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.