*** The Health Care Programs Manual (HCPM) has been replaced by the Minnesota Health Care Programs Eligibility Policy Manual (EPM) as of June 1, 2016. Please refer to the EPM for current health care program policy information. ***
Effective: June 1, 2011 |
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29.15.05 - Overpayment Notification and Collection |
Archived: June 1, 2016 (Previous Versions) |
Clients must receive written notice of overpayments.
Available collection methods vary according to the program, whether the overpayment is determined to be the result of fraud, and whether the person is a current enrollee.
The DHS Financial Management Division collects repayments for MinnesotaCare Operations. MinnesotaCare staff notify Financial Management of overpayments by completing and forwarding the Invoice Request Form, which is available directly from Financial Management staff.
Collections procedures vary among county agencies. Follow your agency’s procedures for informing collections staff of overpayments.
Send clients the Minnesota Health Care Programs Notice of Overpayment (DHS-4939) to notify them of the amount of the overpayment and request repayment. The notice serves to:
l Explain the reason for the overpayment.
l Show how the overpayment was computed.
l Request repayment.
l Advise enrollees that further action may be taken if payment is not made.
l Advise enrollees of their appeal rights.
Note: Use the Notice of Medical Assistance Overpayment (DHS-4600) for overpayments discovered through the IEVS Overpayment Process. DHS uses this form to track these overpayments.
Voluntary repayment is available for all health care programs and for both current and former enrollees. Each agency sets its own procedures for obtaining and collecting voluntary repayments.
l People who are subject to recovery via other methods may choose to voluntarily repay all or part of the overpayment before other methods are used.
l The agency may pursue other methods if people fail to make payments as agreed.
Civil recovery includes obtaining a judgment and pursuing repayment through methods such as garnishment or property liens.
l For MA, federally funded MinnesotaCare, and Refugee Medical Assistance (RMA), these methods are only available after a civil or criminal court judgment with a finding that benefits were incorrectly paid, with or without a finding that fraud occurred.
l For state-funded MinnesotaCare, the county agency or DHS collections may use the Judgment by Operation of Law (JOL) procedures outlined in Minnesota Statutes 256.0471.
Current enrollees are protected from civil recovery while they are enrolled and for six months after enrollment ends.
Revenue recapture allows the agency to recover overpayments in health care programs by intercepting income or property tax refunds and lottery winnings.
l Revenue recapture can be used when the individual is no longer enrolled in the Minnesota Health Care Program for which the debt is owed. Revenue recapture can be used for some current enrollees whose overpayment results from a finding of fraud based on a client waiver or an administrative or judicial determination.
l Some health care overpayments may not be recoverable through revenue recapture. Recovery of overpayments for medical care is prohibited if the person’s income was below certain limits at the time the benefits were received as specified in Minnesota Statute 270A.03.
l Counties and DHS collections submit requests for revenue recapture to the Commissioner of Revenue, who determines if revenue recapture is allowable under the Revenue Recapture Act, Minnesota Statutes 270A.
As part of the sentence for a conviction for fraud, the court may order the person to make restitution. The court may:
l Lower the previously determined overpayment amount.
l Order a monetary restitution for an amount less than the previously determined overpayment amount without reducing the total overpayment. This means that the person must pay a reduced amount as a condition of probation. The county or DHS collections may pursue repayment of the remainder of the overpayment through civil recovery or revenue recapture.
l Order restitution in addition to the previously determined overpayment amount, such as fines, penalties, and accrued interest. Any added restitution is collected and retained entirely by the court or the agency that brought the fraud charge.