Maine not taking full advantage of federal data to fight fraud

Posted June 10, 2012, at 5:07 p.m.
U.S. Sen. Susan Collins
U.S. Sen. Susan Collins Buy Photo

AUGUSTA, Maine — Like many other states, Maine is not taking full advantage of the Public Assistance Reporting Information System operated by the federal government to help states find cases of fraud in a wide array of programs. The Senate Homeland Security and Government Affairs Committee is concerned the lack of reporting leads to more loss of federal funds to fraud.

“I support efforts to ensure that people who need assistance get it and those who would cheat the system do not,” said Sen. Susan Collins, the ranking GOP member of the panel. “The federal government should beef up its system for collecting and making more accessible information about who is, and who is not, eligible for payments.”

The panel has had one hearing on the issue and more are expected, with one estimate that the federal government made $125 billion in erroneous payments last year.

The voluntary program generates reams of possible cases of fraud and Maine, like many states, does not have the staff to sift through the data and determine the validity of the information, although the state is adding more investigators under a measure approved by lawmakers last month.

“We get reports quarterly and there is an awful lot of information that has to be reviewed,” said Scott Fitts, director of the Fraud, Investigation and Recovery Unit at the Department of Health and Human Services. He said there are several federal lists of individuals who may be receiving food stamps, Medicaid or other safety net programs in more than one state.

Fitts said the system works on the basis of Social Security numbers and other federal data submitted by all of the states to the federal government. It covers Medicaid, food stamps, welfare benefits, child care benefits and workers compensation and a state can access all of that information quarterly.

“We have to scrub all that data,” he said, “and we just can’t get through all of it and there are a lot of mistakes, like wrong Social Security numbers or names and often what looks like something is not when we check it out.”

Fitts said there are only nine investigators for the entire state and they are responsible for all fraud investigations, such as tips to the fraud hotline, not just following up information on the leads provided by the PARIS matches. He said in the most recent quarterly match there were thousands of possible cases from PARIS in the various files.

He said many leads simply are not fraud, such as when a person moves from one state to another and shows up in both because they have applied for benefits in another state while still being listed on Maine’s rolls. He said the numbers in the files are also somewhat inflated because a family of five would show up as five separate entries in the computer data, not as a family.

“We are more reactive than proactive to the PARIS matches,” he said, “though we do use the data regularly.”

Fitts said the Legislature added 8 investigators and 2 support staff positions starting Jan. 1, 2012. The total cost of the initiative is $675,000 a year.

Sen. Earle McCormick, R-West Gardiner, the co-chairman of the Legislature’s Health and Human Services Committee, sponsored the measure for Gov. Paul LePage. He said there were some concerns raised during committee deliberations about adding staff when some on the panel did not believe there is a serious fraud problem.

“We have not had a lot of resources to do investigations and a lot of people concluded we don’t have a problem,” he said. “This should answer that question by providing resources to do more investigations than we have done in the past.”

McCormick said the intent is to find any abuses there are in the system, not reduce benefits for individuals. He said it may be that more resources may be needed.

“It seems that everyone has a story to tell about what may be abuse of the system,” he said. “This will provide for more investigations and we can get to what is the size of the problem and how we should best address it.”

Sen. Margaret Craven, D-Lewiston, also serves on the committee and she supported the legislation but unsuccessfully argued some of the investigators should have been dedicated to provider fraud.

“That’s where you could find some big savings,” she said.

Another area where some states are using PARIS and Maine is not is in workers compensation claims. But Workers Compensation Board Executive Director Paul Sighinolfi said he is having his staff review the possibility of using the PARIS system.

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