Medicaid Overpayment

The Department was allowed to seek payment recovery from the petitioner when the petitioner’s total income exceeded the limit of $2,022 for a one-person household and there was no Qualified Income Trusts established. Because there was no QIT established, the petitioner was not eligible for ICP benefits and the hearing officer concluded that an overpayment in the ICP Medicaid program. Fla. Admin. Code 65A-1.701, 65A-1.702(15) Fla. Stat. 414.4111F-8098

The Department’s action to establish an overpayment of ICP Medicaid benefits was upheld where the petitioner’s income was not being counted under the current eligibility status. The respondent indicated that there is no hardship policy for overpayment of Medicaid. Fla. Admin. Code 65A-1.900(1)(b), Fla. Stat. ch. 414.41(1)(2)- 11F-00043

The Department’s action to establish an overpayment of ICP Medicaid benefits was upheld where the Department overpaid the petitioner. At the time of the payment, the petitioner’s trust was underfunded, which resulted in the petitioner exceeding the income limit, and therefore made the petitioner ineligible to receive ICP Medicaid benefits. Fla. Admin. Code 65A-1.900(1)(b), Fla. Stat. ch. 414.41(1)(2)- 11F-00463 

Petitioner transferred facilities without notifying the Department of Elder Affairs, therefore a level of care assessment was not done. The Department alleges Petitioner did not meet level of care during that time and an overpayment occurred. However, no evidence was presented that petitioner failed to meet the level of care when an overpayment occurred. Therefore, appeal is granted, Fla. Admin. Code 65-2.060- 09F-02729

Failure to Report

An overpayment of $130,476.70 occurred when Petitioner inadvertently failed to report stock ownership causing income to exceed the program’s limitations. Petitioner offered proceeds from stock sale and $5 a month (14% of income) to repay the debt. The debt servicer had yet to rule on whether Petitioner’s repayment offer was acceptable. Appeal is granted to allow decision on acceptability of repayment plan, 7 C.F.R. §273.18, Fla. Stat. §414.41, Fla. Admin. Code 65A-1.303, F.A.C. 65A-1.712, F.A.C. 65A-1.900(1)(g), Benefit Recovery Collection Resource Guide July 1, 2005, –08F-07221

Collection Procedures

Definition of, Benefit and Recovery Collection Resource Guide July 1, 2005- 08F-07221

Extreme Hardship

Extreme Hardship can only be applied to agency error cash assistance claims, Fla. Admin. Code 65A-1.900, Benefit and Recovery Collection Resource Guide July 1, 2005- 08F-07221

Recovery of Overpayment due to Mistake or Fraud

Department may make appropriate settlements and take all necessary steps to recover overpayment, Fla. Stat. §414.41(1)- 08F-07221

The agency failed to take action on a reported change. However, under the rules, the petitioner is responsible for repayment, regardless of fault for the overpayment. Appeal denied, Fla. Stat. §414.41(1), Fla. Admin. Code 65A-1.711, F.A.C. 65A-1.900- 09F-07708

Types of Claims

Definition of Recipient Claim, 7 C.F.R. §273.18- 08F-07221

Inadvertent Household Error, 7 C.F.R. §273.18- 08F-07221

Agency Error, 7 C.F.R. §273.18- 08F-07221

Payment Schedule

Officer could find no policy which set minimum monthly payment at $25- 08F-07221

Must be approved by the collection authority- 08F-07221

Can be calculated based on percentage of monthly income, for persons in nursing home $5/mo. was 14% of monthly income which was considered a substantial amount- 08F-07221

Acronym Key


Adult Day Care


Activities of Daily Living


Assisted Living Facility


Brain and Spinal Cord Injury Program


Code of Federal Regulations


Durable Medical Equipment


Florida Administrative Code


Home Health Aid


Independent Care Provider


Personal Care Assistance


Private Duty Nurse


Power-operated vehicle


Prescribed Pediatric Extended Care


Qualified Income Trust


Statewide Impatient Psychiatric Program


Social Security Administration