825-5.1 Rules and Facts That Apply to Overpayments and Understatements of Liability

Effective Date: July 1, 2022

1. Use the rules in effect for each month of the overpayment period to calculate the amount of the overpayment or understatement of liability.

2. Use the facts of the case, as they existed and would have been used in each month of the overpayment period, to calculate the amount of the overpayment or understatement of liability.

3. An overpayment should be referred at the point it is discovered. There is a 3-year statute of limitations on the collection of any overpayment.

a. Overpayments will not be adjudicated and collected on from periods older than 3 years prior to the date the Notice of Agency Action (NAA) is mailed to the member.

b. The overpayment worker will determine which part of the overpayment does not exceed that time frame.

Example –

Member’s overpayment dates from March 2010 to March 2016

The overpayment worker sends the NAA on January 26, 2022 to cover this overpayment period.

Based on the mail date, the 3-year statute of limitations for the overpayment consists of January 2019 through the current date.

Because the overpayment period falls outside the statute of limitations period, we cannot collect anything on this.

Example –

Member’s overpayment dates from March 2014 to March 2020

The overpayment worker sends the NAA on January 26, 2022 to cover this overpayment period.

Based on the mail date, the 3-year statute of limitations period for overpayment consists of January 2019 through today.

The overpayment period consists of any overpayment amount accrued from January 2019 to March 2020. March 2014 through December 2018 are outside the Statute of Limitations and are not allowed.

Example –

Member’s overpayment dates from March 2019 to January 2022

The overpayment worker sends the NAA on January 26, 2022 to cover this overpayment period.

Based on the mail date, the 3-year statute of limitations period for overpayment consists of January 2019 through today.

The overpayment for March 2019 to January of 2022 can be collected because it is within the statute of limitations period.