B-750, Office of Inspector General OIG Responsibilities

Body

Revision 19-4; Effective October 1, 2019

All Programs

The OIG Benefits Program Integrity (BPI) department investigates allegations of recipient non-fraud overpayment and fraud. The BPI department consists of the claims investigation and field investigation units located throughout the state.

 

B—751 Office of Inspector General (OIG) Investigation Staff

Revision 19-4; Effective October 1, 2019

All Programs

OIG staff:

  • screen all types of referrals and investigate valid agency error, inadvertent household error or misunderstanding, fraud, IPV, individual or retailer EBT trafficking, and employee fraud;
  • process referrals including initiation of demand letters and establishment of claims;
  • set restitution or recoupment amounts for active Eligibility Determination Groups (EDGs);
  • respond to follow-up questions from people who receive benefits and staff about the validity of claims;
  • coordinate with Texas Works staff to process fair hearing requests related to claims establishment or collection; and
  • initiate the process to debit an EBT food account to repay a SNAP claim when the request is made.

 

Related Policy

Texas Works Responsibilities, B-740
Texas Works Action on an Inadvertent Household Error/Misunderstanding or Intentional Program Violation (IPV), B-742
Texas Works Action on Agency Errors, B-741

 

B—752 Determining Claim Amounts

Revision 15-4; Effective October 1, 2015

All Programs

OIG staff take the following steps when determining claim accounts:

  • determine the first month of overpayment (see B-752.1, Determining the First Month of Overpayment);
  • exclude any months in which the household did not receive benefits or benefits were expunged;
  • follow applicable policy in A-1300, Income, to budget the overpayment months;
  • budget each month of an overpayment by using actual income amounts received for the month (the income is not converted);

    Exceptions: OIG staff:
    • budget the income originally projected at certification/redetermination when the income does not involve a required change; and
    • budget earned income as reported quarterly to the Texas Workforce Commission (TWC) to determine the overpayment amount when all efforts to verify earned income amounts have been exhausted; allow the household the opportunity to provide verification of actual gross pay per pay period; and recompute the overpayment if the individual provides the verification. Note: For cases sent to an administrative disqualification hearing, staff must verify the employment hire date when computing an overpayment based on TWC wage information.
  • do not allow earned income deductions for any earned income that the household failed to report timely as required and this failure caused an overpayment (deductions for overpayment months caused by an agency error are allowed);
  • for excess resource overpayment EDGs, compute earned interest income to estimate an account balance for the tax year, as reported annually by the Internal Revenue Service (IRS) through the Income and Eligibility Verification System (IEVS), to determine the overpayment amount when all efforts to verify an unreported financial institution account have been exhausted; allow the household the opportunity to provide verification of the interest income and the resource; and recompute the overpayment if the individual provides the verification;
  • subtract the amount the household was entitled to receive from the amount the household actually received before recoupment;

    Exception: There is no recoupment for Medical Programs.
  • total all the monthly amounts of overpayment; and
  • when the household is due unpaid restored benefits, offset the amount to be restored against the overpayment amount and document the offset according to B-831, Procedures for Counting Restored Benefits Toward a Claim.

Related Policy

Computing Benefits by EDG Action Type, A-1357
Reporting Requirements, B-620

TANF

When a child support payment was made during the overpayment month, the total income, less the $75 disregard, is counted to determine the overpayment amount.

 

B—752.1 Determining the First Month of Overpayment

Revision 11-1; Effective January 1, 2011

 

 

B—752.1.1 Errors at Certification

Revision 11-1; Effective January 1, 2011

All Programs

The first month of overpayment is the first month the household received more benefits than it was entitled to receive.

 

B—752.1.2 Errors After Certification

Revision 15-4; Effective October 1, 2015

All Programs

The first month of overpayment for non-streamlined reporting (SR) households is the month in which the change would have been effective had it been reported and acted on in a timely manner. However, the first month of overpayment can be no later than two months from the month the change occurred. Staff may use the following chart to determine the first month of overpayment.

