Maine delegation blasts lack of fraud-cutting cooperation by Medicaid, Medicare

AUGUSTA, Maine — More than 90,000 Mainers qualify for both Medicaid and Medicare, but the two federal programs are not sharing the data needed to make sure individuals are getting all the services they should and to reduce fraud and errors in the programs.

“This is a perfect example of what makes people frustrated about Washington,” said Sen. Susan Collins, R-Maine. “Here we have two federally funded programs that are not communicating and it is costing the taxpayers.”

Medicaid covers about 60 million low-income Americans in partnership with the states and costs $400 billion a year. Medicare provides health care for seniors and costs more than $470 billion a year. There are many poor seniors and disabled people who are called “dual eligibles” because they qualify for benefits from both programs.

“Information about providers who have ripped off the system is not being shared,” Collins said. “This is just not acceptable and has to change.”

Collins said fraud and improper payments in both systems is a serious problem and costs taxpayers billions of dollars. Improper payments alone cost $22 billion for the federal share last year in the Medicaid program and for Medicare the tab was $43 billion.

“We don’t want a silo approach to addressing fraud and abuse,” said Sen. Olympia Snowe, R-Maine. “This is far too serious a problem.”

Snowe is supporting legislation that would require data sharing between the agencies. She said with sophisticated computer systems, the agencies should not only be able to share data between themselves, they should be able to help the states.

“Medicaid is really administered at the state level and the states need to have the information from Medicare to get at mistakes and errors as well as fraud,” Snowe said.

She said so much money is involved in the two programs that crooks have developed sophisticated schemes to rip off the taxpayers. She said the federal government needs to improve its computer capabilities to stop fraud.

“We have had hearings where it was shown we were paying benefits to dead people,” Collins said.

Another scheme uses the identity of a deceased doctor to file claims. There also have been scams charging for services never performed by providers ranging from therapists to ambulance services.

Rep. Chellie Pingree, D-Maine, said she supports legislation in the House similar to the Senate measure. She said while much of the discussion has focused on preventing fraud, better communications between the programs also would result in better care.

“If you are dual eligible, that means you are a senior citizen or you have a serious disability,” she said. “Those are the people that are most vulnerable and are getting all of the help they need to deal with their conditions.”

Pingree said it makes no sense that the programs are not sharing lists of doctors and other providers that have been caught defrauding the government. She said if a provider has been stealing from one program, they often are stealing from the other.

“We are at the point where we cannot afford to spend a dime we don’t have,” she said. “So if you have two giant health care programs that are not well coordinated, we have to do something about it and we have to do it soon.”

Rep. Mike Michaud, D-Maine, said he has co-sponsored legislation that would require the agencies to share information. He said Maine has one of the highest percent of seniors in the country and cooperation between Medicare and Medicaid is crucial to assuring both quality care and in combating fraud.

“It is frustrating that two federal agencies will not cooperate,” he said.
And unfortunately it’s not only these two. We have others that are just as bad.”

Michaud said he hopes the House will act on the legislation this summer, but that is not certain. Collins said the Senate legislation also has not been scheduled for consideration, although she is hopeful it may be made part of other legislation that will be approved.