Commonwealth of Pennsylvania
Department of General Services
RFP #6100036110
APPENDIX P
APPENDIX P
Overpayment Process
Overview
Regardless of the reason for workers’ compensation indemnity overpayments (erroneous amount paid, duplicate paid, payment on wrong file, etc.), the Offeror is responsible for attempting to collect overpayments. The Offeror may not charge the Commonwealth for attempting to recover overpayments.
COPA WC
Indemnity Overpayments. Workers’ compensation indemnity overpaymentsdiscovered before claimants have returned to work, shall be recovered from the ongoing indemnity payments. For overpayments discovered after claimantshave returned to work, a letter shall be sent to the claimant requesting reimbursement. The letter shall explain the reason for the overpayment. However, before the letter is sent, the information about the overpayment shall be supplied to OA, and OA, in cooperation with the Bureau of Commonwealth Payroll Operations will verify and approve the overpayment amounts.Appropriate Bureau of Workers’ Compensation (LIBC) forms are completed and filed to inform the claimant of the overpayment and adjustments.
Information for indemnity overpayments of Heart and Lung and Act 632/534 shall beprovided to OA once a month. OA audits the amounts and makes arrangements to collect overpayments with the Bureau of Commonwealth Payroll Operations.
Medical or Expense Overpayments. OA shall be notified of all medical or expense overpayments. The Offeror shall send lettersto providers to request reimbursement.
Uncollected Overpayments. If overpayments are not collected within six months, the Offeror must submit the uncollected overpayment information to OA. If the Offeror is at fault for the overpayment, liquidated damages may be assessed in accordance with AppendixI- Service Level Agreements.
Collected Overpayments. Upon collection of any overpayment, the Offeror shall document the refund of the overpayment by showing it as a negative amount in the payment file.
WCSF
The Offeror must provide notice by email as soon as any overpayment or payment error of any type is realized or revealed. WCSF will also provide notice if errors are noted by the WCSF. Errors are divided into two types: those made as the result of a “simple oversight” and those made as a result of “gross oversight”. The purpose of this distinction is to identify whether or not the Offeror will be held accountable for reimbursing the WCSF.
Simple oversight occurs when the file documents that all reasonable steps, decisions, actions and reviews were taken to properly manage the claim and there is no evidence of negligence in the handling of the file. If recovery efforts fail, the Offeror will not be asked to reimburse the WCSF yet the Offeror is expected to make all reasonable efforts to recover the funds.
Gross oversight occurs when the WCSF has determined that sufficient documentation exists to demonstrate Offeror failed to take all reasonable steps, decision, actions, and reviews to avoid the issuance of a duplicate payment or overpayment and/or the file notes and documents indicate the adjuster was not responsive to file directives by either the supervisor or WCSF. If recovery efforts fail, the Offeror will be required to reimburse the WCSF.
Charges incurred to collect overpayments such as legal costs, collection costs, etc. resulting from a simple oversight, in most cases, WILL NOT BE the responsibility of the Offeror. Additional charges resulting from the recovery of an error categorized as “gross oversight” WILL BE the responsibility of the Offeror.
To track payment errors and recovery efforts, a Recovery Chart is maintained at the WCSF and entries are added as they are disclosed. The Recovery Chart is exchanged electronically with the Offeror every three(3) months. Offeror needs to designate one person on staff to handle the Recovery Chart exchange. Offeror has SIX (6) MONTHS from the date the entry is made on the Recovery Chart to get the funds back for the WCSF. After the Offeror is put on notice of the amount expected in reimbursement, the Offeror must make payment to the WCSF within two (2) weeks of such notice.
When duplicate paymentsare made, it is the Offeror’s responsibility to initiate the recovery process by requesting a check copy from the WCSF via a Stop Payment Request. Once the duplicate payment is verified by the WCSF, the Offeror must proceed with the recovery.
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