Searching over 5,500,000 cases.


searching
Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.

SeniorsPlus v. Maine Department of Health and Human Services

Superior Court of Maine, Androscoggin

January 23, 2017

SENIORSPLUS, Petitioner,
v.
MAINE DEPARTMENT OF HEALTH AND HUMAN SERVICES, Respondent.

          ORDER ON PETITIONER'S MOTION TO TAKE ADDITIONAL EVIDENCE

          MaryGay Kennedy Justice, Superior Court

         Presently before the court is Petitioner SeniorsPlus's motion requesting that this case be remanded to the Maine Department of Health and Human Services ("DHHS") for the taking of additional evidence before the agency. Based on the following, Petitioner's motion is granted.

         I. BACKGROUND

         Petitioner SeniorsPlus, also as known Elder Independence of Maine, is a private, non-profit corporation registered to do business in the State of Maine. (R. Tab A at 5.) On July 1, 2008, SeniorsPlus entered into a contract with DHHS's Office of Elder Services ("OES") for the 2009 fiscal year, contract number OES-09-351 (the "2009 contract"). (Id.) Under the 2009 contract, SeniorsPlus agreed to provide certain services, including home care management services for DHHS clients, and payment processing for third parties who provide direct home-based care ("HBC") services to DHHS clients. (Id.) The 2009 Contract was amended several times to increase the total dollar amount of the contract and to extend the contract through June 30, 2010. (Id.) The total amount of the 2009 contract through June 30, 2010, was $17, 336, 325. (Id.)

         Pursuant to its terms, the 2009 contract was subject to the Maine Uniform Accounting and Auditing Practices for Community Agencies ("MAAP"), 10-144 C.M.R. ch. 30, et seq. (Id.) Pursuant to MAAP, DHHS conducted an audit of the 2009 contract in 2013. (Id. at 6.) On June 28, 2013, DHHS issued a report that, according to its audit, DHHS had overpaid SeniorsPlus $1, 108, 787 under the 2009 contract and ordered SeniorsPlus to reimburse DHHS in that amount. (Id.)

         SeniorsPlus sent a letter of appeal to the director of the DHHS's Division of Audit on August 12, 2013, asserting that DHHS's determination that it had overpaid SeniorsPlus was in error. (R. Tab DHHS-7.) SeniorsPlus asserted: (1) that approximately $437, 008 in payments from DHHS to SeniorsPlus, though received during the 2009 fiscal year, were for a prior contract and incorrectly included in the agency's 2013 audit; and (2) that the remaining $670, 645 in alleged overpayments were the result of DHHS's use of an improper settlement methodology. (Id.) DHHS's Division of Audit denied the appeal on August 8, 2014. (R. Tab DHHS-8.)

         On October 2, 2014, SeniorsPlus filed a letter of appeal and request for a hearing with DHHS's office of administrative hearings. (R. Tab DHHS-9.) An administrative hearing before a DHHS hearing officer was held on November 16, 2015. (R. Tab A at 1.) On February 16, 2016, the hearing officer issued a recommended decision upholding the agency's determination that SeniorsPlus owed the agency $1, 108, 787 in reimbursement. (Id. at 6.) SeniorsPlus filed exceptions to the recommended decision on March 8, 2016. (R. Tab B.) The Commissioner of DHHS issued final decision adopting the hearing officer's recommended decision on April 13, 2016. (R. Tab C.)

         Pursuant to §11002 of the Maine Administrative Procedures Act ("APA") and Maine Rule of Civil Procedure 80C, SeniorsPlus filed a petition for review of final agency action with this court on May 20, 2016. SeniorsPlus asserts the following: (1) the hearing officer violated the provisions of APA and committed errors of law by improperly excluding relevant evidence, prohibiting SeniorsPlus from presenting evidence and argument on relevant issues, and failing to require DHHS to produce employees with relevant evidence; (2) the hearing officer committed errors of law in interpreting the 2009 contract and finding that DHHS was not estopped by its promises to SeniorsPlus; (3) the hearing officer's interpretation of "cost sharing" was not supported by substantial evidence in the record; and, (4) the hearing officer's decision was arbitrary, capricious, and an abuse of discretion because the hearing officer repeatedly misstated the issues presented, denied SeniorsPlus access to relevant and material evidence, and denied SeniorsPlus the opportunity to present relevant and material evidence and witnesses. (Pet. ¶¶ A-E.)

