Pennsylvania Code › Title 55 - HUMAN SERVICES › Part II - Public Assistance Manual › Subpart G - Restitution and Reimbursement › Chapter 255 - RESTITUTION › GENERAL PROVISIONS › Section 255.2 - Definitions

Current through Register Vol. 54, No. 28, July 13, 2024
The following words and terms, when used in this section
						and §§
											255.1,
						255.3,
						255.4 and
						255.71, have the following
						meanings, unless the context clearly indicates otherwise:
Found by a State or Federal court
-The
						term includes one of the following:
(i) A verdict of guilty, a plea of guilty or
					 a plea of nolo contendere.
(ii)
					 Receiving probation without verdict, disposition in lieu of trial, an
					 accelerated rehabilitative disposition or a similar deferred adjudication
					 process in lieu of trial, including a process in which the accused recipient
					 signs a voluntary consent disqualification agreement which is approved by the
					 court.
Intentional program violation
-An action
						by an individual applying for or receiving AFDC or GA for himself or others for
						the purpose of establishing or maintaining his own, his household's or his
						family's eligibility for AFDC or GA or for the purpose of increasing or
						preventing a reduction in the amount of the grant, which involves one of the
						following:
(i) An intentionally made
					 false or misleading statement or misrepresentation or concealment or
					 withholding of a fact.
(ii) An act
					 intended to mislead, misrepresent, conceal or withhold a fact or propound a
					 falsity.
Overpayments
-Classified either as
						suspected fraud, or as nonfraud will be made by relating the case facts
						nonfraud for purposes of administrative action. The decision as to whether or
						not the overpayment is suspected fraud will be made by relating the case facts
						to the following definitions and criteria.
(i)
Causes of overpayment.
There are two basic causes of overpayment: fraudulent misrepresentation by the
					 client and error on the part of the agency or the client.
(ii)
Fraud.
Suspected if the
					 overpayment was caused by what appears to be willful withholding of information
					 on the part of the client.
(iii)
Nonfraud.
An overpayment resulting from the client's
					 misunderstanding of eligibility requirements or of his responsibility for
					 providing the county office with information, from the innocent concealment of
					 facts, or from county office omission or administrative error in securing or
					 acting on information.
(iv)
Suspicion of fraud.
When a person is believed to have
					 knowingly and deliberately withheld information or provided incorrect
					 information to obtain assistance for which he would otherwise not be eligible,
					 a suspicion of fraud will exist. Only the court will have jurisdiction to
					 convict for fraud. Under the Public Welfare Code (62 P. S. §§
												101-1503), obtaining, or aiding or abetting a
					 person in obtaining assistance by means of a willfully false statement or
					 misrepresentation, or by impersonation, or other fraudulent means, is a
					 misdemeanor. A person convicted of fraud under this statute will be sentenced
					 to make restitution of the money received by virtue of his fraudulent acts and,
					 in addition, will be subject to fine or imprisonment.
(v)
Willful withholding.
The
					 person had in fact been told by the CAO, knew and understood what was required
					 and the consequences of any action or lack of action. It further means that
					 noncompliance with known requirements was planned for the express purpose of
					 getting assistance that would not otherwise have been granted.
Restitution
-Recovery of assistance from
						a recipient who has been overpaid. Overpayment will exist when a person
						receives assistance for which he was not eligible.
State
-The states of the United States
						and the District of Columbia, the Commonwealth of Puerto Rico, the Virgin
						Islands and Guam.
The amendment made to §
													255.2 at 21 Pa.B. 1557 (April 13,
						  1991) was promulgated under section 6(b) of the Regulatory Review Act
						  (71
						  P. S. §
														745.6(b)).
The provisions of this §
													255.2 amended under sections 201
						  and 403(b) of the Public Welfare Code (62 P. S. §§
														201 and
						  403(b)).
This section cited in 55 Pa. Code §
													275.11 (relating to general
						  policy); and 55 Pa. Code §
													275.12 (relating to
						  definitions).