Code of Maine Rules
10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES
144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL
Chapter 500 - RULES GOVERNING THE MAINE CERTIFICATION OF HEALTHCARE COOPERATIVE AGREEMENTS
Section 144-500-7 - ENFORCEMENT PROCEDURES

Current through 2024-38, September 18, 2024

7.1 Enforcement. The department or the Attorney General is authorized to impose one or more of the following enforcement actions or any other actions authorized by law.

7.2 Enforcement of Final Department Action. The Attorney General may file an action in Superior Court to enforce any final action taken by the department regarding COPA application proceedings, or as a result of additional supervisory proceedings. See 22 M.R.S.A. Sections1844(7) and 1845(5).

7.3 Investigative Powers. The Attorney General, at any time after an application or letter of intent is filed, may require by subpoena the attendance and testimony of witnesses and the production of documents in Kennebec County, or the county in which the applicants are located, for the purpose of investigating whether the cooperative agreement satisfies the standards set forth in these rules.

7.3.1 All documents produced and testimony given to the Attorney General are confidential.

7.3.2 The Attorney General may seek an order from the Superior Court compelling compliance with a subpoena issued under Section 7.3 of these rules. See 22 M.R.S.A. §1848(1).

7.4 Enjoin Operation of Cooperative Agreement. The Attorney General may seek to enjoin the operation of a cooperative agreement for which an application for a certificate has been filed by filing suit against the parties to the cooperative agreement in Superior Court.

7.4.1 Filing Court Action. The Attorney General may file an action before or after the department acts on the application for a certificate; however, the action must be brought no later than 40 days following the date the department approved the application for a certificate.

7.4.2 Time Periods Tolled. After the filing of a court action, the time periods specified for departmental action pursuant to Sections 3 and 5 of these rules are tolled until the court action is dismissed by the Attorney General or the Superior Court orders the department to take further action. See 22 M.R.S.A. §1848(2).

7.4.3 Automatic Stay of Issued Certificate. Upon the filing of a complaint under Section 7.4 of these rules, the department's approval of a certificate, if previously issued, must be stayed unless the court orders otherwise or until the action is concluded. The Attorney General may apply to the court for any temporary or preliminary relief to enjoin the implementation of the cooperative agreement pending final disposition of the case.
7.4.3.1 COPA applicants may apply to the Superior Court for relief from the stay.

7.4.3.2 Relief may be granted only upon a showing of compelling justification. See 22 M.R.S.A. §1848(3).

7.4.4 Burden of Proof: Benefits Outweigh Disadvantages. In an action brought under Section 7.4 of these rules, the applicants for a certificate bear the burden of establishing by a preponderance of the evidence that in accordance with Section 4 of these rules the likely benefits resulting from the cooperative agreement and any conditions proposed by the applicants outweigh any disadvantages attributable to a reduction in competition that may result from the cooperative agreement.
7.4.4.1 In assessing disadvantages attributable to a reduction in competition likely to result from the cooperative agreement, the court may draw upon the determinations of federal and Maine courts concerning unreasonable restraint of trade under 15 United States Code, Sections 1 and 2, and 10 Maine Revised Statutes, Sections 1101 and 1102. See 22 M.R.S.A. §1848(4).

7.5 Enforcement of Certificate: No Merger. If the certificate holders in a cooperative agreement not involving a merger are not in substantial compliance (1) with the conditions included in the certificate, or (2) with a consent decree, or (3) with the conditions or measures added pursuant to additional supervisory activities, the Attorney General may seek an order from the Superior Court compelling compliance with such conditions or measures or other appropriate equitable remedies.

7.5.1 Additional Equitable Remedies. If the Superior Court grants relief and that relief is not effective in securing compliance with the conditions or measures, the Superior Court may impose additional equitable remedies, including:
7.5.1.1 The exercise of civil contempt powers; or

7.5.1.2 Revocation of the certificate upon a determination that advantages to be gained by revoking the certificate outweigh the unavoidable costs resulting from a revocation of the certificate. See 22 M.R.S.A. §1848(6)(A).

7.5.2 Burden of Proof. In an action brought under Section 7.5 of these rules, the Attorney General has the burden of proving by a preponderance of the evidence the basis for any equitable remedies requested by the Attorney General and adopted by the Superior Court. See 22 M.R.S.A. §1848(6)(C).

7.6 Enforcement of Certificate: Merger. If the certificate holders in a cooperative agreement involving a merger are not in substantial compliance (1) with the conditions included in the certificate, or (2) with a consent decree, or (3) with the conditions or measures added pursuant to additional supervisory activities, the Attorney General may seek an order from the Superior Court compelling compliance with such conditions or measures.

7.6.1 Additional Equitable Remedies. If the certificate holders to the merger fail to comply with any court order compelling compliance with the conditions or measures, the Superior Court may impose additional equitable remedies to secure compliance with its orders, including:
7.6.1.1 The exercise of civil contempt powers; or

7.6.1.2 Appointment of a receiver. See 22 M.R.S.A. §1848(6)(B).

7.6.2 Divestiture of Assets. If the additional judicial measures in Section 7.6.1 of these rules are not effective in securing compliance with the conditions or measures and the Superior Court determines that the advantages to be gained by divestiture outweigh the unavoidable costs of requiring divestiture, the Superior Court may revoke the certificate and order divestiture of assets. See 22 M.R.S.A. §1848(6)(B).

