County of San Diego Health and Human Services Agency HHSA CalWORKs Program Guide Employment Services Supportive Service Overpayments and Underpayments Number Page 44350L 1 of 2 EffectiveRevision Date July 22 2016 Background State regulations EAS 42751 427652 47440 require taking all reasonable steps necessary to promptly correct any overpayment or underpayment of supportive services payments to a recipient or a service provider including but not limited to all cases involving fraud and abuse Policy 44350L1 Supportive Services Overpayments A supportive service overpayment occurs in the following instances Payments issued for which customer is not eligible Payments issued for a month following the month in which a participant is no longer meeting satisfactory participation Fraud overpayment determination Participant fails to provide required documentation to verify an advanced payment Payment issued for child care services for a time period outside of approved effective dates times and hours Payment issued to a child care provider for services that were not provided 44350L2 Suspected Fraud Overpayments When fraud is suspected coordinate with the eligibility worker to initiate a referral to the Public Assistance Fraud Division PAFD 44350L3 Employment Services Case Closures with Outstanding or Deferred Claims When an Employment Services case closes with existing overpayment or deferred claim send the WTW 12 and WTW 13 for each established claim 44350L4 Underpayments An underpayment occurs when a payment issued to a participant is less than the amount to which heshe is entitled When an underpayment occurs Complete and send the WTW 11 to the participant Issue a supplemental payment for the appropriate amount Send a supportive services approval NOA with the supplemental payment amount Narrate in Case Comments all actions taken County of San Diego Health and Human Services Agency HHSA CalWORKs Program Guide Employment Services Supportive Service Overpayments and Underpayments Number Page 44350L 2 of 2 Procedures Employment Services staff corrects data previously entered into CalWIN following How To 263A Employment Services staff send an encrypted email to the County with the following information o Case name o Case number o Participants name o Liable individuals information o Type of supportive services issued o Date of discovery o Cause of potential overpayment o Amount of potential overpayment o Period of potential overpayment From and Through Date o Attach any supportive documents when appropriate o Name and phone of the WTWCalLearn staff submitting the referral The County evaluates the actions taken by Employment Services staff If appropriate authorizes changes and establish the overpayment sends required notices and enters case comments into CalWIN A separate overpayment computation and referral must be made when there is more than one type of overpayment or there is more than one overpaid payee References EAS 42751 httpwwwdsscahwnetgovordentresgetinfopdf7EASpdf EAS 427652 httpwwwdsscahwnetgovordentresgetinfopdf8EASpdf EAS 47440 httpwwwdsscahwnetgovordentresgetinfopdf15EASpdf Sunset Date This policy will be reviewed for continuance by July 31 2019 Approval for Release Alberto Banuelos Assistant Director Eligibility Operations