LePage: Double Number of DHHS Fraud Investigators
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Of course, these cases have been in the papers. So was Nuttings.
How many cases over the last, say 5 years?
I don't know how many there have been, I just went looking for those that I knew about. I have talked to a friend of mine who is an investigator for DHHS and has been for sometime and he has said that most of the fraud in Mainecare is from the service provider end. Once they figure out how to dupe the system, some do, most don't, but some do...but eventually something gives them away and it makes it very obvious. You see almost no client related fraud with Maincare because it is so difficult for them to benefit. There was the time that the woman who claimed to have had 5 kids in 40 months while on Mainecare just so she could get more WIC and more SNAP as well as other benefits. She actually had only 1 child during that time if I remember correctly.
Tom C should go to work for the state, and sort this all out; he seems to have the best grasp of what's not the problem.
This is not a one size fits all sitch.
"clients" cannot get cash money in their hands, but they can have controlled drugs prescribed, become enrolled fraudulently, and over-utilize benefits.
providers are the ones who reap the cash money benefits for fraud.
There are probably numerous more angles for working the system via prescriptions, etc.
Anyone who thinks the system doesn't eventually gamed by the pros probably believes every federal official fully complies with tax law.
Tom C should go to work for the state, Can you imagine that? I'd be fired in a month for my "attitude". They wouldn't like much that I'd have to say.
The Living Independence case is interesting, I wish I knew more about it. All I know is what the paper reported the investigators said, which I don't give much credibility to. It does seem that Solomon was bilking the system, and that amazes me how she was able to do it. I would want to see the records themselves, and sort out the fact from fiction to se what was really going on. In Solomon's case, the main problem seems to have been service units, the expense side doesn't mean anything if she wasn't cost-reimbursement and subject to a cost audit, which few organizations are nowadays. The state is switching to: "we'll pay you for the service unit, you must meet quality guidelines at the service and organization level, and then what you do with the money is your business." It's dramatic for the paper to breathlessly report that Solomon was paying her father-in-law a salary of over a hundred thousand dollars, but, in itself, meaningless, if she was paid soley for service units, except as a sign of excess assets.
The Nutting case, I think, is an example of investigators gone wild. Did Nutting not provide what we was paid for, or was it a paperwork snafu that overly aggressive investigators went into for their own headlines and glory? The investigation put his business under, and now he is house leader. I offer that it was the latter, and I don't think my tax dollars should be going to support that.
The agency I do volunteer work with has an independent board of directors, a management team, direct services providers who are supervised. I can't say it would be impossible, but it would be very hard to get away with anything that wasn't program-approved. Every once and a while I harumph and demand support for a particular expense that catches my eye. Service units provided have to go through three sets of hands, and are looked at by two administrative people before remitted, mostly by virtue of the complicated state billing system. The organization is subject to audit by an outside CPA firm, and the administration is very conscientiousness about following up on their own errors. "Find 'em before the DHHS does" seems to be the motto of the accounting department.
Of the service industries I've worked with over the years, most have an outside board which is more or less involved. The weakness I see in the small organizations are related party transactions, nepotism and service contracts. I've also seen many small organizations run by volunteer chairs that were as tight as a drum.
Is going to ER when you have a appointment w/ your doctor to avoid copay fraud?
It should be. I have from an impeccable source that recently a Mainecare patient came to the ER in Bangor and was upset with the wait, so he went home and called an ambulance to take him to the ER assuming that he'd get quicker service. In my opinion such immoral behavior should disqualify him from taxpayer funded medical care forever.
Bridgton Hospital is opening a clinic this week for patients with no insurance or no regular doctor or you need a doctor right away and your doctor does not have any available appointments for at least a couple of days or you are here on vacation and need to see a doctor without the inflated ER fees for everyday non-emergency type events.
Tom, the only side I am on is the side of the taxpaying public of Maine.The fact that we're even talking about this subject tells you that this governor is going to focus on fraud. The fact that he canned four DHHS political appointees is proof that he intends to change the culture in the department. I have no idea where the present 11 investigators are located, but having two per county seems to be a reasonable way to approach the problem. Time will tell! I'm still hoping that he comes out with a broader FWA Program.
