None — 1. What are the total amounts of payments and overpayments?
Total benefits paid in 2010: $7,164,884,484 Total overpayments in 2010: $155,773,373 Total percent overpayments: Approximately 2.17% 21.10% of which was fraud 78.90% of which was non-fraud
2. What are non-fraud overpayments? Non-fraud overpayments result from an oversight, misunderstanding, technical error, or other mitigating event that causes an overpayment of benefits. Two main categories of non-fraud overpayments are:
Misreported/non-reported wages Either the claimant or employer does not report wages or does not report them correctly for a period of time the claimant was receiving unemployment benefits Non-monetary An overpayment that results when an initial determination to pay benefits is reversed by an eligibility determination, re-determination, appeal, Unemployment Appeals Commission order or court decision
3. What are the primary causes for non-fraud overpayments? NOTE: The source of the information in item #3 is the AWI Benefit Accuracy Measurement Annual Time Lapse and Error Rate Reports for 2010. The data for these reports are derived from a weekly representative sample of UC payments and disqualifying ineligibility determinations, as outlined in USDOL guidelines.
Approximately 60% of non-fraud overpayments occur when a claimant was the sole cause for the overpayment, including but not limited to: Reporting earnings incorrectly Able and available for work issues Reporting incorrect reason for separation, etc.
Approximately 23% of non-fraud overpayments occur when the claimant and employer were both responsible for the overpayment. The cause could be a combination of both claimant causes from above and employer causes, including but not limited to: Employer did not respond with the reason for separation Employer failed to report or provided incorrect base period wages Employer provided inadequate separation information to an adjudicator Employer provided inadequate information to the agency regarding claimants employment
Approximately 5.5% of non-fraud overpayments occur when the claimant and the agency are both responsible, which could be a combination of both claimant causes from above and the agency causes below, and
Approximately 8.6% occur when the agency alone is responsible, which may include: The adjudicator failed to get a detailed reason for separation during initial investigation, causing the determination to be reversed during an appeals hearing The adjudicator failed to request specific separation information from the employer and the claimant The adjudicator failed to contact the claimant and employer regarding specific separation information, and based his/her determination on information from the initial claim only
4. What accounts for the large volume of unemployment compensation overpayments? The total amount of overpayments was less than 2.20% of the unprecedented total of benefits paid in 2010 (nearly $7.2 billion). However, we believe that even a small percent is too large and we remain diligent in our efforts to prevent, detect and recover all overpayments in all cases.
5. Is there a document within the agency that comprehensively addresses the issue of unemployment compensation overpayments?
Yes. The agency conducts ongoing training for new and current employees utilizing comprehensive documents such as the Benefit Payment Control manual, which includes information on the various types of overpayments, penalties for overpayments, collection processes, etc. We also diligently track and produce numerous reports on the outcomes of the many strategies employed to prevent, detect and recover fraud and non-fraud overpayments (listed below). These reports are used to gauge the effectiveness of each strategy and to guide us in adding or modifying strategies, as necessary, to ensure maximum effectiveness.
6. Is there coordinated effort within the agency to address unemployment compensation overpayments?
Yes. Prevention, detection and recovery of UC overpayments are not only priorities within Florida, there are also well-coordinated and organized efforts spearheaded at the federal level by the U.S. Department of Labor. All states, including Florida, have a Benefit Accuracy Measurement (BAM) unit. The BAM unit is designed to determine the accuracy of paid and denied claims in unemployment compensation programs.
For more information about USDOL efforts, please visit these web sites: http://www.ows.doleta.gov/unemploy/improp_pay.asp http://www.ows.doleta.gov/unemploy/performance.asp http://www.doleta.gov/gsearch.cfm
Some examples of strategies the Agency for Workforce Innovation uses to prevent, detect and recover overpayments at the state level include:
INITIAL CLAIM CROSS MATCHING - Whenever a claim is filed, the agency conducts a series of cross matches with the Social Security Administration and the Florida Department of Highway Safety and Motor Vehicles to validate the claimants identity and help avert overpayments.
WAGE CREDIT POST AUDIT - The Wage Credit Post Audit compares Florida quarterly wage data as reported by employers to the Florida Department of Revenue against unemployment compensation benefit payments made to customers in the corresponding calendar quarter.
INTERSTATE CROSS MATCH AUDIT - Under a reciprocal agreement between all states, claimants who are living in another state but are filing claims against Florida are audited. Wage information from states participating in the Interstate Agreement is electronically matched with benefit payment information for the corresponding calendar quarter. Any apparent conflict generates a wage audit investigation.
NEW HIRE AUDIT - AWI receives new hire information on Florida claimants as reported by employers nationwide to the U.S. Department of Health and Human Resources. The information is electronically cross matched against the unemployment compensation database to determine if the newly-hired individual has continued claiming benefits after returning to work.
