MPBN: Maine Owes More Than $1 Million to Feds in Medicaid Overpayments

By A.J. Higgins

You can read the full article here.

AUGUSTA, Maine — The state Department of Health and Human Services continues to struggle with its Medicaid accounting practices.

A report from the federal Office of Inspector General says the department has yet to devise auditing procedures that can promptly identify Medicaid overpayments to nursing homes.

As a result, the feds say DHHS owes Medicaid a little more than a $1 million for nursing home overpayments that it received in 2011.

Last year, state auditors determined that the Maine Department of Health and Human Services had overpaid nursing homes and assisted-living facilities in previous fiscal year by nearly $30 million. The department laid blame for the bulk of the problems to computer program errors that trace back to 2006.

Now a new Office of Inspector General report claims the department failed to develop protocols to prevent the recurrence of those overpayments, and demanding a fix, as well as the return of $1 million.

“This money that’s due back to the federal government hasn’t been sent back in a timely manner,” state Sen. Anne Haskell says.

Haskell of Portland, who sits on the Legislature’s Health and Human Services Committee, is among State House Democrats who say they’re tired of dealing with nursing home overpayments. She says DHHS officials could solve the problem if they made it a priority.

“To think about all the resources that they’ve put into things that are not proven to be effective, all of the time they spent putting pictures on EBT cards and doing drug tests for such minor results,” Haskell says. “They’ve got resources to do that but they haven’t been able to put resources into this very straightforward and expensive — as far as the state’s concerned — responsibility on their part and that is to rebate that money back in a timely manner.”

“The department really needs to start being more forthcoming with the Legislature about all of these things,” says fellow Democrat Drew Gattine of Westbrook, who is the House chair of the Legislature’s HHS committee, says lawmakers have been hearing from the state that the nursing home overpayments had been addressed, but he says it’s clearly not so.

“The department keeps fighting and pushing back against this kind of transparency and I hope that that’s going to stop because we shouldn’t be hearing about this when the report comes out,” he says. “We should be hearing about this situation from the department ahead of time so we can help them fix these problems as they’re arising.”

But DHHS spokesman David Sorensen says Democrats seem more interested in politics than anything else.

“The fact that Democratic lawmakers are making hay about it shows their motives — they’re simply looking for anything and everything to criticize about the governor” he says.

Sorensen says the department has notified the federal government that it will work to identify outstanding nursing home overpayments and is in the process of refunding the applicable the federal share.

He says balancing the Medicaid books is a fairly routine occurrence and that the amount in question was equal to approximately 1 percent of the system’s $1 billion budget.

Rick Erb, executive director of the Maine Health Care Association that represents around 100 nursing homes and 100 assisted-living facilities, says he believes that the state has addressed the software issues, and points out that the process for determining discrepancies in the amount billed to the Centers for Medicaid and Medicare Services is anything but straightforward.

Erb says he’s not surprised that the state and the feds are still trying to reconcile the books.

“It was not easy to determine the exact amount that was owed because there were underpayments and overpayments at the same time and it was difficult sometimes for the facility and the state to determine the net amount that was owed back by the facilities,” Erb says.

Despite the department’s position on what was described as a routine occurrence, lawmakers such as Haskell and Gattine say the Legislature’s Appropriations Committee is apt to require more detailed information from DHHS.