C.M.R. 10, 144, ch. 101, ch. I, § 144-101-I-1, subsec. 144-101-I-1.05
MaineCare providers must accept the allowances for covered services established by the Department as payment in full. Providers must also comply with state and federal law as well as the provisions of the MBM, Chapter I, Section 1.03-8.
Providers that request or require supplementary payment for MaineCare covered services are in violation of MaineCare rules and are subject to administrative sanctions. Private supplementary payment includes, but is not limited to, charging fees for referrals to other providers or consultants, charging a fee to request prior authorization, or charging fees for any other administrative services required in the process of providing MaineCare services.
Title 42 U.S.C. § 1320a-7(b) specifically provides, in part, for criminal penalties as follows:
"Whoever knowingly and willfully;
Payment may be made by the Department only for MaineCare covered services provided to individuals who are eligible for services on the date the services are actually provided unless otherwise specified in the MBM, or who have been granted retroactive MaineCare eligibility after services have been provided.
Members may not be charged for covered services provided during any period of eligibility unless a member has knowingly misrepresented, in writing, his or her MaineCare status. Enrolled providers must bill the Department for covered services provided to a member during any period of eligibility for which the provider expects to be reimbursed. Nothing in this paragraph shall be construed as prohibiting a provider from providing free care.
C.M.R. 10, 144, ch. 101, ch. I, § 144-101-I-1, subsec. 144-101-I-1.05