Fair Hearings: Fair Hearings and Overpayment Claims

Fair Hearing requests will often be sent to the county office of record for a case. If the overpayment being appealed was submitted / written by an employee at the county office, it is the responsibility of that employee (or another designated county office employee) to complete the hearing summary (Form 13MP002E, H-1-A) and represent DHS at the hearing. Someone will need to be available at the county office to help the client as necessary with their end of the teleconference (setting up the phone etc., to ensure the client can successfully participate in the hearing.) Preferably the assistance would be from administrative staff so that there isn’t an additional implied or literal eligibility opinion provided in the hearing.

If the overpayment being appealed was submitted / written by an employee at the support center, it is the responsibility of that employee (or another designated support center employee) to complete the hearing summary and represent DHS at the hearing.   Support Center staff will connect telephonically to the Hearing Officer and the client for the hearing.

If benefits are being recouped from any currently active case, please notify Benefit Integrity and Recovery (BIR) so all collection activity, including recoupment, can be suspended until the fair hearing decision has been made.

Some fair hearing decisions have rescinded entire overpayments because the agency did not provide adequate documentation and/or detail in the hearing summary to support the overpayment claim. This information is vital in the event a client requests a hearing. County staff should keep a copy of all documentation in the case record as well as sending the information to BIR for a final determination. In some situations, including Office of Inspector General (OIG) investigations, BIR will maintain the case materials and DHS staff can request documentation needed to complete the hearing summary. Documents will be faxed or emailed upon request and can be obtained from BIR by emailing overpayments@okdhs.org or calling 405-522-0933. We encourage counties to ask for this information and have recently noticed the importance hearing officers have placed on documentation / verification and details such as ensuring paid Medicaid bills are available for viewing, along with verification that the Medicaid client ID number match the IMS name and other items. The client must be given copies of all information the agency will utilize during the fair hearing so make sure copies of everything are mailed to the client along with the hearing summary.

Note: The client must receive the copies of the information and hearing summary at least 5 business days prior to the date of hearing.

The OIG may initiate an Administrative Disqualification Hearing (ADH) to determine if a SNAP claim can be classified as an Intentional Program Violation (IPV). This ADH Hearing is NOT the same thing as a Fair Hearing and county or support staff has no responsibility in this type of hearing. BIR will apply any penalties or disqualifications resulting from an ADH hearing.

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