1)">
        <text>Correct continuing payments promptly, if appropriate;</text>
      </paragraph>
      <paragraph num="(2)">
        <text>Authorize corrective payment as a one-time-only payment equal to the total amount of the underpayment from the time of discovery and correction, retroactive to the time the underpayment first occurred; and</text>
      </paragraph>
      <paragraph num="(3)">
        <text>Require that a supervisory level employee review and approve each fiscal authorization to correct an underpayment before payment is made.</text>
      </paragraph>
    </paragraph>
    <paragraph num="B.">
      <text>Corrective payments are not counted as income or resource for determining eligibility in the month paid or in the following month.</text>
    </paragraph>
    <paragraph num="C.">
      <text>The corrective payment is charged to the program funding source according to instructions issued by the Department.</text>
    </paragraph>
    <paragraph num="D.">
      <text>An uncorrected underpayment may be applied to offset an overpayment debt.</text>
    </paragraph>
    <paragraph num="E.">
      <text>When a decision of the Office of Administrative Hearings as applied to individuals similarly situated would result in a benefit, the local department shall, upon request of the individual, make retroactive adjustments to the date that the incorrect action was taken.</text>
    </paragraph>
    <paragraph num="F.">
      <text>A recipient or former recipient may request an administrative hearing to challenge the amount of an underpayment.</text>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".03" heading="Overpayment Procedures.">
    <paragraph num="A.">
      <text>To correct an overpayment, the local department shall:</text>
      <paragraph num="(1)">
        <text>Determine the correct benefit amount promptly and take action to correct the continuing payment as needed; and</text>
      </paragraph>
      <paragraph num="(2)">
        <text>Calculate the total amount of the overpayment retroactive to the time of the error.</text>
      </paragraph>
    </paragraph>
    <paragraph num="B.">
      <text>The local department may waive establishment of an overpayment if the:</text>
      <paragraph num="(1)">
        <text>Overpayment is $125 or less; and</text>
      </paragraph>
      <paragraph num="(2)">
        <text>Case is closed.</text>
      </paragraph>
    </paragraph>
    <paragraph num="C.">
      <text>Administrative Hearings.</text>
      <paragraph num="(1)">
        <text>The recipient may request an administrative hearing to challenge the proposed action to reduce, suspend, or terminate benefits.</text>
      </paragraph>
      <paragraph num="(2)">
        <text>If a hearing decision upholds the proposed reduction, suspension, or termination, the overpayment includes any overpayments made pending the decision.</text>
      </paragraph>
      <paragraph num="(3)">
        <text>A former recipient of benefits may request an administrative hearing to challenge the local department's decision:</text>
        <paragraph num="(a)">
          <text>That an overpayment occurred;</text>
        </paragraph>
        <paragraph num="(b)">
          <text>Of the amount or cause of the overpayment; or</text>
        </paragraph>
        <paragraph num="(c)">
          <text>Of the proposed method to repay the overpayment.</text>
        </paragraph>
      </paragraph>
    </paragraph>
    <paragraph num="D.">
      <text>Collection of an Overpayment.</text>
      <paragraph num="(1)">
        <text>Termination of benefits does not relieve the recipient of the obligation to reimburse the local department for any overpayment.</text>
      </paragraph>
      <paragraph num="(2)">
        <text>The local department shall:</text>
        <paragraph num="(a)">
          <text>Request repayment of the overpayment debt; and</text>
        </paragraph>
        <paragraph num="(b)">
          <text>Refer the debt to the Central Collection Unit of the Department of Budget and Management, if appropriate.</text>
        </paragraph>
      </paragraph>
      <paragraph num="(3)">
        <text>If benefits are subsequently reinstated, the local department shall begin recoupment of the amount of the overpayment in accordance with this chapter.</text>
      </paragraph>
    </paragraph>
    <paragraph num="E.">
      <text>A current or former recipient shall reimburse the local department for any overpayment and the local department shall accept and credit the payment.</text>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".04" heading="Suspected Fraud Procedures.">
    <paragraph num="A.">
      <text>When the local department suspects fraud, the local department shall refer the case to the Office of the Inspector General (OIG) or directly to the local State’s Attorney Office (SAO).</text>
