Department of Health and Human Services
Departmental Appeals Board
AFDC QUALITY CONTROL REVIEW PANEL
SUBJECT: Missouri Department
of Social Services
Docket No. A-92-19
DECISION
The Missouri Department of Social Services (State)
appealed an October 9,
1991 quality control (QC) review
determination by the Regional Administrator
for the
Administration for Children and Families (Agency). The
Agency determined that the State had erroneously withheld
$23 from its
December 1990 Aid to Families with Dependent
Children (AFDC) grant to
B.A. 1/ This money was
withheld from the grant in
conjunction with the State's
efforts to recover a 1984 overpayment to
B.A. Based on
its review of the available evidence, the Agency
concluded that the State had completed recovery of the
overpayment
through withholdings from grants for previous
months prior to December
1990. Thus, the Agency
concluded, the State had improperly recouped
money from
B.A.'s December 1990.
The State argued that the Agency had failed to consider
anomalies in the
course of the recoupment which had
extended that process to December
1990. In its final
submission to the Panel, the State provided
additional
evidence which, it asserted, conclusively addressed the
Agency's concerns.
We find that the evidence in the record supports the
State's
position. Consequently, we reverse the Agency's
decision.
Background and Analysis
B.A. was overpaid $348 from February 1 through May 31,
1984. The
State first began to recoup the overpayment by
withholding $16 per grant
from B.A.'s February, March and
April 1986 grants. 2/ The
recoupment process then
lapsed until the State resumed (somewhat irregular)
collection of the balance by withholding $23 per grant
beginning in
1989.
The Federal QC review occurred in December 1990. On
August
27, 1991, the Agency issued a difference letter
which raised questions about
B.A.'s case, including
possible excessive recoupment of an
overpayment. 3/
The Agency indicated that the State's
recoupment had
continued one month longer than necessary for complete
recovery of the overpayment.
On September 18, 1991, the State asked the Agency to
reconsider the
issues raised in the difference letter.
In part, the State
indicated:
[B.A.] had been overpaid $349.00 and $23.00 was
being recouped for
a period of 15 months. 4/
(23 x 15 = $345.00) This
recoupment began in
July 1989 and should have ended in October 1990.
However, the IPAY verifies that during this period,
. . . [B.A.]
received 3 checks on supplemental
payrolls where the recoupment was not
withheld.
(August, 1989, October, 1989, January, 1990). This
extended the period of recoupment to encompass the
December, 1990 review
date. 5/
In its October 9, 1991 QC determination, the Agency noted
that the
recoupment began in February 1986. The Agency
itemized the State's
recovery to show: $48 recovered in
1986; $115 recovered in 1989; and
$230 recovered in
1990. 6/ Thus, according to the Agency,
$393 had been
recouped on a $348 overpayment (a difference of $45).
The Agency also noted that a January 16, 1991 Inter-
Office Communication
to the State's Deputy Director of
Income Maintenance stated that the
assistance unit had
been underpaid $45 and a refund was due. In view
of its
calculations and evidence the Agency found error in the
$23
recovery for December 1990.
On appeal to this Panel, the State challenged the
Agency's
findings. The State asserted, first, that there
was no recoupment from
the March 1989 grant. Second, the
State asserted that the grant check
issued in June 1990
had been returned to the State and not reissued.
The
State argued that, even though the State's OVPT showed
recoupment
from the June 1990 grant, recoupment could not
have occurred since that
check was never reissued. Thus,
the State alleged that, as of December
1, 1990, it had
collected only $347 of the $348 overpayment from B.A.
The State asserted that the $45 excess recoupment cited
by the Agency
was therefore comprised of the $23 which
had been credited for June 1990,
but never collected, and
a $22 over-collection for December 1990 ($23
automatic
deduction from grant minus $1 balance on overpayment).
The State took the position that, although it recouped
more than the
amount of the overpayment to B.A., there
was no error because there was
still some amount ($1) to
be recouped in the December review month.
In response, the Agency asserted that the State's
calculations of the
recoupment period were inconsistent
and incorrect. Citing the State's
September 18, 1991
request for reconsideration, the Agency asserted that the
State had initially contended that recoupment began in
July 1989.
However, the Agency noted that the State's
appeal to this Panel acknowledged
the $48 recouped in
1986. The Agency also cited documents in the
record
identified as IM-5s. 7/ The Agency noted that the
State relied on IM-5s to prove the 1986 recoupments, even
though the
IPAY did not show them. Thus, the Agency
asserted that the State could
not properly ignore another
IM-5 in the file which showed a $23 recoupment
for
March 1989.
In spite of the conflicting evidence which it cited, the
Agency
summarized this case as follows --
[T]here is . . . only one key issue: was $23
recouped in
March 1989? If so, the $23 recouped in
December 1990 was incorrect and
represents an
underpayment. If not, the December 1990 recoupment
was proper.
