It’s clear there are many instances of undetected fraud or payment mistakes in Maine government and in states across the nation. Overall, Medicare and Medicaid alone make billions of dollars in improper payments each year.
What’s more complicated, though, is determining the best way to catch the improper spending and prevent it from happening again.
Maine uses the Public Assistance Reporting Information System, which is a federal-state partnership that generates tens of thousands of possible instances of improper payments each year in areas of welfare, food stamps, workers’ compensation, child care benefits and Medicaid.
The problem is that Maine currently doesn’t have enough staff members to sift through all the data and determine whether, for example, some people are receiving food stamps when they’re not eligible or whether the state is overpaying for Medicaid services.
Maine’s congressional delegation indicated recently it would support increased federal funding to help states take advantage of all the PARIS data. It’s important for improvement efforts, though, to be holistic. They should build on what Maine has already begun and use a variety of approaches, such as improving the state’s system to catch potential instances of fraud or mistakes before they happen.
The state has already dedicated money in a tight fiscal time to more than double the number of staff members pursuing potential fraud leads in the Fraud, Investigation and Recovery Unit at the Department of Health and Human Services. There are currently nine investigators, and the Legislature agreed to add eight investigators and two support staff positions. They will start Jan. 1.
Gov. Paul LePage’s support for funding the extra positions allowed him to put his strong words in favor of reducing welfare fraud and abuse into action. He also supported the creation of the Fraud and Abuse Prevention team, a nine-member task force, made up of people from the Department of Health and Human Services and the Office of the Attorney General, to help stop fraud and make sure cases of potential illegal activity are properly investigated.
It will be important for the state to monitor the progress made with new hires starting in January. It may be that additional workers are needed.
But just because a state increases its number of staff members working to stem improper spending doesn’t mean the effort will be more successful. The work should be done in tandem with improved measures to identify possible warning signs of fraud or errors before the money is spent.
The U.S. General Accountability Office agrees. In a 2011 report, it suggests a number of ways to cut down on Medicaid and Medicare errors. They include strengthening provider enrollment strategies to reduce the number of people intending from the outset to defraud the system and improving prepayment review of claims, so Medicare pays correctly the first time.
The Centers for Medicare and Medicaid Services, which administers the two government health care programs, estimates they made a total of more than $70 billion nationally in improper payments in 2010. They are vulnerable to fraud, waste, abuse and improper payments in large part because of their size and complexity, according to the GAO.
And more can be done to streamline the data generated by PARIS to make it easier for Maine staff to interpret. Improving the information — possibly by providing data considered verified upon receipt — could mean Maine might be able to hire fewer workers.
It’s good that Maine’s congressional delegation wants to support enhanced efforts to find and prevent fraud and mistakes. Who wouldn’t? We want to make sure efforts proceed in the most effective way — by improving the system at hand through a greater dependence on prevention and technology and not relying unnecessarily on more manpower.
There is no welfare fraud in Maine. These are trumped up charges by the insensitive, greedy, hate mongering “Teapublicans” .
Yeah, and I bet you believe in santa too!
I’m sure all of the people who have been successfully prosecuted for welfare fraud recently will be surprised to find that out. Maybe they can successfully appeal their convictions based on your statement [/fantasy]
My statement was facetious.
Good one, you had them riled up
Perhaps those committing the fraud will think twice now that we have an administration serious about rooting it out. It seems obvious that more manpower is required, and I am confident these resources will be applied in a very smart manner.
The real issue, of course, is that we have too many entitlements serving too many people. In May, we in the U.S. had more people qualify for first-time disability payments than we had new jobs. It does not take a genius to see that there is a real problem here.
The federal government is too big, too unaccountable, and too expensive. We must elect politicians willing to make the hard decisions to repsonsibly reduce entitlements. Gov. King has never demonstrated any political courage in reducing spending, unlike Summers, who as a state senator, stood firmly on principle against Dem opposition.
If you see welfare fraud, call 1-207-287-2409 or
1-800-442-6003.
TTY: (207) 287-6948. Personally, I’ve seen those who rightfully need assistance and can’t qualify while some recipents fraudulently game the system. For the system to really work, we all need to get involved.
Oh, and by the way, consider reporting providers who commit fraud as well, for example, Speaker Nutting.
Speaker Robert Nutting got away with what – a million – two million? Doing a little math, let’s say the average fraudulent recipient can get away with $25,000 a year, ballpark figure. That means that Speaker Nutting was equal to 40 to 80 of your average fraudulent recipients. OK. To be fair it might have taken him more than a year to get away with that much. Let’s say three years. Now he is equal to maybe 15 to 25 fraudsters.
If the Republicans would lay out the facts on Robert Nutting, it would blow away some of the unpleasant odor accompanying these matters.
First, mistakes and intentional fraud should not be lumped together. That the DHHD computers don’t talk to each other or that they cut checks for inelibile people for for unsupported amounts is the State Government’s problem. DHHS needs an audit system (if they don’t already have one) that identifies how many mistakes of what type and what actions have been taken to eliminate these causes. The long term trend in the audit needs to be reported yearly to the public and to the legislature.
Second, real fraud needs as the editorial states more investigators. It also needs prosecutions. The current Speaker of the House was charged with stealing $1.6 million his case was dropped when he won election. Political influence should not protect welfare frauds.
I am all for stopping fraud. I also wish the State to be fiscally responsible.
To these ends, the legislature should make this a temporary program (say for two years). At the end of that time, lawmakers should assess how much was saved by the anti-fraud investigators. If the savings is not above or close to what is being spent to “solve” the problem, then the program should be ended and all the extra help laid off.
I speak to people each and every day that claim to be down and out. They carry a smart phone, drive a nicer car than me and drink $4 coolata’s while they tell me their sad stories of woe. Some of this type of stuff is really, really hard to weed out. Poor choices and over extending leads to their inability to meet their obligations. These people are all mixed up with people who sacrifice, scrimp and save and still can’t pay their bills. There should be a safety net for the truly needy. The money that should go to that needy person is being sucked up by people milking the system and refusing to help themselves. Until we meet that head on and fix it we will continue to feed the beast that is our welfare system until it bankrupts us. Putting more money into this system makes no sense.
Wait a minute, you mean there is waste in government? Well the healthcare reform will put all those checks and balances in place to make sure none of this ever happens again. Now we know why Pelosi was in a hurry to pass the bill, it contains all these nice little accountability features that otherwise we would never find out about.