         Following an extension of time, the certified record was filed on July 18, 2016. SeniorsPlus filed this motion to take additional evidence along with an offer of proof on August 31, 2016. The court granted DHHS's motion to allow the late filing of its opposition to the motion to take additional evidence on October 5, 2016. SeniorsPlus filed a reply on October 24, 2016.

         II. STANDARD OF REVIEW

         Pursuant to Maine Rule of Civil Procedure Rule 80C(e) and § 11006(1) of the APA, a party seeking judicial review of an agency action may file a motion with the court requesting that the court order the taking of additional evidence before the agency. M.R. Civ. P. 80C(e); 5 M.R.S. § 11006(1)(B). The motion shall be supported by a "detailed statement, in the nature of an offer of proof, of the evidence intended to be taken." M.R. Civ. P. 80C(e). The moving party's statement must be sufficient to permit the court to determine whether the taking of additional evidence is appropriate. Id. After hearing, the court shall issue an appropriate order specifying the future course of proceedings. Id.

         Section 11006(1)(B) of the APA provides that the court may order the taking of additional evidence by the agency if: (1) the court finds that that the additional evidence is necessary to deciding the petition for review; or (2) if the moving party demonstrates (a) that the additional evidence is material to the issues presented in the review; and (b) the additional evidence could not have been presented or was erroneously disallowed in the proceedings before the agency. 5 M.R.S. § 11006(1)(B). After the taking of additional evidence, the agency may modify its findings and decisions. Id. The agency shall file the additional evidence and any new findings or decisions with the court, which shall become part of the record for review. Id.

         Under the APA, an agency need not observe the rules of evidence observed by courts. Id. § 9057(1). Generally, evidence shall be admitted before an agency "if it is the kind of evidence upon which reasonable persons are accustomed to rely in the conduct of serious affairs." Id. § 9057(2). An agency may exclude irrelevant or unduly repetitious evidence. Id. DHHS's own Administrative Hearing Regulations mirror the APA: evidence shall be admitted if it is the kind of evidence upon which reasonable persons are accustomed to rely in the conduct of serious affairs; evidence that is irrelevant or unduly repetitious may be excluded; and formal rules of evidence shall not be observed. 10-144 C.M.R. ch. 1, § VII (A)(1)-(3). DHHS's Administrative Hearing Regulations also state, "Evidence which may reasonably be construed as relevant and which is not otherwise unduly repetitious shall be admitted." Id. § VII (A) (4).

         DHHS's Administrative Hearing Regulations further provide that a hearing officer's decision "must be based on agency regulations." Id. § VII (B)(3)(a). Where the agency's regulations are ambiguous or silent, reference to other sources of law for guidance is appropriate. Id. § VII (B)(3)(b). "When a hearing officer relies upon sources of law other than the agency's regulations, the written decision shall indicate the source of law and the reasons for that reliance." Id.

         III. ANALYSIS

         According to the hearing officer's recommended decision, the two issues before the hearing officer were: (1) whether DHHS was correct in its determination that, for the 2009 fiscal year, SeniorsPlus failed to follow the proper "cost-sharing" settlement method illustrated in the in 2009 contract, thereby owing DHHS $1, 108, 787 in reimbursement; and (2) whether the department was correct in its determination that SeniorsPlus must return $437, 008 to the DHHS because $437, 008 was an overpayment under the 2009 contract.[1] (R. Tab A at 3.)

         At the hearing, SeniorsPlus asserted the following arguments: (1) that the approximately $437, 008 were not overpayments under the 2009 contract because those amounts were payments made during the 2009 fiscal year for services actually rendered during the 2008 fiscal year and attributable to the prior contract between SeniorsPlus and EOS for the 2008 fiscal year, contract number OE-08-051 (the "2008 contract"); (2) that it continued to provide services during the 2008 fiscal year in detrimental reliance on DHHS's representations that it would be paid for those services during the 2009 fiscal year; and (3) that the remaining $670, 645 in alleged overpayments were the result of DHHS incorrectly interpreting the term "cost sharing" in the 2009 contract to mean "cost settling" or "cost based" and incorrectly applying a "cost settling" methodology in its audit of the 2009 contract. (R. Tab A at 9-11.)

         SeniorsPlus asserts that the hearing officer erroneously excluded evidence that was material to each of its arguments. (Pet'r Mot. Add'l Evid. 7-10.) The court addresses each issue in turn.

         A. The ...


Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.