The health care fraud investigators at the Maine attorney general’s office can rattle off the cases of some of the worst offenders from memory.
There’s the former provider convicted in 1995 of fraudulent billing who’s still paying monthly restitution 17 years later, $200 at a time. His debt to the state is now down to $20,000.
Then there’s Dawn Solomon, a Harrison woman who bilked MaineCare out of more than $4 million through her company that provided services for children with intellectual disabilities. She pleaded guilty in 2010 to overbilling for services and creating businesses solely for the purpose of fabricating invoices.
Solomon illustrates the damage one small health care provider can inflict, according to Michael Miller, head of a unit within the attorney general’s office that investigates health care crimes.
“Dawn Solomon will see my face more than once in her lifetime,” Miller said. “I will try to collect that money from her as long as I’m in this position.”
Abuse of public benefit programs in Maine often brings to mind recipients who lie to the state about their income or circumstances to unfairly gain access to services. But the bulk of the financial hit Maine suffers from health care fraud comes from health practitioners and drug companies tied into MaineCare, the state’s Medicaid program.
“A lot of our big numbers come from pharmaceutical companies who are doing what they’re not supposed to do, but even the small provider in Maine can do a significant amount of damage to the program,” Miller said.
From January 2010 to Sept. 5, 2012, Maine recovered nearly $40 million from civil fraud cases involving MaineCare providers. The state’s share was about $13 million, with the remainder returned to the federal government.
From criminal MaineCare fraud cases, such as Solomon’s, Maine recovered about $4 million in state and federal money over the same period.
Those millions resulted from fraud that government agencies rooted out, but much more is never even caught, Miller said.
Maine’s crackdown on health care fraud is part of a national effort. U.S. Health and Human Services Secretary Kathleen Sebelius, in a speech Tuesday at the Democratic National Convention in Charlotte, N.C., said the federal government has recovered a record $10.7 billion over the last three years from enforcement of health care and Medicare fraud.
The federal health reform law signed in 2010 by President Obama spelled out new enforcement measures, such as tougher sentences for health care fraud crimes, closer scrutiny of Medicare and Medicaid providers and suppliers, and better coordination among state and federal agencies, to prevent fraud.
Big-ticket national settlements from drug companies account for much of the money Maine has recovered, such as a 2010 agreement with British pharmaceutical company GlaxoSmithKline PLC over allegations that it knowingly manufactured and sold adulterated drugs, including the popular antidepressant Paxil. Maine’s share of the settlement totaled $1.8 million.
The cases also include providers that bill MaineCare for reimbursement for services that never were provided, such as a dentist getting paid for extracting the same tooth twice, Miller said.
“I’ve had cases where the provider was out of state or in jail and billing as if they were in a face-to-face counseling session” with a patient, she said.
Harder to catch but more common is “upcoding,” Miller said, where providers bill MaineCare for a greater share of services than they actually supplied. A Bangor psychologist pleaded guilty last week to engaging in sex acts with a client in his office and billing the sessions to MaineCare as therapy.
The financial impact of health care fraud is steepest among providers because the value of the services they wrongly bill for is high, Miller said. Fraud among recipients of MaineCare is also a serious problem, but criminal enforcement historically has been tougher in other programs within the Department of Health and Human Services, such as food stamps, said Assistant Attorney General Leanne Robbin.
From 2009 to 2011, Maine recovered about $80,000 in restitution from recipients of public assistance programs who were convicted of criminal fraud. That represented about a quarter of the $327,000 the state was owed.
Legislation enacted in May is aimed at rooting out those crimes, including instances of people unfairly taking advantage of MaineCare benefits, Robbin said.
“Health care is a real valuable item, and we are well aware of people who are above the poverty level making misrepresentations in order to get MaineCare benefits,” she said.
The state also has convened a work group that’s looking into health care fraud in Maine and has set up an online health fraud reporting form at www.maine.gov/dhhs/fraud/ and a hot line at 866-348-1129.
