10-144-301 Me. Code R. § 700-FS 777-2
GENERAL RULE - Any suspected program violation shall be investigated. When there is sufficient documentary evidence to substantiate that the violation was intentional, initiate an administrative disqualification hearing, regardless of the current eligibility status of the individual. A second party, preferably the immediate supervisor, shall review the evidence prior to initiating a disqualification hearing.
Do not initiate any collection activity until a determination has been made as to whether or not an IPV has occurred.
DEFINITION OF INTENTIONAL PROGRAM VIOLATION
Federal rules at 7 CFR 273.16(c) state that an intentional program violation has been committed when:
or
The IPV determination can be made by a department hearing officer, a signed Waiver of Hearing, or a judge. The Eligibility Specialist may choose to begin the disqualification process with an interview, at which time the accused individual may choose to sign a Waiver of Hearing.
NOTE: While most Intentional Program Violations result in a monetary loss to the program, a household's willful misrepresentation is sufficient grounds to pursue an IPV even when no overpayment of Food Supplement benefits occurred.
If it is determined that the violation does not meet the definition of a IPV, collection action shall be initiated as an unintentional or agency claim, as appropriate.
REFERRAL FOR CRIMINAL PROSECUTION Individuals determined to have committed an IPV through the administrative disqualification process are automatically referred to the Fraud Investigation and Recovery Unit (FIRU) via the computer, when IPV overpayments are input into the computer system. FIRU staff consider these individuals for prosecution.
NOTE: Do not delay the FS disqualification penalty and collection action pending prosecution.
ADMINISTRATIVE DISQUALIFICATION PROCEDURES
Written notice to the person accused of the violation shall be mailed at least 45 days in advance of the scheduled hearing in order to assure that the notice is received 30 days prior to the hearing. The first notice shall be mailed "CERTIFIED/RETURN RECEIPT REQUESTED/RESTRICTED DELIVERY". The notice shall contain:
NOTE: To determine the approximate disqualification period, the Disqualified Recipient Subsystem (DRS) must be checked for prior IPV(s) in other states. If it is discovered that an IPV occurred in another state, independent verification of the IPV must be obtained and notice provided to the applicable household member before the DRS information can be used in determining an appropriate disqualification period for any subsequent IPV. A recipient has the right to request a fair hearing if the recipient disagrees with the length of the disqualification that DRS indicates was imposed by a State. However, the fair hearing cannot reverse a determination established at a previous administrative disqualification hearing that the recipient has committed an Intentional Program Violation.
A copy of the hearings procedures and the opportunity to waive the right to the hearing shall also be provided.
The person is entitled to one postponement, provided it is requested at least 10 days prior to the scheduled date. The postponement shall be for no more than 30 days. Requests for postponements within 10 days of the scheduled date may be granted, provided both the local office and the accused agree in writing.
If the notice is returned marked "undelivered" or accepted by someone other than the addressee, personal service shall be arranged by any other method which provides proof of receipt at least 30 days prior to the hearing. It will be necessary to reschedule the hearing, allowing another 45 days. Hearings will be scheduled and arranged by the local office, and will be held on Mondays and Fridays. Copies of all notices and waivers will be sent to the Hearings Unit. When the accused replies that he wants a hearing, the Hearings Unit shall be notified of the time and place.
If the notice is returned marked "refused", it shall be assumed that the addressee received notice.
Should the client fail to appear at the hearing, and the notice was received at least 30 days prior to the hearing date, the hearing shall still be conducted. The hearing officer will base his decision on the evidence presented by the Department.
TIME LIMITS - The Department has ninety days from the date the hearing notice is received to hold the hearing, render the decision, and notify the household.
PARTICIPATION PENDING A HEARING - Continued eligibility and benefit level shall be determined, as for any other household.
CRITERIA FOR DETERMINING INTENTIONAL PROGRAM VIOLATION - The hearing officer shall base the determination on clear and convincing evidence which demonstrates that the household member committed, and intended to commit, an intentional program violation as defined at 7 CFR 273.16 (c) and page 1 of this section of the Maine Food Supplement Manual.
DISQUALIFICATION PENALTIES - The disqualification applies to the individual who was determined to have committed an intentional program violation. The disqualification period will begin with the first month which follows the date the household member is sent written notification of the disqualification that results from the hearing decision. The disqualification periods are as follows:
Certain intentional program violations carry more severe penalties. Those violations and their disqualification periods are as follows:
See FS 444-4 for treatment of income and assets of disqualified individuals.
NOTE: All disqualifications for violations committed prior to May 1, 1983, will be counted as a single violation for purposes of determining penalties.
NOTIFICATION OF DECISIONS - When the household member is determined to have committed an IPV, a written notice shall be provided prior to the disqualification. It shall note the date the disqualification begins and ends. Advance notice is not required. See FS 777-3 for collection action.
DISQUALIFIED RECIPIENT SUBSYSTEM (DRS)
DRS is a centralized national database which contains information on IPV disqualifications from all of the states. Updates are received by the national database and matched with Maine's Food Supplement Program caseload on a monthly basis. When a match occurs, the originating state must be contacted for independent verification of the IPV disqualification information. This information must be used to determine if a recipient should be serving a disqualification period imposed by another state and to determine the proper disqualification penalty for an individual found or suspected to have committed an IPV. The originating state should be asked whether the IPV disqualification is under appeal and requested to inform you if the IPV disqualification is reversed. If an IPV disqualification is reversed, the individual must be reinstated if the household is eligible and benefits lost as a result of the disqualification must be restored.
A recipient has the right to request a fair hearing if the recipient disagrees with the length of the disqualification that DRS indicates was imposed by a State. However, the fair hearing cannot reverse a determination established at a previous administrative disqualification hearing that the recipient has committed an Intentional Program Violation.
Once a disqualification period has been imposed against a currently participating member, the disqualification period continues uninterrupted until completed. The household would be subject to a claim for any benefits overissued as a result of the disqualified individual's participation during the period of disqualification.
10-144 C.M.R. ch. 301, § 700-FS 777-2