August 23, 2019
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Maine to contest alleged Medicaid overbilling

AUGUSTA – With state lawmakers already facing a $95 million budget shortfall, Gov. John Baldacci says he doesn’t plan to ask lawmakers for $29.7 million to repay an alleged Medicaid overbilling because he will contest the findings of the federal audit that revealed it.

The audit shows that Maine overbilled the Medicaid program, which is funded jointly by state and federal funds, by more than $44 million in 2002 and 2003. Of that amount, $29.7 million was paid by the federal government.

At issue are charges by the Bureau of Child and Family Services for work it did to help Mainers who are served by Medicaid. The audit by the Inspector General’s Office in the U.S. Department of Health and Human Services says the state overbilled and inappropriately billed Medicaid for services provided by the bureau.

State officials disagree and maintain that the Bureau of Child and Family Services calculated the costs correctly.

“It’s far from settled as far as we’re concerned,” said Deputy Commissioner Kristen Figueroa of the state Department of Health and Human Services. “We’re going to continue to fight.”

According to spokeswoman Roseanne Pawelec at the regional office of the Centers for Medicare and Medicaid Services in Boston, Maine has roughly 30 days from Dec. 7 to file its official response to the audit, including documentation of disputed billing issues. CMS will review the state’s case carefully before deciding whether to issue an order for repayment, Pawelec said.

If the repayment order is issued, Maine can appeal the decision and the two parties then would have six months to try to reach a resolution. Pawelec said if a resolution is not reached, CMS would recoup the $29.7 by withholding that amount from a single quarterly payment to the MaineCare program, as Medicaid is called in Maine.

Pawalec said she did not know whether the federal audit was routine in nature or taken in response to specific concern regarding the MaineCare program, but she said it’s not unusual for states’ Medicaid programs to be audited.

Maine legislative leaders in both parties expressed support for the decision to challenge the findings and said they hope the state prevails.

“I have faith in the department,” said Senate President Beth Edmonds, D-Freeport. “The only legitimate thing they can do” is fight the federal government’s bid for reimbursement.

Maine’s handling of the Medicaid program has been a source of controversy. In 2003, a series of reports documented sloppy bookkeeping.

In 2005, the state launched a new Medicaid billing system that sent incorrect payments or nothing at all to health care providers. The state is in the process of outsourcing management of its Medicaid computer system.


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