An Act To Strengthen the State's Ability To Investigate and Prosecute Misuse of Public Benefits
Maine Legislature, Session 125, LD 1888
Committee Amendment CA_A_S542 (Senate)
Amends: 22 MRSA §3

COMMITTEE AMENDMENT" A" to S.P. 665, L.D. 1888, Bill, "An Act To 
Strengthen the State's Ability To Investigate and Prosecute Misuse of Public Benefits" 
Amend the bill by striking out all of section 9 and inserting the following: 
'Sec. 9. 22 MRS A §1714-D is enacted to read: 
§1714-D. Credible allegations offraud; provider payment suspensions 
If the department determines that there is a credible allegation of fraud by a provider 
under the MaineCare program, the following procedures apply. 
1. Suspension of payments. The department shall suspend payment in whole or in 
part to a MaineCare provider when a suspension is necessary to comply with Section 
6402(h)(2) of the federal Patient Protection and Affordable Care Act of2010, Public Law 
111-148 and 42 Code of Federal Regulations, Part 455. 
2. Administrative appeal; scope. A MaineCare provider may administratively 
appeal the department's decision to suspend payment under subsection 1. 
3. 
No stay during administrative appeal. 
A suspension of payments under 
subsection 1 may not be stayed during an administrative appeal of the department's 
decision to suspend payment. 
The department may provide a fair opportunity for 
appropriate expedited relief from a suspension of payments consistent with federal law. 
4. Final determination; offset. Upon a final determination that fraud has occurred 
and that money is owed by the MaineCare provider to the department, and 31 days after 
exhaustion of all administrative appeals and any judicial review available under Title 5, 
chapter 375, the department may retain and apply as an offset to amounts determined to 
be owed to the department any payments to the provider that were suspended by the 
department pursuant to this section. The amount retained pursuant to this subsection may 
not exceed the amount determined finally to be owed. 
5. Confidentiality. Except as necessary for purposes of the investigation of fraud or 
the administration of the MaineCare program, the department's records regarding a 
determination of a credible allegation of fraud are confidential until the relevant 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT" A" to S.P. 665, L.D. 1888 
MaineCare provider has been given notice of a suspension of payments under subsection 
.L 
6. Rules. The department shall adopt rules to implement this section, including rules 
to define "credible allegation of fraud" and to provide exception and appeal procedures as 
required by and in accordance with the requirements of federa11aw and regulations. If the 
department provides a procedure for expedited relief from suspension of payments, as 
authorized in subsection 3, the rules must include that procedure. Rules adopted pursuant 
to this subsection are routine technical rules as defined in Title 5, chapter 375, subchapter 
2-A. 
7. 
Repeal. This section is repealed if Section 6402(h)(2) of the federal Patient 
Protection and Affordable Care Act of201O, Public Law 111-148 and 42 Code of Federal 
Regulations, Part 455 are invalidated by the United States Supreme Court.' 
Amend the bill by striking out all of section 11 and inserting the following: 
'Sec. 11. 22 MRSA §3S11, sub-§3, as amended by PL 1997, c. 466, §27 and 
affected by §28, is further amended to read: 
3. Overpayment. "Overpayment" means program benefits that an individual or 
assistanoe unit reoeives that exceed the amount of program benefits for which the an 
individual or assistance unit is eligible when the department or a court has determined 
that the benefits were reoeived provided as a result of an intentional program violation, an 
unintentional error by the individual or household or an error by the department. 
"Overpayment" inoludes any oV'erpayment made before or after the effeoti';e date of this 
subseotion does not include an overpayment for medical services by the department 
pursuant to chapter 855 or municipal general assistance pursuant to chapter 1161, if the 
overpayment occurred due to an unintentional error by the individual or household or an 
error by the department or by the municipality in the case of municipal general assistance 
under chapter 1161.' 
