Overpayment Process Training October 2008

Welcome to the Overpayment Process Training Consistency, transparency, and the application of administrative fairness are key components of all ministry decisions and communication with clients. The information contained in this training is intended for Ministry staff to enhance their understanding of the overpayment process.

At the end of this training you will be able to: describe the overpayment process, explain the principles of Administrative Fairness and how they apply to the overpayment process; and discuss related legal authorities.

This flowchart outlines the Overpayment Process for staff. The overarching principles guiding the process of determining and actioning overpayments are Administrative Fairness and our Legal Authorities.

Administrative Fairness Refers to a set of legal principles that courts will apply to the exercise of public powers. Under this process clients have a right to: know the reasons for a decision that affects them know the case against them have an opportunity to reply have an unbiased decision maker have the person hearing the case decide the case Ministry staff apply these principles when making a decision related to a client’s eligibility for assistance and to all activities leading to the decision.

Administrative Fairness (continued) When making a decision, the ministry provides the client: the substantive reasons for making the decision the regulatory basis for the decision an opportunity to respond to the information and provide their own evidence regarding the decision The ministry also offers the client a copy of all available information on which the decision was based, the right to reconsideration and appeal, and assists the client with the reconsideration and appeal process.

Legal Authority Ministry staff operate under the authority of the Employment and Assistance (EA) Act and the Employment and Assistance for Persons with Disabilities (EAPWD) Act. The ministry is authorized to obtain and verify client information under Section 10 of these Acts. The ministry obtains the consent of the individual prior to any collection of their information, and before any third party check is done. The client provides consent for the ministry to obtain information by signing the HSD80 form (Application for Assistance) at intake and at re-application interviews.

Legal Authority (continued) Under section 10 staff may perform reviews or audits that relate to eligibility of the client. The collection, use and disclosure of information under the Acts is governed by the following: Freedom of Information and Protection of Privacy Act (FOIPPA) Provisions of any applicable Memorandum of Understanding (MOU) or Information Sharing Agreement (ISA) entered into by the ministry Information and Communications Technology Resource Usage Policy/Agreement

Legal Authority (continued) The following two slides quote the relevant portions of Section 10 of the Employment and Assistance Act. Section 10 of the Employment and Assistance for Persons with Disabilities Act is identical, except that the term “Income Assistance” is replaced with “Disability Assistance”. Omitted sections [(1) (a), (c) and (d); (3); and (5)] relate to the application process, employability skills and employment plans. These are not relevant to the overpayment process.

Employment and Assistance Act - Section 10 Information and Verification  (1)  For the purposes of: (b) determining or auditing eligibility for income assistance, hardship assistance or a supplement The minister may do one or more of the following: (e) direct… a recipient to supply the minister with information within the time and in the manner specified by the minister; (f)  seek verification of any information supplied to the minister by… a recipient; (g) direct… a recipient to supply verification of any information he or she supplied to the minister.

Employment and Assistance Act Section 10 (continued) (2) The minister may direct… a recipient to supply verification of information received by the minister if that information relates to the eligibility of the family unit for income assistance, hardship assistance or a supplement. (4)  If… a recipient fails to comply with a direction under this section, the minister may declare the family unit ineligible for income assistance, hardship assistance or a supplement for the prescribed period.

Section 10 – Permitted Actions Under the regulation, staff may: direct a client to provide verification of information they have provided or that the ministry has received from another source contact a third party directly to verify information provided by the client declare that a client who does not comply with a direction to provide verification of information is not eligible for assistance until they comply. The decision to declare the client ineligible for failure to comply with a direction under Section 10 is discretionary. Currently, the ministry only applies this sanction if the direction to provide verification of information relates to present eligibility.

Section 10 Matrix

Potential Overpayment Identified Staff may identify that a client has potentially received an overpayment through conducting file reviews, responding to fraud allegations, and/or reviewing various data matches. Overpayments may occur as a result of client error (intentional or unintentional) or ministry error. Potential overpayments involving a duration of three months or longer must be referred to PLMS.

Information Gathering / Data Collection Staff gather information and collect data by: Reviewing and verifying information previously provided by the client Contacting clients to request additional information and to inform the client why the information is being requested Conducting Third Party Checks and data matches

Review and Assessment Staff conduct a review and assessment of a potential overpayment by: Analyzing the information provided by the client compared to other information collected by the ministry, identifying discrepancies or inconsistencies Contacting the client and giving him/her the opportunity to respond to discrepancies or inconsistencies, to discuss the situation, and to provide clarification. The client may provide additional information (for instance, utility bills to demonstrate shelter costs) that will clarify his or her eligibility. Determining if an overpayment has occurred, the nature of the overpayment and the appropriate course of action

No Overpayment Determined Staff complete the following when no overpayment has been determined: Compile and file the information collected Document that there was no overpayment identified

Overpayment Determined If a client received assistance for which he or she was not eligible, an overpayment has occurred. If an overpayment is determined, staff explain the overpayment to the client, how it occurred, and ensure the client understands his or her responsibilities and rights (including reconsideration & appeal).

Debt Calculation Overpayments are calculated by comparing the assistance a client received to the amount for which the client was eligible. Under the EA Act section 27 and the EAPWD Act section 18, clients are liable to repay amounts they received for which they were not eligible. Ministry staff use the Overpayment Calculator (OPC) online systems tool to calculate debt and to ensure accuracy of calculations and consistent application of the regulations. The calculation must be recorded and substantiated with supporting documentation. The client is notified in writing of the overpayment.

Notification of Overpayment Ministry staff complete the following when notifying a client of an overpayment: Send a Notification of Overpayment letter (HSD3092) Contact the client to: Discuss the overpayment & provide the opportunity to respond Explain the overpayment calculation, the rationale (the substantive reasons for the decision), and the supporting documentation (for example, the OPC chart). Explain the overpayment is a debt to the government, and the recovery process Offer the client the right to reconsider, explain the process, and provide a Reconsideration and Appeals brochure. Record the details on the client’s file

Sanctions (Discretionary) The EA Act Section 15.1 and the EAPWD Act Section 14.1 set out sanctions that may be applied if an overpayment results from inaccurate or incomplete reporting by the client. If an overpayment has been confirmed, staff must determine if a sanction for inaccurate or incomplete reporting is to be applied. The decision to apply this sanction is discretionary. The sanction, if applied, is a reduction of $25 in assistance for: Three calendar months for the first occurrence, Six calendar months for the second occurrence, and Twelve calendar months for the third or subsequent occurrences.

Sanctions (continued) When assessing whether to apply a sanction for inaccurate or incomplete reporting, staff are to use discretion, based on the circumstances. Staff should consider: Are there legitimate mitigating circumstances that resulted in the client not having accurate or complete information on the reporting date - for instance, delayed bank statements? Does the client’s mental health prevent accurate and complete reporting? Does imposing the sanction serve the intended purpose of encouraging accurate reporting in the future; for example, did the situation occur in the past and has the client, since then, provided accurate and complete reports?

Sanctions (continued) If a sanction for inaccurate or incomplete reporting is applied, staff must contact the client and provide him/her an opportunity to respond, advise the client that he/she may request a reconsideration of the decision, provide a Reconsideration and Appeals brochure, and assist the client with the reconsideration process.

This concludes the Overpayment Process training Thank you Please contact your local IO for further support Thank you