GN 02201: General Information Title II, Title XVI, and Title XVIII Overpayments - Part I
TN 32 (03-15)
A. Rationale for administrative tolerances
For work flow purposes, we set certain administrative tolerances for restricting the amount of our collection activity on certain classes of debts.
B. When to initiate recovery
Initiate recovery based on the following conditions:
If the… |
Then… |
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Manually computed overpayment is less than $1.00, |
Do not post the overpayment to the beneficiary’s record and do not send a notice. The resources we employ to recover very minor debts may outweigh the benefit. |
Automated action computed an overpayment less than $1.00, |
The system will automatically send an overpayment notice and we will automatically initiate recovery. NOTE: If the beneficiary requests waiver, grant it automatically on the basis that recovery of such a small amount will impede efficient or effective administration of the Social Security Act, per GN 02250.350. |
Manually computed overpayment is:
NOTE: If you do not send an overpayment notice based on the above, do not establish the overpayment. |
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The overpayment is between $1.00 and $30 and:
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Overpayment is $30 or more and the beneficiary is alive, |
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Overpayment is $30 or more and less than $3,000, the beneficiary is deceased, and
NOTE: For more information regarding contingent liability and the priority order if there is more than one contingently liable beneficiary, see GN 02210.007, GN 02210.015, and GN 02210.016. |
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Overpayment is $3,000 or more, the beneficiary is deceased, and there is an estate |
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Overpayment is $3,000 or more, the beneficiary is deceased, there is no estate, and someone is receiving benefits on the deceased beneficiary’s record, NOTE: For more information regarding contingent liability and the priority order if there is more than one contingently liable beneficiary, see GN 02210.007, GN 02210.015, and GN 02210.016. |
NOTE: The contingently liable beneficiary will have the same waiver and appeal options as the original overpaid beneficiary. |
C. Extent of collection efforts for cases when the beneficiary is in non-pay status
The Recovery and Collection of Overpayment Process (RECOOP) is our automated process for billing and following up for overpaid beneficiaries in non-pay status. When an overpayment does not meet the criteria for RECOOP, we process these non-RECOOP cases manually. For more information regarding the criteria for RECOOP, see MS DMS 011.002B.
NOTE: We do not generally refer a title XVIII (Medicare) overpayment to the program service center (PSC) for collection unless the overpayment exceeds $50.00.
D. Use the following criteria to manually process non-RECOOP cases when the overpaid beneficiary is in non-pay status
1. For overpayments that are $30 or less
Take the following actions:
If… |
Then… |
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The beneficiary does not respond to the initial overpayment notice and there is another beneficiary receiving benefits on the record, NOTE: For more information regarding contingent liability and the priority order if there is more than one contingently liable beneficiary, see GN 02210.007, GN 02210.015, and GN 02210.016. |
NOTE: The contingently liable beneficiary will have the same waiver and appeal options as the original overpaid beneficiary. |
There is no response to the initial overpayment notice and there is no one else currently receiving benefits on the record, |
Terminate collection per GN 02215.235. NOTE: If the overpayment is on ROAR, the system will generate a reminder notice. |
An overpayment of more than $30 is reduced to $30 or less through benefit withholding and the beneficiary is no longer receiving benefits, |
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An overpayment of more than $30 is reduced to $30 or less through regular installment payments and the payments stop, |
Follow the instructions in GN 02210.180B.2. |
2. For overpayments that are more than $30 but less than $200
Take the following actions:
If there is… |
Then… |
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No response to the initial overpayment notice and there is another beneficiary receiving benefits on the record, NOTE: For more information regarding contingent liability and the priority order if there is more than one contingently liable beneficiary, see GN 02210.007, GN 02210.015, and GN 02210.016. |
NOTE: The contingently liable beneficiary will have the same waiver and appeal options as the original overpaid beneficiary. |
No response to the initial overpayment notice and we cannot recover the overpayment from a contingently liable beneficiary, |
NOTE: If within 30 days there is no response to the follow-up notice, make limited pursuit of the debt (e.g., call-in letters, telephone calls) following the instructions in GN 02210.212 and GN 02210.213. |
3. For overpayments that are $200 or more but less than $3,000
Take the following actions:
If there is… |
Then… |
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No response to the initial overpayment notice and there is another beneficiary receiving benefits on the record, NOTE: For more information regarding contingent liability and the priority order if there is more than one contingently liable beneficiary, see GN 02210.007, GN 02210.015, and GN 02210.016. |
NOTE: The contingently liable beneficiary will have the same waiver and appeal options as the original overpaid beneficiary. |
No response to the initial overpayment notice and we cannot recover the overpayment from a contingently liable beneficiary, |
NOTE: If within 30 days there is no response to the follow-up notice, make limited pursuit of the debt (e.g., call-in letters, telephone calls) following the instructions in GN 02210.212 and GN 02210.213. |
4. For overpayments that are $3,000 or more
Take the following actions:
If… |
Then… |
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Recovery from the debtor is unsuccessful and we cannot recover the overpayment from anyone else on the record, |
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E. $1,000 Administrative waiver tolerance
For information on how to process a waiver request when the overpayment is $1,000 or less and it is clear the overpaid beneficiary is without fault, see GN 02250.350. In addition, the Kansas City Region created a decision tree to assist in determining when it is appropriate to apply this waiver tolerance. Use this link to access the decision tree: Administrative Waiver Decision Tree.
F. References
SM 00610.721 Recovery of an Overpayment from Other than the Overpaid Person
SM 00610.720 Recovery of a Title II Overpayment When the Overpaid Person is in LAF T1 – Death Case
GN 02210.015 Priority of Adjustment – Overpayment
GN 02205.005 Contingent Liability for Title II Overpayment Recovery
MS DMS 006.016 Establish Offset (OLP) (DROL)
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