What a mess has been made by many. Let’s all try being honest. People are destroying themselves by being greedy. Stop now or we all fall down.
and then Mainers elect them to leadership positions, like Maine Speaker of the House Robert Nutting.
http://bangor-launch.newspackstaging.com/2010/11/17/politics/nutting-says-medicaid-overbilling-was-an-honest-mistake/
Your nym should be SingleTrackMind.
Wow. A personal insult. Very deep.
Did you have another point to make or do you just want to talk about my nym?
Of course LePage and his posse are more concerned with denying benefits than they are with regulating these activities where a single provider can cost the system more than 100 of these recipients he’s throwing under the bus. Go after all the MaineCare fraudsters.
All Mainecare fraudsters are real! What part of that don’t you understand?
No fraud should be tolerated but there is much more money to recover from providers than from enrolled individuals.
True enough, point is, get them all.
Oh Oh, Ath20 is loose, lock you doors:)
Correction: lock “your” doors.
Right, so the recipients cheating should get a free pass?
What do you do for work?
“Right, so the recipients cheating should get a free pass?”
Nobody should get a free pass, but a cost-benefit analysis clearly indicates that more resources should be allocated to eliminating provider fraud than recipient fraud.
With better lawyers, it takes more work and political will for the AG to go after providers and drug companies than it does a fraudulent Mainecare recipient. Also, what part of “go after ALL the Maincare fraudsters” don’t you understand?
What part of my post did *you* not understand. Obviously none of it.
Speaker of the Maine House, Bob Nutting got away with over a $million in fraudulently billed medicare charges that he never paid back.
.
He was “punished” by being elected into a leadership positiopn.
No kidding ! 1st I’ve heard of it.
http://bangor-launch.newspackstaging.com/2010/11/17/politics/nutting-says-medicaid-overbilling-was-an-honest-mistake/
I was managing a human services agency that did significant business with Nutting’s business when this all hit the fan. When discussing the case, his employees had a difficult time keeping a straight face when asked if it was really an honest mistake. It was an employee that blew the whistle on Nutting’s fraudulent actions.
What I don’t understand is, how does bankruptcy protect the guilty from being prosecuted for fraud and being forced to return what was stolen? Unless, of course, there really is a “good old boys club” and there really are two different sets of laws.
I wish Dawn Solomon and Bob Nutting could get together to answer that question for me. One was prosecuted. The other not.
Amazing isn’t it?
Drug companies, health care providers cost state millions in MaineCare fraud
Absolutely Mind Boogleing!
Schneider comes up with this revelation years after Obamacare addressed the issue and the repubs call to repeal Obamacare while saying that Obama is cutting Medicare Benefits instead of the fraud to providers and drug companys that he really cut!
These miscreants belong in jail for deception!
The LePage solution is to screw the working poor in Maine by gutting benefits. We need not-for-profit universal healthcare now!
Not going to happen, SEE Greece.
We are Greece, except we still operate a printer!
another government bailout. dont hold them responsible for their actions, just take more from the poor! blame the problem on the people who actually need mainecare/fooodstamps/welfare to survive because of the LAST bailout and the recession as a result of the LAST time they werent held responsible for their actions. sit back and scratch your head and wonder why crime continues to increase instead of taking a step back to look at the bigger picture. these people are products of their environment. the environment created by the government and the ceo’s paying off the politicians so they can continue to abuse their positions of power. its sick. did it really take an article like this to understand that abuse of mainecare/food stampts/welfare is not limited to its’ receipients?
it was the Medicaid or, as it is called in Maine, MaineCare, not medicare, which is a federal program
MaineCare is funded more by the federal Medicare program than by state funds.
.
It is Medicare as it is implemeted in Maine.
“Drug companies, health care providers cost state millions in MaineCare fraud.” And although they pay off both Rs and Ds (One more than the other of course) they all vote Republican! It’s time for the average American to get out and vote to stop the thievery by voting out the biggest offenders. That would be thieves like Nutting, or simply those who support through their votes industries that steal from taxpayers and the weak solely for their own self gain.
