Maine lacks funds to investigate all social service fraud cases, officials say

AUGUSTA, Maine — A federal system alerts Maine and other states to tens of thousands of instances of possible fraud and mistakes each quarter, but the state doesn’t have the staff or the money to investigate each case, according to officials. So Maine’s congressional delegation is supporting increased federal funding to help states take full advantage of the data.

“Fraud and abuse are the issues that have been confronting these programs over time, and we need to do all that we can to help the states use this system,” said Sen. Olympia Snowe, R-Maine. She said there has been progress made in the use of the various federal databases to find mistakes and fraud in such huge programs as Medicare and Medicaid.

The Public Assistance Reporting Information System is a voluntary program that generates tens of thousands of instances of possible fraud and mistakes, but states don’t have the staff to sift through the data or determine the validity of the information, said Scott Fitts, Director of the Fraud, Investigation & Recovery Unit at the Maine Department of Health and Human Services.

He said there are several federal lists of individuals that may be receiving food stamps, Medicaid or other safety net programs in more than one state and a data entry mistake on middle initials would flag the file for possible review.

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, childcare benefits and workers compensation, and a state can access all of that information quarterly.

“If the states do not have the staff to handle all of this data they are receiving, as I understand is the case in Maine, we should help with staff,” Snowe said.

Fitts said his office cannot follow up all the leads that are received quarterly from the system. Currently nine investigators and they are responsible for all fraud investigations, not just reviewing the leads generated by PARIS, though the Legislature added eight investigators and two support staff positions that will start Jan. 1.

Sen. Susan Collins, R-Maine, is the ranking GOP member of the Senate Homeland Security and Government Affairs Committee. She said the Medicare program has about $60 billion a year in improper payments and the Medicaid program another $22 billion. That includes mistakes as well as fraud.

“I believe that the federal government would actually save money by investing in better data collection, ensuring the integrity of the data and assisting the states in using the data,” Collins said. She said while the major savings would be in Medicaid and Medicare programs, it would also yield savings in such programs as welfare payments and food stamps.

“There is also a great deal the federal government can do to improve the integrity of the data that would lessen the burden on the states,” Collins said. She said improved programs for the states to analyze the computer files sent by the federal government would also help.

U.S. Representative Mike Michaud, D-Maine, said as Congress struggles with budget cuts to decrease the federal deficit, reducing fraud and errors should be high on the list. He said it is clear modest investments by Congress could yield big savings.

“If we are going to implement programs to help the states look at fraud, waste and abuse, we also have to provide the resources to there so that states can implement the program,” he said. Michaud said the states should also provide some of the costs of the program because they benefit from any savings found in Medicaid.

U.S. Rep. Chellie Pingree, D-Maine, said a lot of the fraud is provider fraud and the database analysis has resulted in multi-state federal fraud cases. She said with Congress looking at cutting needed programs, errors and fraud should be reduced or eliminated first.

“Frankly, there is nothing more frustrating than being unable to uncover some of the fraud and abuse in the system because you can’t access the data, you can’t utilize the data,” she said.

Collins said her committee is considering legislation that would improve the quality of the data and provide some help to the states to make better use of the information.