Id. at 1. 8/
In its reply brief, the State provided additional
evidence to support its
assertion that no money was
recouped in March 1989. 9/ The
State submitted an
IPAY, showing grant checks to and restitution withheld
from B.A. dating back to January 1988. Additionally, the
State
submitted an OVPT, showing the recoupment from
B.A., dating back to February
1986.
We find that the December 1990 recoupment was proper. As
discussed
below, the State provided persuasive evidence
that it had not recouped the
full amount of the
overpayment to B.A. as of the beginning of the review
month. There is no dispute that, if this was the case,
the State
did not err in recouping additional amounts in
the review month, even if the
recoupment exceeded the
balance of the overpayment. 10/
Both the IPAY and OVPT support the State's version of the
facts.
The IPAY shows no recoupment from B.A.'s March
1989 grant. The OVPT
lends further support to the
State's position as there is no evidence in
that printout
of repayment by B.A. for March 1989.
Although the Agency cited apparent contradictions in the
IM-5s and the
State's arguments regarding recoupment in
March 1989, we do not think that
those inconsistencies
are necessarily relevant in this case. As noted
above,
the IM-5 appears to be a local agency change of status
form. Other than the fact that the State relied on the
IM-5s to
support its assertion that some recoupment
occurred in 1986, we do not know
the specific role, if
any, these forms played in the overall recoupment
process. Consequently, there is no way to accurately
gauge the
parties' reliance on them. Moreover, the
Agency did not dispute the
State's ultimate contention
that the IPAY and the OVPT accurately reflect
the State
and B.A.'s payment/recoupment history. The IPAY and OVPT
are centrally-generated forms produced by the State's
automated payment
system. Thus, these forms are
inherently better evidence of the
State's recoupment
history involving B.A.
Additionally, the Agency's reliance on a January 1991
State Inter-Office
Communication, which noted that the
assistance unit had been underpaid $45
and a refund was
due, is not persuasive. The Agency cited the
document,
but did not explain the basis for its underlying
conclusion. However, as the State explained, the figure
referred
to there is apparently the result of a mistaken
credit for the June 1990
recoupment, which never
occurred, and the over-collection on the $1 balance
which
remained in December 1990.
Conclusion
Based on the preceding analysis, we find that the State's
recoupment from
B.A.'s December 1990 grant was correct.
Accordingly, we reverse the
Agency's determination.
_________________________
Thomas
D. Horvath
_________________________
Carolyn
Reines-Graubard
_________________________
Carmen
Cafasso
* * * Footnotes * * *
1. We identify the recipient
by her initials in
order to protect her privacy. The State QC Review
number
is 47984.
2. Under
�402(a)(22) of the Social Security Act,
an AFDC grant may be reduced to
collect "any overpayment
or underpayment of aid under the State Plan . . .
."
This statutory provision is implemented by regulation at
45
C.F.R. �233.20(a)(13)(i) (1990), which also defines
"overpayment" as a
"financial assistance payment received
by or for an assistance unit for the
payment month which
exceeds the amount for which that unit was
eligible."
3. The other
issues raised in the difference
letter were resolved in the State's favor
before the case
reached this stage.
4. While the State's reconsideration request
cited the
overpayment as $349, the parties, in their
briefing to this Panel, cited the
overpayment as $348.
Consequently, we rely on the lesser
amount.
5. The IPAY is the
transaction identification for
the automated AFDC payment system screen
which shows all
grant payments made to a client and also shows the
amounts recouped. The OVPT (discussed below) is the
State's
transaction identification for the automated
claims system screen which
shows payments made by a
client toward the balance of a claim. State
Submission
(November 19, 1991) at 1. The Agency did not challenge
the State's explanation of the role of these documents in
its
record-keeping process.
6.
The Agency indicated that its itemization was
based on documentation
enclosed in the file. Agency QC
Determination (October 9, 1991) at
2. It is unclear what
documentation this refers
to.
7. The heading "Change
of Status" "County
Office" appears at the top of the IM-5s.
Thus, they
appear to be forms used by the local QC agencies.
However, we note that neither party explained the purpose
of these
forms.
8. The itemized list
of recoupments in the
Agency's October 9, 1991 determination did not show a
June 1990 recoupment. Thus, there was no reason for the
Agency to
challenge the State's contention that there was
no recoupment for that month
because the check which
would have effected a recoupment was returned and
never
reissued.
9.
Although given an opportunity, the Agency
chose not to respond to this
evidence.
10. The State
cited section 3310 of the Agency's
Quality Control Manual for the
proposition that the
Agency could not inquire into whether the amount of the
recoupment in the review month was correct. State
Submission
(November 19, 1991) at 2.