If a change was... then the first month of overpayment is the month that begins more than...
reported timely, 23 days after the date the change was reported. (Example: Change occurred January 5 and was reported January 10. Count 23 days to February 2. March is the first month of overpayment.)
not reported timely, 33 days after the date the change occurred. (Example: Change occurred January 5. Count 33 days to February 7. March is the first month of overpayment.)

 

Exception: The first month of overpayment may be earlier for errors caused by moves out of state. The first month of overpayment may be as early as the month after all members of the household leave the state and there is duplicate participation in that month.

Charts in C-1140, TANF and SNAP Overpayment Determination Chart, provide help for determining the first month of overpayment for both timely and untimely change reports.

 

SNAP

An overpayment does not exist on a streamlined reporting EDG unless:

  • the household fails to timely report a required change, or
  • the agency fails to timely act on a reported change.

Note: The 10-day reporting requirement for SR EDGs is from the first payment that exceeds the 130 percent Federal Poverty Income Limit (FPIL) threshold. For example, an individual receives a pay raise effective May 15. The individual's gross monthly income exceeds the 130 percent FPIL with the June 27 paycheck. The household must report the change within 10 days of June 27 to be timely.

The first month of overpayment is the month after the second month the income exceeds the 130 percent FPIL for the household size. For example, income exceeds the 130 percent FPIL on June 27 and for the month of July. August is the first month of overpayment.

 

Related Policy

Reporting Requirements, B-620

 

B—753 Establishing Claims

Revision 13-3; Effective July 1, 2013

 

 

B—753.1 Identifying Liable Members

Revision 19-4; Effective October 1, 2019

TANF, One-Time TANF (OTTANF), and One-Time Grandparent Payments

The liable household members responsible for repayment of a claim are determined in the following order:

  • Caretaker or payee.
  • Second parent or step-parent who was an adult household member at the time of the overpayment.

SNAP

The liable household member responsible for repayment of a claim is determined in the following order:

  • The head of household.
  • Any household member who was an adult at the time of overpayment.

TANF and SNAP

An authorized representative (AR) is liable for paying a claim when the AR causes an overpayment or traffics in SNAP benefits.

Sponsors and eligible aliens are jointly liable for overpayments resulting from incorrect information provided by the sponsor unless the sponsor:

  • can show good cause,
  • can show the eligible alien or sponsor was not at fault for the error, or
  • receives benefits in the same program in which the overpayment occurred.

The sponsor, alien, or both may appeal the amount or fault of an overpayment.

 

B—753.2 Demand Notices

Revision 19-4; Effective October 1, 2019

TANF and SNAP

OIG staff send either Form OIG 5034, Notice of SNAP Overpayment Claim, or Form OIG 5039, Notice of TANF Overpayment Claim or both, along with Form OIG 5027, Repayment Agreement, to the household.

To be timely, OIG staff must send the notice no later than 180 calendar days from the date the investigation was created in the Automated System for Office of Inspector General (ASOIG).

When the case involves an alien with a sponsor, OIG staff send separate demand notices to the alien and the alien’s sponsor. The demand notice informs the sponsor that the sponsor is not responsible for the person when:

  • the sponsor has good cause for the error;
  • is not at fault; or
  • receives benefits in the same program that the alien’s overpayment occurred.

Note: Calls about overpayment demand notices are referred to the local OIG unit for clearance.  Local office contacts can be found by clicking on this link: OIG Facilities Local Office Contacts.

After navigating to the website, click on “OIG Facilities Local Office Contacts” on the right side of the page.

 

B—753.3 Claim Disposition

Revision 19-4; Effective October 1, 2019

TANF and SNAP

OIG staff mail a household a repayment agreement notice and an overpayment claim notice. A claim in the Accounts Receivable Tracking System (ARTS) is then established the same date of the notice.

The claim notice provides:

  • an explanation of how the overpayment claim amount was calculated;
  • repayment options (either restitution or recoupment); and
  • information about the person’s right to request a fair hearing within 90 days of the effective date of claim notice.

The person indicates whether they prefer to repay the claim by restitution or recoupment on the repayment agreement notice and must return the agreement within 30 days of receipt.  

Repayment of the claim is delayed only when the person requests a fair hearing.