Amend the bill by inserting after section 12 the following: 
'Sec. 13. Emergency rules. Notwithstanding the Maine Revised Statutes, Title 5, 
section 8054, the department may adopt emergency rules to implement Title 22, section 
1714-D without the necessity of demonstrating that immediate adoption is necessary to 
avoid a threat to public health or safety or the general welfare, if notice is given through a 
MaineCare provider list and 5 days or more are allowed for comment prior to adoption of 
the rules.' 
Amend the bill by striking out all of section 13 and inserting the following: 
'Sec. 13. Appropriations and allocations. The following appropriations and 
allocations are made. 
HEALTH AND HUMAN SERVICES, DEPARTMENT OF (FORMERLY DHS) 
Office for Family Independence Z020 
Initiative: Provides funding for 8 Fraud Investigator positions and 2 Office Associate 
positions and related All Other costs funded 50% from the General Fund and 50% from 
Other Special Revenue Funds in the Office for Family Independence. 
COMMITTEE AMENDMENT 
'. 
COMMITTEE AMENDMENT" A" to S.P. 665, L.D. 1888 
GENERAL FUND 
Personal Services 
All Other 
GENERAL FUND TOTAL 
OTHER SPECIAL REVENUE FUNDS 
POSITIONS - LEGISLATIVE COUNT 
Personal Services 
All Other 
OTHER SPECIAL REVENUE FUNDS TOTAL 
2011-12 
$0 
$0 
$0 
2011-12 
0.000 
$0 
$0 
$0 
2012-13 
$313,011 
$19,643 
$332,654 
2012-13 
10.000 
$313,011 
$28,837 
$341,848 
Amend the bill by relettering or renumbering any nonconsecutive Part letter or 
section number to read consecutively. 
SUMMARY 
This amendment is the majority report of the committee. The amendment removes 
from the bill a provision regarding the scope of administrative hearings with regard to 
appeals of suspensions of payments for credible allegations of fraud. The amendment 
adds a provision on confidentiality. The amendment authorizes the Department of Health 
and Human Services to adopt by rule a procedure for expedited relief from suspension of 
payments. The amendment revises the requirement on adoption of rules and requires 
rules to define "credible allegation of fraud" and to provide exception and appeal 
procedures as required by and in accordance with the requirements of federal law and 
regulations. The amendment narrows the definition of "overpayment" with respect to 
certain public assistance program benefits. The amendment provides that the provisions 
concerning credible allegations of fraud and MaineCare provider payment suspensions 
are repealed if Section 6402(h)(2) of the federal Patient Protection and Affordable Care 
Act of 2010 and 42 Code of Federal Regulations, Part 455 are invalidated by the United 
States Supreme Court. 
FISCAL NOTE REQUIRED 
(See attached) 
COMMITTEE AMENDMENT 
Approved: 04/06/12 
~ac. 
LD 1888 
LR 2801(02) 
An Act To Strengthen the State's Ability To Investigate and Prosecute Misuse of Public Benefits 
Fiscal Note for Bill as Amended by Committee Amendment" A" S -5*2 
Committee: Health and Human Services 
Net Cost (Savings) 
General Fund 
Appropriations/Allocations 
General Fund 
Other Special Revenue Funds 
Correctional and Judicial Impact Statements 
Establishes new Class D crimes. 
Fiscal Note Required: Yes 
Fiscal Note 
FY 2011-12 
$0 
$0 
$0 
FY 2012-13 
$332,654 
$332,654 
$341,848 
Projections 
FY 2013-14 
$342,045 
$342,045 
$351,239 
The collection of additional fines may also increase General Fund revenue by minor amounts. 
Fiscal Detail and Notes 
Projections 
FY 2014-15 
$351,717 
$351,717 
$360,911 
Provides a General Fund appropriation of $332,654 and an Other Special Revenue Funds allocation of $341 ,848 in 
2012-13 for 8 Fraud Investigator positions and 2 Office Associate positions and related costs for the Office of Family 
Independence in the Department of Health and Human Services to strengthen the department's ability to investigate 
and prosecute the misuse of public benefits. The additional costs to the Department ofthe Attorney General can be 
absorbed utilizing existing budgeted resources. 
LR2801(02) - Fiscal Note - Page 1 of 1