overpayments

B.  Establishing an overpayment

The Division of Finance, Office of Financial Recovery (OFR), is responsible for the collection of debts owed to the department.

Three-Year Look-Back Period for Provider Overpayments

In April 2006, DSHS directed all child care provider overpayments not go back more than three years. This three-year look-back period began November 15, 2005. The three-year look-back period is applied to the first of the month after the overpayment is established in WCAP (see Establishing an Overpayment below). This policy will remain in effect for the Department of Early Learning (DEL).

• All child care providers, including in-home/relative providers.

• Overpayments found during case reviews, state audits, local audits, Payment Review Program (PRP) audits and other overpayment discovery processes.

• Client overpayments.

• Any overpayment the Division of Fraud Investigations (DFI) determines fraudulent.

• Errors discovered by a provider and turned into the office (referred to as "self-reported").

• The modified overpayment date. Apply the three-year look-back period to the original establishment date.

worker responsibilities

1. Review the potential overpayment for possible fraud elements and follow the Working Connections Child Care Manual Fraud section for DFI referrals as necessary.

2. Apply the three-year look-back period to the overpayment, using the first day of the month following the month the overpayment is established in WCAP.

3. Document actions in WCAP. Include if the three-year look-back period needed to be applied and if it affected the time period of the overpayment. You can refer to the Child Care Provider Overpayments-Change in Practice memo dated June 2006 for support when you apply the three-year look-back period.

Forms required by the Office of Financial Recovery (OFR)

1. Complete the following forms in WCAP:

   1. DSHS 18-399(X) Social Service Incorrect Payment Computation and either:

   2. DSHS 18-398(X) Client Overpayment Notice for consumer overpayments; Or

   3. DSHS 18-398(A) Vendor Overpayment Notice for licensed provider overpayments.

2. All overpayment forms are automatically sent to OFR through the Document Management System (DMS), when processed in WCAP. After the forms are saved in WCAP, they are assigned to OFR’s DMS “to-do” list. Do not send a copy of the forms to OFR by mail.

establishing an overpayment

1. The date of establishment for an overpayment is the date the required overpayment forms (see #2 from Required Forms above) are completed in WCAP and sent to OFR (via DMS).

2. Complete the Social Service Incorrect Payment Computation form, DSHS 18-399(X) and the Client Overpayment Notice, DSHS 18-398 for consumer overpayments, or the Vendor Overpayment Notice DSHS 18-398(A) for vendor overpayments. Document in the WCAP notes screen the reason and details of the overpayment.

3. The overpayment covers the dates of service and not the date the overpayment notices were completed by the department. Notification of an SSPS overpayment to the DSHS Tax Desk or Accounting Services is not necessary when a Client Overpayment Form is submitted to OFR. OFR sends this information directly to the Office of Accounting Services.

4. DO NOT forward a copy of the overpayment notices to the consumer or to the vendor/provider. OFR will forward overpayment notices via certified mail. The forms will be sent to OFR through DMS when they are saved in WCAP.

overpayment disputes

1. If a consumer or provider objects to the department's overpayment decision, they may file a fair hearing request per WAC 388-290-0260.

2. Overpayment disputes resulting from PRP overpayments are handled by PRP. Refer the consumer or provider to the number on their overpayment notice.

Editing overpayments

Once an overpayment is saved it is an established overpayment and receives an overpayment tracking number on the bottom right of the forms. This tracking number identifies one overpayment from another. To correct a previously established overpayment:

• Access the original overpayment from the WCAP edit overpayment option, be sure the box for modifications is checked on the overpayment notice (found on the top left of the notice).

• Edit both the computation form and the notice if needed. On the overpayment forms, clearly state the reason for the modification whether it is a change in dates, amount, reason, removal of the entire overpayment, etc.

• Resend the forms to OFR through DMS by using the Save/Print/DMS button.

• Document the reasons for the changes in the WCAP notes screen.

The modified overpayment forms retain the same overpayment tracking number from the original overpayment. OFR can track the overpayments and subsequent modifications with this number. Once an overpayment is saved, it cannot be deleted from WCAP or removed from DMS. It can only be modified.