One of LePage’s biggest campaign contributors was a drug company.
There is obviously a “good old boy club” that Nutter is a part of where they watch each others backs. But hey, somebody has to vote this Nutter fool into office and must not care that he got away with stealing taxpayer money with his fraudulent accounting. If it were you or I, or even Dawn Solomon, we’d be prosecuted and forced to pay back what we stole. Obviously two sets of laws here.
Lock up ANYONE who is caught frauding Maine Care or any other government entity no matter WHO they are! If the drug companies are committing fraud, lock up the CEO’s of the companies. Enough is enough! Oh one other thing…If a politician gets caught they should get a life sentence!
You can’t imprison a CEO unless he had knowledge of each case. In most cases, CEOs wouldn’t have this knowledge.
In some cases they where “””Retroactively Retired””‘ when the crimes took place!
I could..
I disagree on this one. The CEO’s know more than they let on. The makers of Vioxx including the CEO knew that it had the potential of killing people and it did. What they did was set money aside to pay out for the class action lawsuits. Now if that isn’t inder handed what is?
Me too. They should know what’s going on.
So change corporate law/criminal law to make corporate management criminally liable to give them a reason to know what their corporation is doing. As it stands now, management has no incentive to know.
Better yet, redefine corporations so that they are not legally “individuals”. That would make corporate management responsible and invalidate “rights” that corporations have ( like freedom of speech, etc) without responsibility. As one wag opined, “I’ll believe corporations are individuals when Rick Perry executes one.”
Have you ever heard of Sarbanes Oxley? It’s a federal law enacted in the wake of the Enron debacle specifically dealing with business executives’ ability to say “I didn’t know” and all though the focus is mistatement of a company’s financial position I suspect (hope) it could be used to prevent them from denying knowledge of medicare fraud as well.
If individuals not entitled to benefits obtain them through fraud, then they should be held accountable. This is true even when it is a provider that is billing the state for services not rendered. I hold them even more accountable in the sense that professionals have ethical obligations to meet, and they fail to do this when they cheat their clients and cheat the system.
A hospital charged MaineCare over 50K for a 1 Liter IV of nutrients given to a leukemia patient and only used half of it! MaineCare was notified of the overcharges however chose to ignore it. I believe LePage was right about Maine’s management being corrupt.
“A hospital charged MaineCare over 50K for a 1 Liter IV of nutrients given to a leukemia patient and only used half of it! MaineCare was notified of the overcharges however chose to ignore it.”
Are you seriously suggesting that IV nutrients should be shared between patients?
Possibly the remainder could have been reused on the SAME patient, assuming it did not have an expiry that prevented that. 50K for IV nutrients sounds a little suspicious to me, even if all of it were used. I would like to know what the facility paid for it. I understand the concept of overhead but this may be a little radical.
Bob “Batman” Nutting will check it out right after he pays his money back !
You wanna see Nutting move just mention that the various Drug Company’s are looking at recovering the funds he ‘defrauded’ them out of, or the ‘payola’ of brand vs generic used in filling perscription’s that he collected. And forget the AG’s Office since they can’t even read and apply their own Statute’s (Look at their trying to define what a Veteran is). Instead have one of the Drug Company’s lawyer’s start asking question’s and talking to the employee of Nutting’s that finally said “Oh no, this don’t go”. Just watch how fast Nutting, and his various political crony’s, ‘suddenly’ appear with briefcase’s of cash to settle these claim’s.
