Did a “citizen journalist” catch the state Department of Health and Human Services being complicit in an attempt to defraud the MaineCare program? Or does the hidden-camera video recording released this week show a perplexed DHHS worker trying to placate and efficiently process one goofy applicant?
The truth likely lies somewhere between those two conclusions.
The Maine Heritage Policy Center, a conservative advocacy group that often targets what it sees as wasteful government spending, called the video recording “explosive evidence” of the “shocking potential for fraud” in MaineCare (Maine’s name for the federal Medicaid program).
In the clandestine recording, a man acting as an undercover investigator of sorts applies for MaineCare. He rambles on to Diane, the DHHS staffer, about having a cash-only income, doing business in international waters on his boat “The Bob Marley” and owning a Corvette. If the worker is seeing the red flags the applicant is waving about “pharmaceutical importation” and hidden wealth, she doesn’t let on in the recording. One wonders what she may have been thinking; her somewhat frozen smile gives some clues.
“As far as I’m concerned, I don’t have an income. Help me out,” the fake applicant says. She replies by steering him to seek continuing his family’s private health insurance under COBRA laws.
Later, she does mirror his implied plan to deceive: “You don’t have to go into details. You don’t have a paycheck. You don’t pay taxes. You don’t have an income,” Diane says accommodatingly.
But she also says, to his pointed question about getting on the MaineCare rolls: “I can deny you MaineCare,” and suggests he consider using a nearby free clinic. Diane tells him he does not fit into the categories for coverage and that he will placed on a waiting list. She suggests he apply for Dirigo coverage.
Gov. Paul LePage declined the ripe opportunity to pile on following release of the video, and instead noted that the conclusion of the 45-minute interaction did not result in fraud because the applicant was denied.
In addition to accurately noting that the defraud attempt fails, the governor was right in concluding that more training for DHHS workers is needed.
Those who do this sort of work typically — and appropriately — are sympathetic for and empathetic with the needy. They want to help the applicant receive assistance. Of course, this should not result in coaching the applicant to lie or fail to disclose income and assets.
Anyone who has worked in social service agencies knows that in this intake interview, as it is called, the staffer does his or her best to separate the wheat from a lot of chaff. The presumably needy person is likely — and not coincidentally — poorly educated, inarticulate, confused about the labyrinthine nature of such agencies, frightened, embarrassed and quite possibly prone to slightly incoherent rambling.
The best change that might come with training would be to have front-line DHHS workers ascertain what the applicant’s most pressing needs are. Is it a visit to a doctor? Housing? Food? A job? While the state should not put up hurdles between needy Mainers and the services we all have agreed to fund through our taxes, a more sophisticated interface is possible and desirable.
Additionally, there is a certain amount of judgment in determining assistance eligibility. In recent years, temporary assistance options have been developed with eligibilty requirements less stringent so someone like the phony applicant could have been helped without compromising the integrity of MaineCare.
Lastly, the method the Project Veritas investigator used is suspect. The use of hidden cameras has become a stock tactic that purports to reveal the unfiltered truth. TV news shows like 60 Minutes, Dateline and others have used this method and, in more recent years, conservative crusaders like Andrew Breitbart have scored big with the candid camera.
But one wonders what this videographer did not share; how many such DHHS interviews did he record in which nothing happened? And how many people watched the full 45-minute interview?
This sting had more buzz than bite.