"I Can't Pay That!": S ocial S ecurity Overpayments and - - PowerPoint PPT Presentation

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"I Can't Pay That!": S ocial S ecurity Overpayments and - - PowerPoint PPT Presentation

Nov 21, 2023 353 likes •702 views

"I Can't Pay That!": S ocial S ecurity Overpayments and Low-Income Clients Kate Lang, S enior S taff Attorney Trinh Phan, S enior S taff Attorney February 22, 2017 Justice in Aging is a national organization that uses the

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"I Can't Pay That!": S

  • cial

S ecurity Overpayments and Low-Income Clients

Kate Lang, S enior S taff Attorney

February 22, 2017

Trinh Phan, S enior S taff Attorney

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Justice in Aging is a national organization that uses the power of law to fight senior poverty by securing access to affordable health care, economic security, and the courts for older adults with limited resources. S ince 1972 we’ ve focused our efforts primarily on populations that have traditionally lacked legal protection such as women, people of color, LGBT individuals, and people with limited English proficiency.

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Today

  • Overpayments overview
  • Appealing an overpayment
  • Requesting waiver of an overpayment
  • Common problems

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Overpayments Overview

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Overpayments

  • What is an overpayment?
  • S

S A withholds funds from benefits to repay

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TITLE II (OASDI) TITLE XVI (SSI) No limit on withholding (Full monthly benefit may be withheld) Up to 10%

  • f full check ($73.50

max for 2017)

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Why?

  • Over income limit/ fluctuat ing income
  • Over resource limit
  • In-kind support and maintenance
  • Outside U.S

. for more than 30 days

  • Institutionalized for more than 30 days

(nursing home, prison)

  • Work income, S

S DI work incentive rules

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Non-disability appeal vs.

  • verpayment appeal

The example of Mrs. B:

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Looking Forward

  • NDA

Looking Back - Overpayment

VS.

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Overpayment Options

  • Appeal the overpayment
  • Request a waiver
  • Negotiate a lower repayment amount
  • Do nothing

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Appeal or Waiver?

  • Can do either or BOTH
  • Considerations:

– Appeal – subj ect to 60 + 5 day deadline – Waiver – can file at any time – When in doubt – DO BOTH

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Overpayment Appeal

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Overpayment Appeals

  • Appeal of merits (disputing fact or amount) of
  • verpayment
  • Form 561: Request for Reconsideration
  • Deadline: 60 days (plus 5 for mailing)
  • Appeal rights

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iAppeals

  • Can now file an overpayment appeal
  • nline
  • Benefit of submitting appeal online
  • Go to secure.ssa.gov/ iApplNMD/ start

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Overpayment Appeals

Effect of filing appeal on recoupment:

  • If filed within 30 days of notice, recoupment

will not start

  • If filed between 31 and 60 days of notice,

recoupment will stop

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POMS : GN 02201.011 S I 02220.017.A.4.e

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Overpayment Appeals

Title II: case review POMS GN 02201.025 Title XVI: Goldberg protections case review, informal conference, formal conference POMS S I 02220.017, S I 04020.030 Written notice of reconsideration determination

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Overpayment Waiver

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Overpayment Waiver

  • S

eparate from merits of overpayment –

not making a statement on the correctness

  • f the overpayment
  • Asking that overpayment be forgiven
  • File at any time (no deadline)

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Overpayment Waiver

Requirements:

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Without Fault Defeat purpose of the Act (Financial hardship) OR Against equity and good conscience

AND

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Overpayment Waiver Requirements

“Without Fault”

  • Term of art: “ blameless in creation of
  • verpayment”
  • Individualized, everyone’s situation is different

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POMS : GN 02250.005 S I 02260.010

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Overpayment Waiver Requirements

“Defeat the Purpose of the Act”

  • Construed as financial hardship
  • Presumed met for S

S I recipients and recipients

  • f other public assistance
  • Title II beneficiaries must do financial

development

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Overpayment Waiver Requirements

“Against Equity and Good Conscience”

  • Alternative to showing financial hardship
  • For situations where it would be unfair to

require repayment

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POMS : GN 02250.150 S I 02260.025

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Overpayment Waiver

Held v. Colvin (Filed March 2015)

  • EM-16013 REV 2: presume waiver has been requested
  • Presume waiver should be granted on the basis of

“ without fault” and “ against equity and good conscience”

  • Local offices do not have authority to deny waiver; any

denial must first be reviewed by S S A ’s Central Office

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Overpayment Waiver

Procedural Steps:

  • 1. File Request for Waiver (Form 632)
  • 2. Request that S

S A cease recoupment pending waiver

  • 3. Right to personal conference before waiver

denied

  • 4. Right to written decision
  • 5. Full appeal rights if denied

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Administrative Waiver

Administrative waiver of overpayments $1,000.00 or less

  • POMS

S I 02260.030

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Overpayment Waiver

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POMS SI 02260.035. D – waiver rules that apply to S S I overpayments that result from excess

  • resources. Must first be found without fault.
  • 1. Overpayment is $1,000 or less
  • 2. Exceed resource limit by $50 or less
  • 3. Total overpayment is more than the

amount by which resources exceeded the resource limit

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Common Problems

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Repayment Rate

  • $10/ month withholding for those

receiving Medicare Low-Income S ubsidy (LIS ) POMS GN 02210.030. B. 6

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Overpayment Problems

  • Collection starts before notice sent, or within 60

days of notice

  • Individual disputes fact or amount, S

S A directs to file waiver

  • Even when appeal is filed, treated as waiver or

as request for payment plan

  • Appeal or waiver not logged in, not processed in

timely fashion

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Overpayment Problems (cont.)

  • Collection continues after appeal/ waiver filed
  • Cannot reach staff at Processing Center (Title II)
  • No personal conference held before waiver

denial

  • Personal conference conducted improperly -

focused on setting up payment plan instead

  • f waiver
  • No written decision on appeal or waiver

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Overpayment Problems

2014 study of 55 overpayment cases in system:

  • 35 Title II cases
  • 20 Title XVI cases
  • Not statistically significant

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Tips for Resolution

  • Persistence pays off
  • Put requests in writing and provide support

with documentation

  • Follow up with phone calls
  • Local office personnel have a lot of discretion

in deciding “ without fault” in waivers

  • Develop good working relationship with field
  • ffice staff/ supervisor
  • Get decisions in writing – must have written

notice to file appeal

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What Y

  • u Can Do

 Represent claimants on overpayment

appeals and waivers

 Request formal conferences  Do not accept improper collection

while appeal or waiver pending

 S

pread word about systemic advocacy to networks

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Additional Resources

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Regulations 20 C.F .R. §§ 404.502 – 545 (Title II) 20 C.F .R. §§ 416.550 – 590 (Title XVI) Program Operations Manual S ystem (POMS ) GN 02201.000 et seq. (Title II) S I 02201.000 et seq. (Title XVI) S S A F AQ: What can I do if I get an overpayment? https:/ / faq.ssa.gov/ link/ portal/ 34011/ 34019/ Article/ 3810/ What-can-I-do-if-I-get-an-overpayment

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Case Consultations

  • Case consultation assistance is

available for attorneys and professionals seeking more information to help older adults. Contact NCLER at NCLER@ j usticeinaging.org

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Questions?

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Kate Lang klang@ j usticeinaging.org Trinh Phan tphan@ j usticeinaging.org @ j usticeinaging