April 07, 2020

Medicaid billing roast

I read with increasing bafflement of the problems of Maine’s Medicaid billing system.

My career spanned 40 years of involvement with computers, including programming, auditing, management and selling. I know a little something about system design, parameter setting, acquisition qualification, performance testing, performance guarantees and operation.

In the Sept. 29 edition of the Bangor Daily News an article, “Panel updated on troubled billing system,” appeared on the current status of the Medcaid system. We are informed that in the nearly two years since the system went into operation, a disaster from the beginning, the problem is not yet solved.

Mike Hall, deputy commissioner of the Department of Health and Human Services, is quoted as saying the capacity of the system to process claims remains “steady and high” at the 90 percent level, peaking at 92 percent the previous week, and all-time high.

I came to Maine 32 years ago as a financial officer of a company that performed the computer processing for a number of local banks. We processed hundreds of thousands of financial transactions every week. If we had bragged to our board of directors that we had reached an all-time high of 92 percent accuracy, they would have roasted the entire management team over a slow alder fire in public view at the mouth of the Kenduskeag Stream with Bill Bullock, chairman of Merrill Trust Company, lighting the match.

So far, throughout the entire fiasco, I have read of no one losing their job.

Why not?

Harold F. Shaw


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