7.6.3 Burden of Proof. In an action brought under Section 7.6 of these rules, the Attorney General has the burden of proving by a preponderance of the evidence the basis for any equitable remedies requested by the Attorney General and adopted by the Superior Court. See 22 M.R.S.A. §1848(6)(C).

7.7 Revocation of the Certificate

7.7.1 Revocation by Department. The department is authorized to seek a court order revoking a certificate under circumstances specified in Sections 6.7.1 and 6.7.2 of these rules regarding additional supervisory activities.
7.7.1.1 The standards for adjudication to be applied by the court are the same as in Sections 7.4.4, 7.5.2, and 7.6.3 of these rules: that is, the department has burden of proof by a preponderance of the evidence, except pursuant to Section 7.7.2.1.2.

7.7.1.2 In assessing disadvantages attributable to a reduction in competition likely to result from the cooperative agreement, the court may draw upon the determinations of federal and Maine courts concerning unreasonable restraint of trade under 15 United States Code, Sections 1 and 2, and 10 Maine Revised Statutes, Sections 1101 and 1102.S ee 22 M.R.S.A. §1845(4).

7.7.2 Revocation by Attorney General.If, at any time after the 40-day period specified in Section 7.4.1 of these rules, the Attorney General determines that, as a result of changed circumstances or unanticipated circumstances (Section 1.15), the benefits resulting from a certified cooperative agreement or a consent decree entered under Section 7.9 of these rules, do not outweigh any disadvantages attributable to a reduction in competition resulting from the cooperative agreement, the Attorney General may file suit in the Superior Court seeking to revoke the certificate of public advantage. See 22 M.R.S.A. §1848(5).
7.7.2.1 The standard for adjudication for an action under this section of the rules is as follows.
7.7.2.1.1 Except as provided in Section 7.7.2.1.2 of these rules, the Attorney General has the burden of establishing by a preponderance of the evidence that, as a result of changed circumstances or unanticipated circumstances, the benefits resulting from the cooperative agreement and the unavoidable costs of revoking the certificate are outweighed by disadvantages attributable to a reduction in competition resulting from the cooperative agreement. See 22 M.R.S.A. §1848(5)(A).

7.7.2.1.2 If the Attorney General first establishes by a preponderance of the evidence that the certificate was obtained as a result of material misrepresentation to the department or the Attorney General or as the result of coercion, threats or intimidation toward any party to the cooperative agreement, then the parties to the agreement bear the burden of establishing by clear and convincing evidence that the benefits resulting from the agreement and the unavoidable costs of revoking the agreement outweigh the disadvantages attributable to any reduction in competition resulting from the cooperative agreement. See 22 M.R.S.A. §1848(5)(B).

7.8 Department Proceedings Stayed: No Further Department Action. After the Attorney General files a court action in accordance with these rules, the department may not take any further action under these rules until the court action is dismissed by the Attorney General or the Superior Court orders the department to take further action. See 22 M.R.S.A. Sections1844(7), 1845(5), and 1848(2),(7).

7.9 Resolution by Consent Decree. The Superior Court may resolve any action brought by the Attorney General under these rules by entering an order with the consent of the parties.

7.9.1 The consent decree may contain any conditions authorized by Section 4, or conditions or measures authorized by Section 6 of these rules.

7.9.2 The consent decree may not be filed with the Superior Court until 30 days after the filing of the application for a certificate in accordance with Section 3.3 of these rules.

7.9.3 Upon entry of the consent decree order by the court, the parties to the cooperative agreement have the lawful conduct protection specified in Section 2.5 of these rules and the cooperative agreement has the effectiveness of a lawful agreement. See 22 M.R.S.A. §1848(9).

7.10 Reasonable Attorney Fees and Costs: Attorney General Prevails. If the Attorney General prevails in an action taken pursuant to Sections 7.3.2 (subpoena compliance), 7.4 (enjoin operation of cooperative agreement), 7.5, 7.6 (enforcement of certificate), 7.7.2 (revocation of certificate), or 7.9 (consent decree) of these rules, the Attorney General and the department are entitled to an award of the reasonable costs of deposition transcripts incurred in the course of the investigation or litigation and reasonable attorney's fees, expert witness fees and court costs incurred in litigation. See 22 M.R.S.A. §1848(8).

7.11 Reasonable Attorney Fees and Costs: Department Prevails. If the department prevails in an action taken pursuant to Section 6 (continuing supervision), or 7.7.1 (revocation of certificate) of these rules, the department and the Attorney General are entitled to an award of the reasonable costs of deposition transcripts incurred in the course of the action and reasonable attorney's fees, expert witness fees and court costs incurred in the action. See 22 M.R.S.A. §1845(6).

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