D.C. Mun. Regs. r. 7-133

Current through Register Vol. 71, No. 24, June 14, 2024

Rule 7-133 - OVERPAYMENT

133.1

If the Program makes an overpayment to a claimant as a result of an error of fact or law, the Program shall recoup the overpayment from the claimant or, if a claimant is receiving compensation from the Program, adjust the claimant's compensation payments to correct and recoup the overpayment, as provided in this section.

133.2

In order to adjust or recoup an overpayment, the Program must make a preliminary finding as to whether the claimant was "at fault," as defined under Section 2329(b)(2)(A)(i) of the Act, in the creation of the overpayment.

133.3

If the Program makes a preliminary finding that the claimant was at fault in the creation of the overpayment, the Program shall issue a notice of adjustment or recoupment forthwith.

133.4

If the Program preliminarily finds that the individual was not at fault in the creation of the overpayment, a notice of adjustment or recoupment shall only issue where the Program has determined that the adjustment or recoupment would not defeat the purpose of the Act or be against equity and good conscience, as provided under Section 2329(b) of the Act.

133.5

A notice of adjustment or recoupment shall advise the claimant of the following:

(a) That the overpayment exists and the amount of the overpayment;

(b) That a preliminary finding shows that the claimant either was or was not at fault in the creation of the overpayment;

(c) That the claimant has the right to inspect and copy the Program's records relating to the overpayment;

(d) That the claimant has the right to request a waiver and present evidence within thirty (30) days of the notice to challenge

(1) The fact and amount of the overpayment; or

(2) The Program's preliminary finding of claimant's fault in the creation of the overpayment; and

(e) That the claimant's failure to present evidence within the thirty (30) days provided shall result in a final determination supporting recoupment of the overpayment, unless the deadline to present evidence is extended pursuant to § 133.9 of this chapter.

133.6

Any request for a waiver or challenge to a preliminary finding of overpayment must be submitted to the Program within thirty (30) days of the date of the overpayment notice issued by the Program.

133.7

Failure to submit evidence to challenge the overpayment or in support of a waiver pursuant to Section 2329 (b-1)(2) of the Act within thirty (30) days of the date of the overpayment notice shall result in the issuance of a final determination without participation of the claimant.

133.8

Final determinations on overpayment shall be determined based Section 2329 (b-1)(2) of the Act.

133.9

If a claimant fails to request a waiver or challenge a preliminary finding of overpayment within thirty (30) days of the date of the overpayment notice and

(a) A final determination has not issued pursuant to § 133.6, the claimant may submit the request directly to the Program for consideration pursuant to Section 2329 (b-1)(2) of the Act.

(b) A final determination has issued pursuant to § 133.6, the claimant may appeal the Program's final determination to the Chief Risk Officer pursuant to § 156.1 of this chapter. The Chief Risk Officer shall grant the appeal and remand the belated challenge or waiver of overpayment to the Program for consideration pursuant to Section 2329 (b-1)(2) of the Act, only where the claimant submits evidence that establishes the claimant's inability to timely act resulted from:

(1) Good cause;

(2) Mental or physical incapacity; or

(3) Lack of timely receipt of the notice of adjustment or recoupment.

133.10

The Program may treat any overpayment as an employee debt to the District pursuant to Section 2902 and 2904 of the Act. Pursuant to Section 2901(g) of the Act, Sections 2901(a) through (f) of the Act shall not apply to limit the Program's ability to collect overpayments; and

133.11

If the Program has reason to believe that the overpayment may have occurred as a result of fraud or other criminal activity on the part of the claimant, the Program shall refer the matter to the Office of the Inspector General, the United States Attorney's Office, or another appropriate law enforcement entity.

D.C. Mun. Regs. r. 7-133

Final Rulemaking published at 59 DCR 8766, 8805 (July 27, 2012); amended by Final Rulemaking published at 64 DCR 6325 (7/7/2017)

Authority: Chief Risk Officer of the Office of Risk Management (ORM), Executive Office of the Mayor, pursuant to the authority set forth in section 2344 of the District of Columbia Government Merit Personnel Act of 1978 (CMPA), effective March 3, 1979 (D.C. Law 2-139; D.C. Official Code § 1-623.44 (2012 Supp.)); section 7 of Reorganization Plan No. 1 of 2003 for the Office of Risk Management, effective December 15, 2003; and Mayor's Order 2004-198, effective December 14, 2004