Texas

What do I do?

Authored By: Partnership for Legal Access
Contents
Information

Information

WHAT DO I DO IF TxHHSC SAYS I RECEIVED AN OVERPAYMENT OR THAT I COMMITTED FRAUD?

vOverpayment decisions byTxHHSCare very serious. Seek legal advice immediately ifTxHHSCsays that you received an overpayment.

vThere are several ways that you may learn that TxHHSC believes you received an overpayment and/or committed fraud:

ØForms that TxHHSC might send to you:

§Notice of Benefit Denial or Reduction (Form 1017) - gives notice of decision and informs you about your right to fair hearing at time of determination of overpayment.

§Notice of Administrative Disqualification Hearing (Form H4851) - gives notice that a hearing is scheduled to determine:

·Whether you received an overpayment of benefits, and

·If you did receive an overpayment of benefits, was the overpayment due to an Intentional Program Violation (IPV), Inadvertent Client Error (an unintentional action by you), or Agency Error (a mistake by TxHHSC not caused by you)

§Notice of Food Stamps Overpayment Claim (OIG Form 5034) - gives you notice that TxHHSC believes that you received an overpayment and requests that your repay a certain amount. It gives you the option to:

·Enter into a repayment, or

·File an appeal and request a Fair Hearing.

§TxHHSC / IRS Recoupment letter - a letter from TxHHSC stating that you must make payment arrangements or TxHHSC will ask the Internal Revenue Service (IRS) to withhold your income tax return to pay back the overpayment.

§TxHHSC Office of Program Integrity - Investigation Letter

ØMeeting with an investigator from TxHHSC Office of Inspector General (OIG) - you may either be called to set a meeting with a TxHHSC investigator or an investigator goes to your home.

§The investigator will ask you to sign a form which waives your right to have an attorney present during the meeting. You should request that the meeting be postponed to another day so that you may have a legal representative present during the meeting.

§If you chose to go forward with the meeting, the investigator will most likely ask you to complete a form in your own handwriting about how and why the overpayment occurred. This form can and will be used against you to prove that you received an overpayment. It can and will be used if TxHHSC chooses to have you criminally prosecuted for the overpayment.

§Anything that you tell the investigator during the meeting can and will be used against you to prove that you received an overpayment and possibly to prove that you committed a crime.

ØIf the overpayment case is still in administrative proceedings and has not been referred for criminal prosecution, you can request an "Administrative Disqualification Hearing"

§This hearing is to decide whether the overpayment occurred

§You should receive WRITTEN NOTICE of when and where the hearing will be held.

§You have a right to review your caseworker's file, as well as to get a copy of the hearing officer's file to prepare for you the Administrative Disqualification Hearing. Contact your hearing officer to request copies of these documents.

§At the Administrative Disqualification Hearing:

·You will have a chance to explain why the decision is wrong.

·The case worker gets to explain why the decision is correct.

·You can question the case worker and witnesses.

·You should bring your own witnesses with you, if you have any.

·The hearing officer (judge) can question you, the witnesses, and the caseworker.

·You have the right to an interpreter during the hearing.

·You have the right to a legal representative to assist you in your appeal.

·You can have a legal representative present during the hearing.

·Your legal representative does not have to be an attorney.

·You may contact your local legal aid organization to request free legal representation at the Administrative Disqualification Hearing.

·You have the right to receive a written decision regarding the outcome of your appeal.

§If the overpayment did occur, did it occur due to

·an Intentional Program Violation (IPV) - a deliberate act by you so that you would receive more benefits than you were eligible to receive;

·you made an "inadvertent error" or unintentional mistake that result in your receipt of benefits that you were not eligible to receive; or

·TxHHSC made an agency error that resulted in an overpayment.

§If there is a determination at hearing that you committed an IPV:

·The head of household will be disqualified from benefits for at least 12 months,

·The children in the household may still be eligible to receive Food Stamps, and

·You will have to repay the overpayment to TxHHSC

§If there is a determination at hearing that you did not commit an IPV, but an overpayment did occur due to an inadvertent error by you or an agency error

·You will not be disqualified from receiving benefits, and

·You will have to repay the overpayment.

¨If you continue to receive Food Stamps, a small portion of your Food Stamps will be withheld monthly until the overpayment is paid back, or

¨If you do not presently receive Food Stamps, you will need to enter into a plan to pay back the amount of the overpayment.

§If there is a determination at hearing that you did not receive an overpayment, there will be no interruption in your Food Stamps and there is no amount to repay.

ØFrom the Criminal Court system:

§Letterfrom District or County Attorney's Office - you should seek legal representation to advise you regarding this type of letter

§"Request For Summons" from the District or County Clerk's Office - this letter is a notice which requires you to go before a judge on a certain date.

·You must appear on the date given to you.

·You may take an attorney if you can afford to hire one.

·You will most likely go through the process of being formally arrested and a bond being set for your release.

·Failure to go to court on the date given to you will result in a warrant being issued for your arrest

§Criminal Indictment - this letter is from the District or County Clerk's Office and states that you have formally been charged with a crime (usually felony theft)

·You must go before a judge on the date given in the cover letter - it is the date of your arraignment

·You will have to tell the court whether you will plea "guilty" or "not guilty"

·If you can afford to, you should hire an attorney to go with you to court

·If you cannot afford to hire a private attorney, you should request that the judge appoint you a criminal attorney to represent you

·Failure to go to court on the date given to you will result in a warrant being issued for your arrest

vTo determine the existence of fraud, TxHHSC must establish certain facts:

ØThe individual must deliberately misstate or conceal information.

ØThe individual must be misstating or concealing information to obtain assistance to which the individual is not entitled, or a greater amount of assistance than the individual is entitled to receive.

vThe department may use the following criteria to identify cases which may involve fraud:

ØThe individual must misrepresent information that is considered a concealment of facts.

ØThe individual must misrepresent information that is material to the overissuance or receipt of assistance to which the individual is not entitled.

ØThe individual must present information that is untrue, and the individual must know or believe it to be untrue.

ØThe individual must present information with the intent of influencing the worker in the determination of program eligibility or total amount of assistance received.

ØThe worker to whom the information is presented must believe and rely on it and have the right to do so.

ØThe worker must act on the information, and his action result in a loss to the program.