112-10        CLAIMS UNIT ROLE

The Claims Specialist establishes claims and collects all program losses from clients who received more benefits than they were entitled.  This includes maintaining records and collecting IPV Intentional Program Violation overpayments for Temporary Assistance, Food Stamps, Adult Public Assistance, and Medicaid.  See the Administrative Manual section 111 for more information on processing claims.

112-10 A.   DISQUALIFIED INDIVIDUAL FOR IPV Intentional Program Violation

The Claims Specialist receives from:

• The Fraud Control Unit, the signed disqualification hearing waivers
   

• The Office of Hearings and Appeals section, the administrative disqualification hearing decisions
   

• The Department of Law’s Welfare Fraud Section, the notification of convictions on welfare fraud

If the Food Stamp or Alaska Temporary Assistance case is currently open, the Claims Specialist sends a Disqualification Penalty for Intentional Program Violation form and a copy of the signed waiver, disqualification hearing decision or notice of conviction to the current caseworker.  This form advises the caseworker to initiate the disqualification period.  The form states when the penalty begins, how long it will last, and which EIS Eligibility Information System notice to send.

112-10 B.   ESTABLISHING AND COLLECTING FRAUD CLAIMS

The Claims Specialist establishes a claim on EIS Eligibility Information System and initiates reduction of benefits when the case is open.  The Claims Specialist pursues repayment and accounts for all payments received on active fraud claims until the overpayments are paid in full.

The most common method of repayment of fraud claims is monthly benefit reduction of current benefits.  Assignment of Permanent Fund Dividends, promissory notes, offsetting federal income tax refunds through the Treasury Offset Program (TOP Treasury Offset Program), and direct monthly payments from the client are other methods of recovering fraud-related overpayments.

The Claims Specialist sends notices to clients making direct payments whenever a payment is received, or if they become delinquent in their payments.  Clients who fail to meet the terms of their repayment agreements may be referred to the Department of Law to have their probation revoked.  The Claims Specialist also garnishees Permanent Fund Dividends to collect delinquent overpayment debts.