Office of Payment Accuracy and Recovery /
Notice of Overpayment and Planned Action for Provider Overpayments / Date of notice:
Provider name:
DPU provider number:
We found that from // to // the Department of Human Services (DHS) and Oregon Health Authority (OHA) paid you $ more than you should have been paid.
The reason for this overpayment is: .
This overpayment is Agency caused Provider caused
This overpayment is related to the following DHS case:
Case number: Case name: Worker ID: Branch:
You must pay back the money you were overpaid even if it was not your fault. You have to pay it back even if you didn’t know you were getting too much money. If you have questions about this overpayment, contact the Overpayment Writing Unit, childcare provider overpayment team, at: 503-373-1872 (Salem area), 1-877-888-3578 (toll free) or by fax
503-378-3872.
You may also contact us in writing at the following address:
Overpayment Writing Unit
P.O. Box 14150
Salem, Oregon 97309-0850
DHS|OHA may increase the amount of this overpayment if we learn of additional payments that you were not eligible to receive. Oregon Administrative Rules;
461-155-0150, 461-165-0160, 461-165-0180, 461-165-0430, 461-195-0501,
461-195-0511, 461-195-0521, 461-195-0551, 461-195-0621
Recovery/repayment methods
1. Oregon law requires that you repay this money to DHS|OHA and also says DHS|OHA can take court action to collect the overpayment. Oregon Law allows DHS|OHA to collect money from other state agencies that may owe you. For example, we can take Oregon tax refunds. We will credit the amount collected minus any collection fees or costs charged to DHS|OHA in the collection process.
2. If you are currently an active provider for DHS|OHA, we will recover this overpayment by withholding current or future payments from you when you bill DHS|OHA for child care services you are providing to agency clients. If the overpayment amount is more than the amount we would otherwise pay you, we will withhold all or part of your future payments until the overpayment is paid back. This is in addition to number one (1) of this section.
If your household is low income and this withholding causes a financial burden, we may consider a repayment plan. You must contact the Overpayment Writing Unit, childcare provider overpayment team, at: 1-877-888-3578 (toll free) or 503-373-1872 (Salem area) within 45 days from the date of this notice to request a repayment plan.
3. If you are not currently an active provider with DHS|OHA and the overpayment is not satisfied within 60 days, you will not be eligible for payment from DHS|OHA until the full amount of the overpayment has been paid (see number four (4) below).
4. To repay this amount, please send your check or money order along with this
notice to:
DHS|OHA – Accounts Receivable and Receipting Units
OFS RSTARS Receivables
P.O. Box 4325
Portland, OR 97208-9992
Questions call: 503-947-5126 (Salem area) or 1-866-631-0745 (toll free)
Note: Be sure to include a copy of this notice with your payment or write your provider number on your check. Your provider number can be found at the top of the first page of this notice.
If you do not agree
You have the right to ask for a hearing if you do not agree with this overpayment. At the hearing, you can explain why you do not agree with the overpayment. You can also have people testify for you. You can have a lawyer or someone else help you. We cannot pay the costs of witnesses or a lawyer. You may call the Public Benefits Hotline (a program of Legal Aid Services) at 1-800-520-5292 for advice and possible representation. You may also be able to get free legal services through your local bar association. The laws about your hearing rights and the hearing process are at OAR 137-003-0501 to 0700,
461-025-0300 to 0375, ORS 183.411 to 183.470, and ORS 411.703.
If you want a hearing, you must ask for one within 45 days from the date of this notice. You have the right to ask for a delay paying DHS|OHA back until a hearing decision is made. Your hearing request must be in writing and may be submitted on a DHS|OHA Administrative Hearing Request Form (DHS 443). The form is available at your local DHS office. DHS|OHA staff can help you fill out the form. If the hearing is in your favor, you will receive a written notice of the outcome based on new findings.
There are times when you do not have a right to a hearing. They are:
· When you already had a hearing on the same issue.
· When you did not ask for a hearing within 45 days from the date of the notice.
· When you signed legal papers admitting you received this overpayment.
· When a court has decided that you received this overpayment.
If you do not ask for a hearing on time, or if you withdraw the hearing request or miss your hearing, you may lose your right to have one. This notice will be the final DHS|OHA decision (called a "final order by default"). You will not get a separate notice. The case file, along with any materials you submitted in this matter, is the record. The record is used to support the DHS|OHA decision upon default. You may appeal the final order by default by filing a petition in the Oregon Court of Appeals (ORS 183.482). If you do not ask for a hearing, this appeal must be filed within 60 days of the date this notice becomes a final order by default. If you withdraw a hearing request or miss your hearing, the appeal deadline is indicated in the dismissal order.
NOTE TO MILITARY PERSONNEL: Acitve duty service members have a right to stay at these proceedings under the federal Servicemembers Civil Relief Act (SCRA). For more information you may contact the Oregon State Bar (800-452-8260), the Oregon Military Department (800-452-500) or the nearest legal assistance office (https://legalassistance.law.af.mil).
(Agency representative) (Telephone number)
DHS|OHA will not discriminate against anyone. This means DHS|OHA will help all who
qualify. DHS|OHA will not deny help to anyone based on age, race, color, national origin,
sex, sexual orientation, religion, political beliefs or disability. You can file a complaint if
you think DHS|OHA discriminated against you for any of these reasons.
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