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C.__For the purposes of this subsection, "overpayment" does | | not include an overestimate made as part of a prospective | | interim payment, a 3rd-party liability recovery, a | | departmental administrative error or receivership fees or | | debt.__In addition, this subsection does not apply to routine | | adjustments of $2,500 or less that result from claims editing | | or processing. |
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| | | Sec. 2. 22 MRSA §42, sub-§7, ¶H, as enacted by PL 2003, c. 419, §2, is | | amended to read: |
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| | | H. In an administrative appeal of an informal review decision under this | | subsection, the department bears the burden of proving a violation of law | | or rule by a preponderance of the evidence. If the department proves | | that existing and available records of goods or services are defective, | the department may impose the a fee or sanction of, including total | | recoupment.__Total recoupment for defective records is warranted only | | when the provider has failed to demonstrate by a preponderance of the | | evidence that the disputed goods or services were medically necessary, | | MaineCare-covered goods or services and were actually provided to | | eligible MaineCare members. |
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