Md. Code Regs. 13A.14.06.14

Current through Register Vol. 51, No. 21, October 18, 2024

Section 13A.14.06.14 - Intentional Program Violations

A. Notice of intentional program violation disqualification penalties shall be posted in clear and prominent lettering on the:

(1) CCS Program application form used by a customer to apply for child care subsidy; and

(2) Terms of agreement completed by a provider when a child is enrolled for CCS Program services.

B. If the contractor receives information that a customer or a provider may have committed an intentional program violation, the contractor may:

(1) Refer the information to the Division's fraud investigator, who shall:

(a) Conduct an investigation of the suspected intentional program violators;

(b) Prepare a report on the completed investigation showing the methods used to obtain information;

(c) Make the report available to the Division; or

(d) Refer the customer or the provider to the local State's Attorney if the alleged facts in the case meet the guidelines established by the State's Attorney for prosecution;

(2) Allow a customer or a provider to waive the customer's or the provider's right to an administrative disqualification hearing; or

(3) Refer the customer or the provider, as applicable, to the Office of Administrative Hearings (OAH) for an administrative disqualification hearing.

C. Supervisory Review. Before providing advanced written notification that a customer or a provider may waive the customer's or provider's right to an administrative disqualification hearing, the contractor shall ensure that a supervisor:

(1) Reviews the evidence against the customer or the provider; and

(2) Determines whether the evidence warrants scheduling of a disqualification hearing.

D. Waiver Hearing. When the contractor decides to allow a customer or a provider to waive the customer's or the provider's right to an administrative disqualification hearing, the contractor shall notify the customer or the provider in writing. The notice shall include:

(1) A summary of the charge against the customer or the provider and the evidence to support it;

(2) Information regarding the administrative disqualification hearing including:

(a) A statement that the customer or the provider may waive the right to an administrative disqualification hearing;

(b) The date the contractor will refer the case to the OAH for a hearing if the contractor has not received the signed waiver, which is not later than 20 calendar days after the mailing of the notice;

(c) The requirement that the customer or the provider shall sign the waiver;

(d) A statement that the customer or the provider has the right to remain silent and that anything the individual says or signs concerning the charge may be used in future administrative or judicial proceedings; and

(e) A statement that signing the waiver will result in disqualification and reduce or terminate services for the customer or the provider;

(3) An opportunity for the customer or the provider to admit to the facts presented by the CCS Branch;

(4) A statement that the disqualified customer or provider is responsible for repayment of any overpayment received;

(5) A statement that a hearing does not preclude the State or federal government from prosecuting the customer or the provider for the intentional program violation in a civil or criminal court; and

(6) The name and telephone number of the person to contact for additional information.

E. If the local State's Attorney decides that a case does not warrant prosecution, the contractor shall refer the case to the OAH for an administrative disqualification hearing.

F. If the local State's Attorney does not act on a referred case within 30 calendar days, the referral shall be withdrawn and the case shall be referred to the OAH for an administrative disqualification hearing.

G. The contractor may not initiate an administrative disqualification hearing:

(1) Against a customer or a provider whose case is being referred by the State's Attorney for prosecution; or

(2) After the State's Attorney or a court of appropriate jurisdiction has taken any action against the customer or the provider in a case arising out of the same or related circumstance.

H. Imposition of Disqualification Penalties. If the contractor receives a signed waiver of the right to an administrative disqualification hearing, the contractor shall apply the disqualification penalty at the beginning of the next service period.

I. If the contractor does not receive a signed waiver of the right to an administrative disqualification hearing within 20 calendar days of providing advance notification in accordance with §D of this regulation, the contractor shall refer the individual to the OAH for a hearing in accordance with COMAR 13A.14.06.15.

J. The referral shall include:

(1) Identifying case information;

(2) A summary of the alleged intentional program violation;

(3) Copies of the contractor's supporting documentation; and

(4) Documentation that the customer or the provider has been:

(a) Previously disqualified for an intentional program violation; or

(b) Convicted by a court of fraud involving the CCS Program.

K. A pending disqualification hearing does not affect the customer's or the provider's right to be certified and participate in the program.

L. The contractor shall terminate or reduce the services if:

(1) The customer or the provider returns the signed waiver to the contractor;

(2) The customer or the provider fails to request a hearing and continuation of benefits after notice of termination or reduction;

(3) The decision of the contractor is upheld upon disposition of an intentional program violation hearing; and

(4)The State's Attorney Office's final disposition of a referred proceeding is received.

M. A customer or a provider who has waived the right to an administrative disqualification hearing or was found to have committed an intentional CCS Program violation is ineligible to participate in the CCS Program as follows:

(1) For the first violation, the customer or the provider may not receive any CCS Program payments for 6 months from the date payment was denied or until the customer or provider makes full restitution to the CCS Program, whichever is earlier;

(2) For the second violation, the customer or the provider may not receive any CCS Program payments for 12 months from the date the payment was denied or until the customer or the provider makes full restitution to the CCS Program, whichever is earlier;

(3) For the third violation, the customer or the provider shall be permanently barred from receiving CCS Program payments and shall pay restitution to the CCS Program; and

(4) For a determination of an intentional program violation based on a customer's or a provider's conviction in a federal or state court on charges that the person misrepresented the location of his or her residence in order to obtain services from two or more states, the customer or the provider is not eligible to receive CCS Program services or payments for 10 years from the finding.

N. The disqualification period begins with the service period after which the customer or the provider is sent written notification of the disqualification:

(1) Upon disposition of an intentional program violation hearing if the decision of the contractor is upheld;

(2) When a waiver is signed; or

(3) Upon final disposition of any proceeding referred to the local State's Attorney Office.

O. Once a disqualification penalty has been imposed under §M(1) or (2) of this regulation, the period of disqualification continues uninterrupted until the earlier of:

(1) Full repayment of the benefit; or

(2) Completion of the time period.

P. Before imposing the sanction, the CCS Branch shall provide written notice to the customer or the provider of the:

(1) Effective disqualification date;

(2) Reason for imposing the sanction;

(3) Payment that the applicant, customer, or provider was receiving; and

(4) Date on which the customer may reapply or the provider may begin offering service because the disqualification period has expired.

Q. If a customer or the provider has been disqualified pursuant to this regulation, the contractor shall send the customer or the provider a demand letter for restitution, which shall include:

(1) The amount owed;

(2) The reason for the claim;

(3) The period of time covered by the claim;

(4) The procedure for paying the claim;

(5) The right to request renegotiation of any repayment schedule if the customer's or the provider's economic circumstances change; and

(6) The requirement to:

(a) Sign the repayment notice to indicate agreement to make restitution;

(b) Select the method of payment; and

(c) Return the repayment notice within 30 calendar days of the date of the notice.

R. The customer or the provider may request a hearing before the OAH if the individual disagrees with the amount of the overpayment or the method of repayment.

Md. Code Regs. 13A.14.06.14

Regulations .14 adopted effective July 21, 1976 (3:15 Md. R. 785)
Regulation .14 amended effective May 10, 1982 (9:9 Md. R. 902)
Regulation .14 adopted effective 42:6 Md. R. 512, eff.3/30/2015