<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".35" citation="COMAR 07.02.11.35" title_num="07" subtitle_num="02" chapter_num="11" heading="Correction of Payment Irregularities to the Out-of-Home Placement Provider.">
  <paragraph num="A.">
    <text>Within 30 days of the knowledge of payment irregularity, the local department shall commence overpayment procedures.</text>
  </paragraph>
  <paragraph num="B.">
    <text>Overpayment Procedures.</text>
    <paragraph num="(1)">
      <text>To correct an overpayment, the local department shall:</text>
      <paragraph num="(a)">
        <text>Determine the correct payment amount and take action to correct the continuing payment;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Calculate the total amount of the overpayment; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Notify the provider in writing of the suspected overpayment amount within 10 days after determining that an overpayment exists.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>The local department may not recoup an overpayment from a provider until the local department has notified the provider in writing that an overpayment has been identified.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>The local department may propose to reduce, suspend, or terminate payment to correct the overpayment.</text>
    </paragraph>
    <paragraph num="(4)">
      <text>The provider may request a fair hearing to challenge the proposed action.</text>
    </paragraph>
    <paragraph num="(5)">
      <text>If the local department's decision following a fair hearing is upheld, the proposed reduction, suspension, or termination of the overpayment includes any overpayment made pending the decision.</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>Termination of payment does not relieve the provider of the obligation to reimburse the local department for any overpayment.</text>
  </paragraph>
  <paragraph num="D.">
    <text>To obtain reimbursement, the local department shall:</text>
    <paragraph num="(1)">
      <text>Request repayment of the overpayment; and</text>
    </paragraph>
    <paragraph num="(2)">
      <text>If appropriate, initiate collection efforts in conformity with the procedure required to refer the debt to the Central Collection Unit, Department of Budget and Management.</text>
    </paragraph>
  </paragraph>
  <paragraph num="E.">
    <text>If payment to the provider is subsequently reinstated, the local department shall recoup the amount of the overpayment as prescribed in §I of this regulation.</text>
  </paragraph>
  <paragraph num="F.">
    <text>If a person repays the local department, the local department shall accept and credit the payment.</text>
  </paragraph>
  <paragraph num="G.">
    <text>Fair Hearing.</text>
    <paragraph num="(1)">
      <text>Before the local department takes action to recover or recoup an overpayment, the local department shall advise the provider of the:</text>
      <paragraph num="(a)">
        <text>Right to a fair hearing; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Procedure and time limit for requesting a fair hearing according to Regulation .38 of this chapter and COMAR 07.01.04.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>The provider may request a fair hearing to challenge the:</text>
      <paragraph num="(a)">
        <text>Decision of the local department that an overpayment occurred;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Amount or cause of the overpayment; or</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Proposed method to repay the overpayment.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>Within 30 days following a fair hearing, the Office of Administrative Hearings shall notify the individual in writing of the:</text>
      <paragraph num="(a)">
        <text>Agency decision; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Reasons for the decision.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="H.">
    <text>Suspected Fraud Procedures.</text>
    <paragraph num="(1)">
      <text>If the local department determines that a case is one of suspected fraud as defined in Regulation .03B of this chapter, the local department shall refer the case to the:</text>
      <paragraph num="(a)">
        <text>The Department's Office of the Inspector General (OIG); or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>State's attorney's office (SAO).</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>Before the local department refers a case to the (OIG) or SAO, the referral document shall be approved by a supervisor or the director's designee.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>After making the referral, the local department:</text>
      <paragraph num="(a)">
        <text>Shall inform the OIG or the SAO of any new facts or changed circumstances in the case;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Shall provide access to relevant information in its possession to the assigned investigators; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>May not notify a provider of the referral to the OIG or the SAO but may answer “yes” or “no” when the provider asks whether a referral was made.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="I.">
    <text>Recoupment Procedures.</text>
    <paragraph num="(1)">
      <text>Recoupment.</text>
      <paragraph num="(a)">
        <text>Except as noted in §I(1)(b) of this regulation, the local department shall take action to recoup an overpayment and determine with the provider:</text>
        <paragraph num="(i)">
          <text>The total amount to be recouped; and</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>An amount to be recouped through a monthly deduction from the continuing payment for as many months as are necessary until the overpayment is repaid.</text>
        </paragraph>
      </paragraph>
      <paragraph num="(b)">
        <text>In the case of foster care providers, the amount recouped may not reduce the personal needs allowance by more than 50 percent of the monthly foster care payment rate.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>Procedures for Dual Jurisdictions. When a provider moves from one local department jurisdiction to another, the:</text>
      <paragraph num="(a)">
        <text>Forwarding local department shall notify the receiving local department of the recoupment process; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Receiving local department shall continue the recoupment process, if appropriate, and credit all money recouped to the program funding source according to the Department's instructions.</text>
      </paragraph>
    </paragraph>
  </paragraph>
</regulation>