And God help Nutting if the Fed’s decide to get into this. Forget the fraud charge, which is bad enough. Now he’s gonna have the IRS zeroed in on him since bankruptcy is also an IRS tax issue. He sold an undeclared asset to Walmart, but didn’t declare that sale’s profit as part of the proceedings that are subject to IRS reg’s, and that is something that the Fed’s are going to be looking into very seriously, not to mention the Maine Revenue Service folk’s. Same for the Fed’s DHHS since any number of the perscription’s that were filled were filled thru the use of Federal Medicare and Medicaid funding. That might not seem like much but multiply them by how many are filled daily over the course of a year and it’s now a number that staggers the imagination, not to mention making a hot shot IRS auditor lick their chops at the thought of finally putting one of these type’s in the lock-up for a good long time for the damage they inflicted on the public that depends on them. Someone going to Ayer’s or Dix for a little ‘vacation’ has been shown to do wonders for compliance.
A kick in the Nuttings would be wonderful !
Does this mean that all the lawmakers that own or work for the “non profit” companies would be checked for fraud.Wow that seems like a good place to start.
MaineCare is the pot of gold @ the end of the rainbow for scam artists everywhere. Well known to be the easiest program in the country to qualify for. Residents of other states on the East Coast have been known to move here SIMPLY TO QUALIFY FOR MAINECARE, GIVE BIRTH ON THE MAINE CITIZENS’ DIME & AND THEN MOVE BACK TO THE STATE THEY ORIGINALLY CAME FROM. This is not a one in a million story, it happens routinely.
Yes. Hordes of professional welfare grifters are currently waddling across the NH bridge to have you pay for their babies. Sounds like an excellent argument for national standardized healthcare.
Read the article.
“But the bulk of the financial hit Maine suffers from health care fraud comes from health practitioners and drug companies tied into MaineCare, the state’s Medicaid program.”
fyi: he was being sarcastic, in reply to TruthHurts.
Prove it! Don’t just pull it out of your butt.
Give us real examples, please, not anecdotes.
I work in the healthcare industry. Have seen this with my own two eyes. Not giving out patient’s names to appease you. If you think this does not happen, continue to keep your head buried in the sand.
Typical response to a request for evidence…
TruthHurts-ME, I totally agree with you, I too work in the healthcare industry and because of HIPAA laws, we are unable to disclose details…but I too have seen it….too many ppl do keep thier head in the sand….I’ve seen ppl crying “disability” unable to work from a bad back, yet they can boogie on a dance floor, cut and haul xmas trees out of the woods, go hunting and pull their prize out of the woods, but they can’t work, OK!?!?!?!
So, do your part to help keep fraud down, and report them! We are all in this together! It does not matter Republican or Democrat…we all live in the US and we all rise and fall together!
http://www.maine.gov/dhhs/fraud/
HIPAA doesn’t prevent you from reporting criminal behavior. Report it and keep reporting it to the authorities. If authorities do nothing about it, report the authorities in the media. With today’s availability of places like youtube, facebook, etc reporting authorities is easy. If you are more old fashioned, organize a political action committee to out the authorities who ignored the fraud. Or, be lazy and do nothing about it except complain in the comment section of the BDN . . .
As someone with an “invisible” disability, a heart problem, I just need to mention that not everyone who is disabled and does an occasional bit of exertion, such as getting a Christmas tree, ONCE A YEAR, may not be a fraud. As a widowed parent, I do have to do some heavy lifting sometimes. Sometimes, it hurts me, and sometimes it doesn’t. I try to take really good care of myself, take my meds as prescribed, but sometimes there are circumstances, when I have to lug a heavy trash bag or move something. I am not on MaineCare and I am not a fraud. I do see people look at me when I park in a handicapped spot, for which I have plates, because I am not supposed to walk more than 60 feet without resting. I have an inherited heart condition that is considered unstable 24/7. I have had two heart attacks, one at work, the other while sitting at my kitchen table. I have had chest pain while doing nothing, being under stress, and while exerting myself, the trick is know when I can exert myself, when I shouldn’t. ditto with stress. My point is someone who is disabled because of a “bad back” may be able to get away with a once a year strain, like the Christmas tree. However, if that same person were working under the table as a lumberjack, then there is an issue. Please judge us carefully.
Gee, don’t blame the Repub’s for everything, they just need the money for an elevator for their auto’s.
