If you’re on MaineCare or you’re a doctor or medical care provider, the computer problems at the Maine Department of Health and Human Services concern you because you rely in some way on the department’s ability to accurately process medical claims.
If you live in Maine, you probably care about errors because a lot of state and federal tax dollars are used to fund the department. In 2011, the total budget was $3.3 billion.
So you might have been disconcerted to learn recently that the department had overpaid $10.7 million to providers for about 7,700 Mainers who no longer were eligible for MaineCare, which is Maine’s version of Medicaid.
It happened because a system responsible for determining whether a patient was eligible for services was not communicating with a different system responsible for processing the claims. That means people who were deemed ineligible did not have their cases closed when they should have been.
It’s an unfortunate mistake. But it’s not a calamity when you look at the greater context. If anything, the department’s biggest hurdle will be to overcome its chronic image problem. Though the current situation is different, the department has experienced serious data-management problems going back nearly a decade.
Public confidence will be restored only if the department handles the problem openly, allows an independent and complete review of what went wrong, makes the best possible effort to fix the problem and then doesn’t let it happen again.
It appears the department is taking the right approach in this. After adjusting to two new claims systems in the last eight years, it doesn’t need a new one that would require employees to learn new skills and likely necessitate a fresh round of troubleshooting. And having another state take over claims processing, as has been suggested, could prove costly.
Instead, the department is working to improve its Maine Integrated Health Management System, launched in 2010. The department has a team of people from its office, the Office of Information Technology, Office of the State Controller and Office of MaineCare Services that is analyzing how exact improvements can be made, DHHS communications director John Martins said.
In addition, the Office of Program Evaluation and Government Accountability is conducting a review. And people experiencing problems with the system can write in directly online to let MaineCare know.
“There clearly are issues with the system that need to be addressed, and we are working to better understand the relationship with all data systems, including a decade-old eligibility system and how it interfaces with the new claims management system. This is — and will continue to be — a work in progress,” Martins said.
Fixing the problem is not as simple as training employees, but it does involve them, as computer programs will do what they are told to do. The people at the department are working to develop a mechanism to double-check information feeding between system components.
And they’re making progress on tackling requests for system adjustments. So far they have addressed 3,200 requests since the system launched, and they have 500 more to go.
The situation is embarrassing and the department should have been more aware of the possible problems, given its history. A bright spot is that department leaders seem to grasp that this is not just about money but the trustworthiness of the state, and they already have shown they’re willing to work hard to make the complicated system better. That is a sign that improvement is possible.
An unfortunate mistake? How about an example of bloated bureaucratic red tape for a program that costs too much, serves too few and shows no signs of ever going away?
Such is all welfare. Once started they grow exponentially and are for the most part unstoppable.
That’s an impressive flowchart (fig. 1), even in the Navy or at a very large bank did I ever see one like that. The major problem, as I understand it, is that the two computer systems didn’t know what the other was doing, no communication between systems, when there should have been. It’s quite possible this error is one the initial contractor should have fixed long ago. Did the State ever ask for any of that money back?
Now stop to think of the one for the new healthcare bill… the one that created over 100 new agencies to enforce.
I was under the impression that the computer programs were created by the ‘Private Sector’.
Yet the programs were approved for purchase by the “Public Sector,” despite obvious shortcomings.
Then I guess we should be electing computer experts and programers instead of lawyers.
There wwere.
In 2008 a company signed a seven year contract with the state of Maine to handled computer work at DHHS. The information I read said it would handle Maine Care and provide access to the Maine eligibility list. That sounds to me like it was two separate systems even that far back. Definitely sounds counter intuitive to have two separate systems that apparently don’t communicate with each other. Maybe somebody with a degree in computing or a masters in social work could explain it. Considering the flow charts pictured maybe more than that.
Well at least we finally know what company Dilbert works for.
what a mess and we have to suffer for it
Some dedicated, hard working public servant [/sarcasm] was charged with writing the contract and monitoring progress for that system. Twice. What are we overpaying these people for?
This illustrates the main difference between “government run” operations and those in the private sector.
Any private company, oozing money the way DHHS has, for years, due to incompetence in management and accounting depts, would have ceased to exist because expenses exceeded income.
Meanwhile in Augusta, those responsible get promotions, we are assured the problems are surely fixed this time, and everyone on the payroll continiues to enjoy compensation and benefits better than most all the rest of us in Maine could ever dream of.
There are two kinds of people in Maine, those who work for the government, and all the rest of us. Those who are paying the bills are sick of watching nothing but “incompetence be rewarded”.
Defend the bureaucracy all day long, BDN. Mainers expect those responsible for these mistakes to be held accountable. Suspensions and/or terminations best be coming – soon.
This editorial reminds me of car wreck news: “An SUV today ran into three pedestrians…” It ain’t the car’s fault – it’s the driver’s.
Likewise, it ain’t the dual computer systems’ fault, it’s the managers.
Why wasn’t it the fault of the people for all of the other issues before LePage took office?
Didn’t say it wasn’t. This is not a party issue; it is a bureaucracy vs. the people issue. Years after the massive computer messes of the previous administration, the state still owes hospitals and other health providers millions. If any of these organizations owed the state the amounts of money the state owes them, Maine Revenue Service and its battalion of lawyers would have shut them down by now.
DHHS is too darn big to know what the fingers on any hand are doing, nevermind what the left and right hands are doing. Time to Cut!
Outsourcing the development of this system may have seemed cheaper to start with , but now you have a bunch of employees that don’t know how to fix the system.
The complexity is designed in on purpose — to provide cover for the larceny. When you keep the grass mowed short, there’s fewer places for the snakes to hide.
Judging from recent resignations and new hires there’s not much chance of this kind of mess being cleared up soon.