MULTI-CLAIMANT ADDRESS AND TELEPHONE AUDITS - A data warehouse report advises if three or more beneficiaries share the same mailing address or phone number and received payments. An investigation is conducted to determine if these shared addresses and telephone numbers are legitimate or if this is a case of one individual filing multiple claims.
DECEASED CLAIMANT AUDIT - A list of beneficiaries whose Social Security numbers match a deceased persons records and for whom payments were issued after the date of death is routinely reviewed.
STOP INMATE FRAUD AUDIT - Under Florida law, an individual is not entitled to unemployment compensation benefits while incarcerated or enrolled in a work release program for the majority of the customary work week. If the agency determines that a beneficiary received payments while incarcerated, the agency reviews the case and issues a fraud determination, as well as contacts the individuals corresponding law enforcement authority, as appropriate.
HOTLINE TIPS - A toll-free hotline and online tips form are available for the general public, so they may anonymously inform the agency if they suspect that a beneficiary may be working and receiving unemployment compensation at the same time. All tips are: Reviewed to determine whether they merit an investigation Forwarded to the Benefit Payment Control Unit for handling or additional review
EMPLOYER PROTESTS - A Statement of Benefit Charges Notice is mailed by the Florida Department of Revenue to employers at the end of each calendar quarter. The form lists the beneficiarys name and the amount of benefits charged to the employers experience rating account. The employer may question the charges. When there are allegations of a beneficiary working while claiming benefits or other questions of eligibility, an investigation is initiated to determine if improper payments were made.
BENEFIT ACCURACY MEASUREMENT UNIT - This unit operates under authority of a federally -mandated program designed to determine if benefits have been properly paid. The unit audits a randomly selected number of claims per week as mandated by the U.S. Department of Labor (USDOL). When an overpayment exists, the information/investigation is routed to the agencys Benefit Payment Control unit, where an overpayment determination is issued and appropriate action is taken.
LEGISLATIVE REMEDIES Legislation passed in 2010 requires employers to respond to the initial notice of a claim within 20 days from the mailing date. Employers who do not respond to the claim within 20 days will not be relieved of benefit charges against their experience rating, even when the agency has determined that the claimant has a non-fraud overpayment.
NATIONAL STRATEGIES -
USDOL UI INTEGRITY INSTITUTE - Florida is one of 11 high volume states developing plans that will be provided to all states as a role model through its participation in the USDOLs Unemployment Insurance (aka Unemployment Compensation) Integrity Institute. Through this initiative, the agency created a Strategic Plan focused on strategies to reduce improper payments that will be an integral component of the annual Florida State Quality Service Plan for federal performance year 2012.
NATIONAL DIRECTORY OF NEW HIRES - The National Directory of New Hires is a national repository of employment, unemployment insurance and quarterly wage information; Florida utilizes the NDNH as an overpayment prevention and detection tool by performing weekly cross matches with information entered into the NDNH database.
ADDITIONAL STRATEGIES - Additional strategies employed by the agency to recover overpayments include, but are not limited to:
Referring delinquent fraud overpayments suitable for prosecution to the local state attorney Referring delinquent non-monetary overpayments to one of two collection agencies under state contract Filing for garnishment of wages for delinquent overpayments belonging to a claimant who is working Filing in civil court to obtain a lien on delinquent non-fraud overpayments Offsetting payable benefits payments against delinquent overpayments belonging to a claimant eligible for new benefits Applying lottery winnings to outstanding overpayments
7. How much has the agency recovered in overpayments?
Of the $155,773,373 in total fraud and non-fraud overpayments for 2010: An average of 25% of fraud overpayments is recovered by law the agency has 5 years to recover fraud overpayments An average of 30% of non-fraud overpayments is recovered by law the agency has 3 years to recover non-fraud overpayments
Furthermore, the U.S. Department of Labors core performance measure for the Benefit Accuracy Measurement Unit and overpayment detection for the federal performance year 2010 was 55.4% of the estimated detectable, recoverable overpayments. Floridas performance was 66.11% detected, which exceeded the national goal. This is significant because USDOL guidelines state the performance outcome cannot be below 50% or greater than 95%, or it is assumed the state is improperly administering its Benefits Payment Control or Benefits Accuracy Measurement programs.
8. Closing comments:
Overpayments are not unique to Florida; all state unemployment compensation programs deal with overpayments and all work vigorously to combat them. Florida consistently ranks in the top half of all states with regard to overpayment detection and collection.
The agency takes the issue of overpayments very seriously and we believe that even one single dollar of taxpayer funds paid in error is one dollar too many. For this reason, we consistently employ organized, diligent and concerted strategies to prevent, detect and recover all overpaid funds.
WFTV
