AUTHORITY
Income and Employment Supports Act (IESA), Parts 6 and 9
Income Support, Training and Health Benefits (ISTHB) Regulation, section 99
Recovery Regulation

INTENT
To outline the overpayment process from the initial identification of a potential overpayment to the debt notification.

POLICY
Processing an overpayment involves three phases with multiple steps. A comprehensive understanding of all program policies is required to ensure they are accurately applied throughout the process. The following chart outlines the three phases of the process and who is responsible for each step.

Phases	Responsibility
1. Identifying an Overpayment
Identifying a potential overpayment	Front Line Worker
Calculating an overpayment	Overpayment Worker
2. Overpayment Decisions
Assessing an overpayment	Delegated Authority
Determining the requirement to repay	Delegated Authority
Notifying the client	Delegated Authority
3. Becoming a Debt Due
Convert to a permanent debt	Overpayment Worker

 

Phase 1 - Identifying an Overpayment

An overpayment occurs when a client:

• Received benefits to which they were not entitled due to non-disclosure of material fact, false representation, error or any other reason, or
• Did not use a benefit, supplemental benefit, health benefit, training benefit, for its intended purpose.

 

A potential overpayment should be assessed within a timely manner from the date it was discovered. If a potential overpayment is identified, but there is in insufficient information to calculate the overpayment, the client is responsible for providing additional information as described in the eligibility impacts policy. An overpayment is calculated using the Recoveries System.

Note

The client's ongoing eligibility must also be reviewed at this time.

 All medical benefits issued are included in overpayments that are the result of Total Ineligibility.

Overpayments as a Result of a Retroactive Payments is applied when a client receives retroactive income that would have otherwise been received as periodic payments.

This overpayment process is not followed for the following circumstances:

• Repayment agreements and court orders for repayment (i.e. restitution) become a permanent debt due immediately and do not follow this overpayment process.
• Sponsorship defaults are entered into the Recoveries System by Treasury Board and Finance once the sponsor brings in their default notification letter and do not follow this overpayment process.

 

The rates and policies in effect at the time the overpayment was incurred must be used.

Earnings exemptions are not provided if the client intentionally did not report income, or intentionally reported a lesser amount than they received. If the client had no intent to mislead Seniors, Community and Social Services (SCSS), an earnings exemption is provided against the unreported income.

All overpayments resulting from the Canada Emergency Response Benefit (CERB) and Canada Response Benefit (CRB) issued during the COVID 19 pandemic require full repayment and all levels have the delegated authority to make these overpayment decisions while following an abbreviated process where only one letter is sent.

Phase 2 - Overpayment Decisions

The delegated authority makes two concurrent decisions:

• assessing an overpayment, and
• determining the requirement to repay an assessed overpayment.

 

The director’s authority to assess and exempt or require the repayment of an assessed overpayment is described in the Delegated Authority for Overpayment Decisions policy and is subject to review by an Appeal Panel.

If fraud or wilful misrepresentation is suspected, the overpayment process stops until an Investigation is considered, regardless of the dollar value. If a Request for Investigation (RFI) is not accepted, the overpayment process may proceed with an explanation of why the RFI was not accepted and documented in Compass comments. This does not mean there is no wilful misrepresentation or fraud suspected, only that an investigation will not be pursued.

Provided there are no grounds to suspect fraud or wilful misrepresentation, the director has delegated the authority to program staff to not assess an overpayment in the following circumstances:

• the value is determined to be less than $50 for each Period of Assistance (POA) to a maximum value of $1,000, or
• the time elapsed is greater than three years from when the overpayment occurred (in its entirety) and the date it is discovered.

Note

In general, new overpayments are not assessed against deceased clients. These overpayments are reviewed on a case-by-case basis, to determine if an overpayment should be established. For assistance with these cases refer to Communicating with Delivery Supports.

If it is determined that an overpayment should not be assessed, COMPASS comments are required to indicate that a potential overpayment was identified and the reason the overpayment is not being assessed.

The delegated authority for overpayment decisions is responsible for communicating their decisions to the client by issuing a Notice of Assessed Overpayment Letter (EMP 12202, EMP 12209, or EMP 12210).

Note

A client may choose to agree to a Voluntary Repayment of an Overpayment at any stage of the process.

Phase 3 – Becoming a Debt Due

Within 30 days of receiving a Notice of Assessed Overpayment letter (EMP 12202, EMP 12209, or EMP 12210), the assessed overpayment is identified as a temporary debt in the Recoveries System and is not yet considered a debt due to the Government. At this stage the client may appeal one or both of the decisions as described in the Notice of Decision policy.

If the client provides additional information that impacts the calculation or understanding of the circumstances leading to the overpayment, the delegated authority who made the original decisions reviews the information and determines if this information changes their original decisions.

An assessed overpayment remains a temporary debt in the Recoveries System until:

• the appeal period has elapsed,
• the appeal has been disposed of by the Appeal Panel,
• the appeal panel upholds the Ministry’s decision, or
• the appeal has been determined to be abandoned by the Appeal Panel.

 

Once the above scenarios have passed and the temporary debt is converted to a permanent debt in the Recoveries System, the collection on active files commences automatically through monthly deductions. The Recovery of Debts policy describes the recovery rate and circumstances to consider for adjusting the rate of recovery.

