IM-65 July 12, 2023; IM-40 May 28, 2008; IM-142 December 2, 2005
Determine the total number of months the household received an overpayment for each claim period.
- Administrative Error (AE) claim:
- Calculate back no more than twelve months including the month of discovery (see 1142.015.05 Administrative Error)
Example: A possible overpayment for March 2022 through June 2022 is discovered on May 6, 2023. The 12-month look-back period is June 2022 through May 2023. A claim is established for the month of June 2022 only. Do not establish a claim for March 2022, April 2022, and May 2022.
- Inadvertent Household Error (IHE) claim:
- Calculate back no more than twenty-four months including the month of discovery (see 1142.015.10 Inadvertent Household Error)
Example: A possible overpayment for March 2021 is discovered on May 6, 2023. The 24-month look-back period is June 2021 through May 2023. A claim is not established.
- Suspected Program Violation (SPV) and Intentional Program Violation (IPV) claims:
- A look back period of thirty-six months is allowed for (see 1142.015.10.05 Suspected Program Violation/1142.015.15 Intentional Program Violation).
- If a suspected program violation overpayment month occurred within the thirty-six month look back period, calculate the overpayment back for up to seventy-two months.
- If there is no month in which an overpayment occurred due to the suspected program violation within the look back period, a claim amount is not calculated, and the discovery is rejected.
- The look back period includes the month of discovery.
Example: A possible overpayment for March 2020 through June 2021 is discovered on May 6, 2023. The 36-month look-back period is June 2020 through May 2023. Since one of the months of the claim period falls into the 36-month look-back period, a claim is established for the entire claim period.