    </paragraph>
    <paragraph num="B.">
      <text>A supervisory-level employee shall approve the referral document and the director of the local department or designee shall sign it before a referral is made.</text>
    </paragraph>
    <paragraph num="C.">
      <text>After a referral has been made, the local department shall inform the OIG or the SAO of any newly discovered facts or changed circumstances in the case.</text>
    </paragraph>
    <paragraph num="D.">
      <text>The local department shall provide access to the relevant records in its possession for the investigators assigned to investigate suspected fraud.</text>
    </paragraph>
    <paragraph num="E.">
      <text>The local department may not give notice to an applicant or recipient of any referral to OIG or SAO for action on suspected fraud except that the local department representative may answer “yes” or “no” when the recipient asks whether referral has been made.</text>
    </paragraph>
    <paragraph num="F.">
      <text>The decision to refer a case of suspected fraud may not be the sole basis for requesting a fair hearing not withstanding the regulations in the Fair Hearings Chapter.</text>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".05" heading="Recoupment Procedures.">
    <paragraph num="A.">
      <text>Local Department Action. The local department shall:</text>
      <paragraph num="(1)">
        <text>Take action to recoup an overpayment except as described in §C of this regulation;</text>
      </paragraph>
      <paragraph num="(2)">
        <text>Determine the total amount to be recouped; and</text>
      </paragraph>
      <paragraph num="(3)">
        <text>Set an amount to be recouped through a monthly deduction from the continuing benefit for as many months as are necessary until the overpayment is repaid.</text>
      </paragraph>
    </paragraph>
    <paragraph num="B.">
      <text>Recoupment Amount. The recoupment may not cause the family's remaining income from all sources and savings or other liquid assets to be less than 90 percent of the allowable payment for an assistance unit of the same size with no other income.</text>
    </paragraph>
    <paragraph num="C.">
      <text>Local Department Action with Respect to Specific Situation. The local department:</text>
      <paragraph num="(1)">
        <text>Shall handle any improper food supplement issuance in accordance with COMAR 07.03.17.53—.55;</text>
      </paragraph>
      <paragraph num="(2)">
        <text>Shall refer any case in which an overpayment was made to an ineligible individual to the Maryland Department of Health for possible recovery of any overpayment of medical assistance benefits;</text>
      </paragraph>
      <paragraph num="(3)">
        <text>May not recoup from:</text>
        <paragraph num="(a)">
          <text>Emergency Assistance to Families with Children; or</text>
        </paragraph>
        <paragraph num="(b)">
          <text>Burial Assistance;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(4)">
        <text>Shall recoup from Public Assistance to Adults only after the recipient fails to comply with court-ordered collection or restitution which is the result of fraud; and</text>
      </paragraph>
      <paragraph num="(5)">
        <text>May not reduce through recoupment the personal needs allowance of the Public Assistance to Adults recipient by more than 50 percent.</text>
      </paragraph>
    </paragraph>
  </regulation>
  <annotations>
    <annotation type="Authority">Human Services Article §§4-207, 4-303, 5-207, and 5-607, Annotated Code of Maryland(Agency Note: Federal Regulatory Reference 45 CFR 233.20(a)(12))</annotation>
    <annotation type="History" subtype="Administrative History">Effective date: January 18, 1982 (9:1 Md. R. 19)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .01B amended effective May 23, 1983 (10:10 Md. R. 872); March 23, 1987 (14:6 Md. R. 713)</annotation>
    <annotation type="History" subtype="Administrative History">Regulations  .02, .03C, and .05A, C amended effective May 23, 1983 (10:10 Md. R. 872)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .03E adopted effective July 25, 1988 (15:15 Md. R. 1808)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .05 amended effective March 23, 1987 (14:6 Md. R. 713); April 12, 1993 (20:7 Md. R. 640); October 1, 1996 (23:18 Md. R. 1315)</annotation>
    <annotation type="History" subtype="Administrative History">Chapter revised effective October 29, 2001 (28:21 Md. R. 1854)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .04 amended effective April 28, 2014 (41:8 Md. R. 469)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .05C amended effective August 16, 2004 (31:16 Md. R. 1253); April 28, 2014 (41:8 Md. R. 469)</annotation>
  </annotations>
</chapter>