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Morning Sentinel
MEDICAID BILLING MESS
Time to
crack the whip
Kennebec Journal & Morning Sentinel Thursday, May 17, 2007

We're running out of descriptive words.

There's "deadbeat," "hapless," "incompetent." Then there's "unconscionable," "derelict" and "irresponsible."

Whatever you choose to call it, the state's failure to pay providers of Medicaid services years after they did the work now amounts to stealing. If the state was a private individual, they'd have been taken to the collection agency and small claims court long ago. If the state was a private insurance company, it would have been shut down by now -- by the state bureau of insurance.

Yes, we know that a lousy computer system bollixed everything up. But a computer system is an inanimate object. People who run businesses -- dentists, doctors, physical therapists, hospital administrators -- aren't. And this problem is hurting people. For all the state's commitment to its small businesses and large employers, this strung-out episode is putting the lie to that commitment.

Every time a reporter dips or digs into the issue for the latest update, they find businesses that are hurting. Doctors who won't take Medicaid patients any more because it's unlikely they'll get paid to take them. Hospital administrators at their wits' end. The story's the same, but there's a seemingly infinite cast of victims. And while the state took steps to reimburse providers with so-called interim payments, those payments have hardly settled the outstanding claims.

It's hard to believe that this is a problem that totally defies solution. We can only surmise that somebody, somewhere in state government has made the calculation that we're in so deep, we can't afford to get out of a billing system that's the cyber-version of an unending nightmare. And now the state is saying that it will be three years before a new system will be up and running. Hard to swallow.

Surely, there are some diabolical geniuses out there in the world where computers and finance overlap, who can figure this one out. They're probably only 14 years old, but at this point, we'll put our faith in anyone other than the discredited functionaries in Maine state government. Those folks need to go back to school, and let somebody competent and responsible take over this mess. No more excuses.


Reader comments

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Eric Rutberg of Wilton, ME
May 22, 2007 12:52 PM
I'll tell you what is "unconscionable." Perpetuating the stigma of people being "less-than" if they have Mainecare is a dispicable concept. You know what is irresponsible? The devisive bigotry, snobbery and hypocricy of any neo-conservative who would preache moral fortitude out of one corner of his mouth, while demeaning a person for using a perfectly legal insurance program in order to keep themselves and their children healthy.

The innane accusations that providers who accept Mainecare are morally deficient, committing billing fraud and unworthy of reimbursement is just another attempt to marginalize this accounting debocle. This sham is a mockery of a travesty and as a provider of services paid by Mainecare I will be approaching the State for reimbursement of my losses as I an enttled according to Public Law 2005, Chapter 519.
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AJ of Rome, ME
May 17, 2007 12:19 PM
To the Editorial Staff of the KJ,
Your loyal online readers will SURELY remind you of THIS missive on the "deadbeat," "hapless," "incompetent." Then there's "unconscionable," "derelict" and "irresponsible." State's ability to handle THIS medical insurance issue when they start pushing "single payer" on us and you support them.report abuse
Jeff Holt of Industry, ME
May 17, 2007 11:03 AM
Some Medicaid providers deserve the sympathy of the KJ and the media, while others do not.

Accountability is a 2-way street and some providers in the state would stop their incessant drum beat with their friends in the media if they knew their books and their billing codes and procedures were going to be more closely scrutinized. Perhaps it is easier for some Medicaid providers to run to a sympathetic media as it makes for "good press" than to have their payments properly accounted and audited.

It is true that the State of Maine certainly deserves the blame for the MECMS mess, however, there are sound reasons why some payments are held up and there is an appeals process for providers to to be heard should they choose to exercise that right.

Is the KJ suggesting that we throw even more money at the Medicaid providers and worry about the accounting and the regulations concerning the payments of Medicaid dollars "later"?
I must say as a taxpayer, I am astonished to hear the KJ trumpet for more "business as usual" between the Medicaid community and the State especially given the vacuuous lack of accountability with respect to Medicaid dollars.

IMO, former REP. Stan Moody is dead on when he writes, "It is time to Call in the Feds."
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John Smythe of Bangor, ME
May 17, 2007 11:02 AM
Where is the outrage in the legislature over this incompetence? There is none because the legislature and the governors’ office are also incompetent. If they started investigating this mess the lid would pop off of the whole can of worms that is Maine state government.report abuse

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