I bet you’re a secretary or a MA…most people who say they work in the “healthcare industry” say it that way so as not to reveal that they do not hold a position that gives them credibility.
Secretary’s in the health care industry are not credible.Most see a lot more than the Doctor or owner of the business.
To clarify : I am not a secretary nor an MA (your attempt to minimize those who do perform these jobs shows your own ignorance). Trust me an MA or secretary from a medical practice would have volumes of credible information to contribute to this conversation. I routinely visit medical practices from one end of this state to the other and interact with providers daily. I would LOVE to say there is no fraudulent behavior on behalf of providers, corporations or patients tied to the MaineCare system. This couldn’t be further from the truth.
“I routinely visit medical practices from one end of this state to the other and interact with providers daily.”
He’s a pharmaceutical rep.
Exactly. great comment.
That happens routinely? I doubt that !! Sounds like another LePage LIE.
The truth is most fraud is provider based. And that truth just seems to hurt you. The truth is prosecuting the stereotypical cheating welfare recipient costs far more than the amount of their fraud (a lose/lose situation) while prosecuting the businesses and providers who cheat welfare has the potential to recoup more than the cost to prosecute (a they lose/we win situation).
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The answer is so simple its ludicrous. Pay a bounty to those who turn in the fraudsters.
We have just such a program already in place. Lucky us.
Are you Homer Simpson the famous person:)
guess u gotta tell people about it… like printed on the checks or debit cards they receive from the state!
Drug companies? You cited one example… Why was Mainecare paying for Paxil CR anyway? Everyone know’s it’s a bullshi- drug that the company put out when regular Paxil’s patent was about to expire. (Just like Ambien CR came out when Ambien regular’s patent expired) Mainecare needs stricter criteria for what drugs are covered and not covered. The PA process is foolish– I’ve heard people say they flushed their Tier 1 meds down the toilet and told their doc it didn’t work, so they could get the more desirable and expensive Tier 2 medications. It’s too easy to circumvent the system to get what you want. I’m so tired of people always pointing the finger at the “big evil pharmaceutical companies.” Innovation costs money- developing new treatments takes a lot of work. Without a competitive pharmaceutical market, innovation will cease. I understand there are issues of malfeasance and greed, but lets not paint the entire industry with such a broad brush.
“I’m so tired of people always pointing the finger at the ‘big evil pharmaceutical companies.’ Innovation costs money- developing new treatments takes a lot of work.”
I need clarification – are you saying it’s OK to defraud the taxpayer as long as you spend the illegal gains wisely? Are are you just so devoted to worshipping money that you are willing to overlook the evil actions of the pharmaceutical giants?
Are you so blind you’re forgetting the benefits that some of these medications provide? Namely, keeping people out of the hospital (which is of course, is very expensive), and improving quality of life? A few greedy people at GSK knowingly selling disintegrated tablets, and now the whole industry is evil? C’mon. That’s like saying the oil industry is evil– but I bet you’re not walking to work.
Has anyone looked at what the cost is for many medicines!!!!!! Without insurance most people can’t even afford the most common meds, let alone some of the others!!! How many people can really afford meds that cost anywhere from 500 -2000.00 a month!!! Try it and see how fast you go down!!! Some life savings drugs are much much more, do we say only the rich can have them?
This is a non-issue it is just missing context:
Total spent by MaineCare in 2011: $2.44 billion [i]
Total owed from 2009-2011: $327 thousand [ii]
327 thousand ÷ 2.44 Billion = 0.000134 or about 1/75th of 1%.
I hear a lot about personal responsibility, especially when people talk about cutting MaineCare, Medicare, welfare and other safety nets. However, it is the personal responsibility of every capable person to care for those whom cannot care for themselves.
It is unfortunate that in this politically charged environment people find the need to inflate clear incidences of fraud into an omen of systemic problems. For my part, 1/75th of 1% is an acceptable loss ratio in a system that supports so many who cope with so little.