Any portion of an outstanding debt for closed or active files can be paid at an Alberta Supports Centre. SCSS Financial Operations is responsible for the management of debts on closed files as well as the collection of these debts through Treasury Board and Finance and/or contracted agencies.

 

PROCEDURES
The Provincial Overpayment Tracker is designed to monitor the entire overpayment process including the initial identification of a potential overpayment, the overpayment decisions and when it converts to a debt due. The information collected is used for reporting and oversight of all overpayments. This tracker and Compass must be updated throughout the process with copies of letters and forms used being saved to the client’s file.

Phase 1 - Identifying an Overpayment

The front line worker at the program delivery site who identified a potential overpayment:

1. Collects information needed from the client to confirm details using the optional Notice of Potential Overpayment Request for Information Letter (EMP13447) as required.

2. Refers the potential overpayment to the overpayment team, or

3. Completes a Request for Investigation (EMP 0037) as described in the Investigations policy, if fraud or wilful misrepresentation is suspected.

Note
Only if the EMP0037 is not accepted does the overpayment get referred to the overpayment team.

The worker assigned to calculate the overpayment:

4. Identifies the POA(s) impacted and calculates the overpayment using the Recoveries System. The Budget Reconciliation (DS12146) form may be used to assist with the calculation.

5. Issues the Notice of Potential Overpayment – Request for Information letter (EMP12201) with the Overpayment Notice from the Recoveries System attached.

6. Revises the Overpayment Notice as required, if the client responds with additional information that requires changes to the calculation.

Note
The Overpayment Notice explains the reason for the overpayment and must contain language a client can understand. Acronyms should be avoided. The calculation and comment section should include the values referenced and where they came from if applicable.

Income Services Investigation Unit (ISIU) Operational Supports processes overpayments that result from Requests for Investigation (RFI) referrals accepted by the ISIU.

Phase 2 - Overpayment Decisions

Once 30 days has passed since the Notice of Potential Overpayment – Request for Information letter (EMP12201) was issued or when the client provides a response, the worker assigned to calculate the overpayment:

7. Completes Section 1, 2, 3 and 4 of the Request for Decisions Regarding Calculated Overpayment (DS12200) explaining the circumstances, when the overpayment was discovered and the cause of the overpayment to assist the Delegated Authority with the decisions related to the overpayment.

Note

The DS12200 must explain why the RFI was not accepted if wilful misrepresentation or fraud is suspected and include the client’s response to the EMP 12201, if applicable.

8. Moves to step 11, if the worker is delegated with the authority for the decisions or submits the DS12200 along with the required information to their supervisor for review and escalation, if required.

The supervisor:

9. Reviews Sections 1, 2, 3 and 4 of the DS12200 form to:

• ensure policy has been accurately applied,
• verify the calculation, POAs and
• review the worker’s recommendation regarding repayment.

Note

If any corrections are required, the supervisor coordinates with the worker to update the content of the DS12200 and updates the name and date at the end of Section 4 as required.

10. Moves to step 11, if the supervisor is delegated with the authority to assess the overpayment or submits the DS12200 along with the required information to the appropriate Delegated Authority (manager or the statutory director) for their review.

The respective Delegated Authority:

11. Reviews the information and documents the decisions made by completing Section 5 and 6 of the DS12200 and issues one of the Notice of Assessed Overpayment letter to the client:

• Full Repayment Required Letter (EMP12210)
• Partial Repayment Required Letter (EMP12209)
• No Repayment Required Letter (EMP12202)

 

12. Provides a copy of the completed DS12200 and Notice of Assessed Overpayment letter (EMP 12210, EMP 12209 or EMP 12202) to the worker who completed Section 1 to 4 of the DS12200 and their supervisor to ensure the decisions are recorded in the Provincial Overpayment Tracker and on the client’s file.

The worker assigned to overpayments:

13. Records the decision in Compass Comments.

14. Saves the completed DS12200 and Notice of Assessed Overpayment letter to the client’s file.

15. Updates the Provincial Overpayment Tracker to reflect the decisions made.

16. Adjusts the Overpayment Notice and enters Internal Comments in the Recoveries System to reflect the amount that must be repaid.

17. Sets a reminder to convert the temporary debt to a permanent debt after at least 30 days has passed or the other requirements have been met.

Note

If the client chooses to appeal one or both of the decisions and provides new information with an appeal submission, the new information must be shared with the Delegated Authority responsible for the original decisions. The Delegated Authority must return to step 11 and confirm or revise the initial decision by creating a revised DS12200 and issuing a revised Notice of Assessed Overpayment letter to reflect the decisions in consideration of the new information.

Phase 3 - Becoming a Debt

Once the requirements have been met to change the debt to permanent in the Recoveries System, the worker assigned to overpayments:

18. Changes the temporary debt to a permanent debt in the Recoveries System which adjusts the R Flag on the LISA system to reflect the recovery rate as described in Recovery of Debts.

19. Prints and issues the Debt Notice from the Recoveries System which includes the Statement of Debt.

Note

The Debt Notice must be printed to ensure the LISA system is updated.