MaineCare fraud occurs on the provider end because that is where the money is made. it is very easy to do that on a subtle, long-term basis because the patient is not paying and consequently does not review the services actually provided versus those claimed. It happens on the same basis as other types of health insurance fraud, except that the patient pays little or no attention to the bill. As long as the service is covered and looks legitimate, it doesn't get questioned.
I know three different families on Mainecare and I have asked them about this in the past and they have told me that they never receive any type of billing information as to what Mainecare is paying for. So it is hard for even those that would question what Mainecare is being billed for if they don't see a copy of the procedures being billed for.
Well.....look at it from the provider side; what possible good would it do for the client to see the bills, as compared to what trouble it could cause.......
Wanna bet they would strongly oppose any effort to provide 'EOB's' to clients as 'too costly, and too much of a work load?'
2 per county approach ought to be fun to watch fail...you think two investigators in Cumberland County is the same as two in a northern county? Can you say ...workload....divide investigators by county by number of recipients, or have a roving team that just scours a tip line or other mechanism.
Old Town woman pleads guilty to methadone clinic mileage scam
By Judy Harrison, BDN Staff
Posted Sept. 13, 2011, at 6:08 p.m.
BANGOR, Maine — An Old Town woman pleaded guilty Tuesday to illegally receiving more than $10,000 in reimbursements for mileage to and from a Bangor methadone clinic.
Kurstin L. Kill, 20, admitted at the Penobscot Judicial Center that she overbilled the state under the MaineCare program for mileage over a three-year period before moving to Old Town.
She was indicted in May by the Penobscot County grand jury for theft by unauthorized taking.
Old Town woman pleads guilty to methadone clinic mileage scam
So we take a heroin addict, and ask her to submit her mileage and then give her more cash the more mileage she submits.
First of all, why are we paying these people for milage? If they WANT to get well, they'll get themselves to the clinic.
Secondly, why is it a surprise when a drug addict lies?
This thing was a failure from the start. As well as Ms. Kill, we should also put the bozos that came up with this plan in jail for criminal stupidity.
Tom C. It sounds like Ms. Kill is being properly held accountable for her crime. I've read a number of your posts, and just want to say that your use of the terms "them, those people, hyaenas (on another thread), etc" is obnoxious, arrogant, and occasionally hateful. I'm not sure if you do that for effect or whether you believe yourself to be superior in some way. I suggest looking back at the entirety of your posts and list all of the "them" and "those people" you've directed your anger towards over time. Then, imagine putting aside all of "those people". Finally, look around you to see who's left. I hope you find some peace in your life.
What are you talking about? I have the most sympathy for Ms. Kill, and also believe she should be held accountable. Please read what I actually write, rather than what you imagine I write.
I've know plenty of drug addicts. If you actually read my posts, rather than just spouted off about them, you'd know that I have over a decade in recovery myself. I AM one of "those people", bud, and I've never claimed otherwise. And, as such, I might have a little insight into what to expect from them, and Ms. Kill acted just as we would expect a drug addict to act.
Putting her in this position was stupid. How is pointing out the obvious "hateful"? It's a plain fact.
Finally, look around you to see who's left. I hope you find some peace in your life.
Holy cow. Are you for real?
First of all, why are we paying these people for mileage? If they WANT to get well, they'll get themselves to the clinic.
Now Tom, these people fall under the protection of the American's With Disabilities Act. They have been forced into taking addictive drugs and cannot be expected to get clean on their own. It is illogical and irrational to expect someone undergoing treatment to have any personal responsibility.
My word man, try to keep up!
CV43: In each of the cases you cite, it has been personal choices that led to a particular outcome, of which the general populace is expected to either capitulate, condone, or accept. The very fact that people are paid or reimbursed from the population for their personal screw up is mind boggling to those of us who think rationally.
I was also very surprised to find out that the state is reimbursing addicts for their mileage. Heck, we make cancer patients claim their own medical mileage on their Federal taxes. I would imagine the same is true for most residents receiving MaineCare. Are addicts somehow more "special"?
Yes, they are considered 'disabled' and fall under the protection of the ADA. I was also surprised to learn this through the ongoing battle with the methadone clinic company (CRC) in Warren.
My girlfriend used to work at a methadone clinic, and said some 'clients' have become disruptive at other clinics so they are banned from local ones, necessitating a long drive to another clinic, since they cannot be denied care. They do, of course, get the extra mileage for driving the additional distance. Since they must take a daily dose and there are far reaching rules for a 'take-home' dose (due to the likelihood it will be sold rather than taken), and they must spend so much time traveling, they are often compensated by the state as well for their 'disability', since they have little time in which to work a normal job.
So remember kiddies: if you make a personal choice and screw up by taking drugs, you will be compensated for it later on. If you get something like cancer, you're screwed and on your own.
Tom C,
I'm sorry for missing the sympathy in your last post. I guess it didn't jump off the screen to me. I read your post in the context of the totality of your posts, in which I believe you tend to speak with contempt of people with whom you disagree. My observation of your posts (rants) is that you tend to unfairly group the targets of your rants together under either a stereotype or a derogatory term (for example...you refer to people as "bozos" in your post). I probably could have picked a better post to make my point, but this one just rubbed me the wrong way. I guess it's hard for me to distinguish when you refer to "these people" with contempt from when you refer to "these people" with sympathy, or better, compassion.
Maybe you just don't understand me.
I'm just a soul whose intentions are good...
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As far as "compassion," the liberal would beleive that Ms. Kill WAS treated with compassion by coddling her, and letting her submit her own milage reports.
However, nothing is further from the truth. I think the clowns that came up with that scheme were a bunch of bozos.
This "investigation" was a waste of taxpayer resourses and human effort. Ms. Kill is worse off than she was before. The state will probably never get paid back, and we'll have to pay for three hots and a cot in the Graybar Hotel for Ms. Kill for six months, and I'd even venture to suggest it's probable that when Ms. Kill comes out she be more cynical and less employable.
This is a case where the problem was the program. Doing FWA on blundercluck of a program like that is just using more government to try to fix bad government.
Heck, I think everyone should be outraged by this fusterclark.
All the rules, regulations, polices, and laws, are nothing but words to paper unless there is a mechanism in place to ensure compliance, and if necessary, penalize those who do not. Ms. Kill made her choice, another bad one at that, and got caught.
I'm not outraged at all, in fact, I'm delighted that somebody scamming the system will have to answer for it. No complaints here seeing tax dollars spent on investigating and prosecuting any like violations. The same goes for monies spent on the corrections side of the equation.
If she really and truly wants to lift herself from the hell of addiction, job one is to be honest to the most important person involved, herself. Her actions tell me otherwise and indicate she will hardly be more cynical or employable than she already is. If there is any outrage to be had, direct it at her for biting the hand that feeds her.
I don't have any problem with her being held accountable.
I do have a problem with the nitwit that came up with this idea.
Do they drive after taking methadone? Seems it would be a DUI offense.
Do a Google search on driving after methadone, and you'll find a ton of articles and information. What you will also find is tons of propaganda from the methadone people, citing numerous doctors, that state the patient isn't impaired. All the associated crashes are just pure coincidence...
Posted: 4:32 PM
Westbrook woman pleads guilty to immigration fraud
PORTLAND — A Westbrook woman pleaded guilty ...to one count of making false statements on immigration applications and two counts of making false statements on benefit applications.
...snip
.... Sharif purported to be someone else when she entered the country and was admitted as a refugee.... also accused of fraudulently obtaining a Social Security number and receiving federally funded benefits.
...snip
Sharif's lawyer...said ... her situation ...extremely extenuating" and that he hoped the court would recognize that in determining the penalty in her case.
*************
Sorry, but they all think their own circumstances are "extremely extenuating."
Is there any talk of having a 1-800-welfare fraud number. How about 1-800 i-pay-taxes for taxes?
IfW deals with animals. You break animal game laws and you might have someone dial operation game thief and you get investigated. So....operation welfare thief? With the same rewards that game thief offers?
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State records show Decent Home Care first received state funds in 2006, the year it was incorporated, and was paid $118,909 that year. Payments to the company increased by 796 percent, to more than $1 million by 2008, and so far this year the company has received $422,731.
Word Press
A 42-year-old Harrison woman who ran a company that provided services for children with mental disabilities has pleaded guilty to allegations she overcharged the state of Maine’s MaineCare program $4 million.
BDN
Here are two instances where businesses have taken large sums of funds from Mainecare.