——————————————————————————–
[i] From DHHS Medicare Review available from:
http://www.maine.gov/dhhs/budget/MaineCare%20Financial%20Projection%20and%20Shortfall%20Analysis%20-%20Attachment%20A.pdf
[ii] From this article:
http://bangor-launch.newspackstaging.com/2012/09/05/health/drug-companies-health-care-providers-cost-state-millions-in-mainecare-fraud/
If you ae saying it is the responsibility for each individual to care for those who cannot care for themselves I agree. I do not agree that the government should be in the business of taking care of those who cannot take care of themselves.
A society that won’t take care of it’s weak and it’s elderly is not a society at all. It’s a pack of preditors.
What happens when the weak become preditors? What happens when they take advantage of the handout? You can’t tell me with a sttraight face that everyone that is weak cannot take care of themselves. If you think you can, come to work with me for a week and just listen to some of those poor weak souls.
If you know they are abusing the system, REPORT them! Don’t punish the ones who are truly in need.
So simple to an outsider. Some get reported, most have no consequence. Sure report them…..will they ever be able to pay? Should they get jail time? Jail time costs more to the tax payer. The fraud system is overburdened so most cases don’t get investigated.
What happens after the fact is unimportant. You sound like you want to complain and throw everyone in the gutter rather than to get the abusers off the system. Where’s the problem? The people who need help or the ones scamming the system?
There is no problem, you have it solved. Likely your solution will cost tax payers more, but hey, money grows on trees!
YOU are the one complaining about the abusers you see and do nothing about.
Logical conclusions based on established fact. Very nice and truly appreciated. However, many prefer hyperbole based on anecdote. To too many, preconceptions are mightier than the truth.
pharmaceutical and oil companies…. rats and scumbags
Well, then you should stop buying medications, including Tylenol and stop driving. you forgot the government, they are made up of rats and scumbags.
“you forgot the government, they are made up of rats and scumbags.”
When you say that the American government is made up of rats and scumbags what you are really saying is that Americans are all rats and scumbags. I think you do not truly believe in government of, by and for the people when you express that kind of opinion. Not believing in the American system of government makes you anti-American.
Being a veteran and pro-American I believe in the fundementals of the American Government. A goverment of the people, by the people, and for the people is dear to my heart. The US Constitution is near to my heart. The system of electing representatives to the government; I believe in. Not all Americans are rats and scumbags. Somewhere along the way we’ve changed course. Those elected are puppets in a grand show.
No, he meant to say it was just the Repub’s that are like the ones in the US House.
i don’t take Tylenol… as a matter of fact, i don’t take any medications…. and what’s my driving got to do with it?
i don’t take Tylenol… as a matter of fact, i don’t take any medications…. and what’s my driving got to do with it?
Maine has recovered $40 million from Maine Care “Providers” and the state is owed $327 thousand from people who fraudulently apply for public assistance. After you do the math it makes you wonder why the conservatives constantly bash the needy and praise the business community for their entrepreneurship. Fraud is fraud , regardless of who commits it, but conservatives always want to attack those most vulnerable because they are the least able to fight back.
Republicans “praise the business community.” Conservatives are more cautious about economic power wherever it’s concentrated. We understand that “public-private partnership” (like publicly-funded, privately-provided health care) is often code for “two sets of trotters in the public trough” and that business people are sometimes foolish and greedy. But a market economy – not laissez faire, but leaning that way – still seems to us to be the least bad way of securing general prosperity.
The government loans to the auto industry is a good example of the government lending a helping hand to private business. There was no private money out there to help or at least no one wanted to so the evil government stepped in and loaned them the money and saved millions of jobs. Thanks to us taxpayers and President Obama the U.S. Auto industry is back on top. All of you business minded conservatives yelled and screamed about what a failure this was doomed to be because the government shouldn’t be in the automobile business. Remember when they dubbed GM “Government Motors”? I believe in a free market system but it should not be an un-regulated free market system. I also believe that the government and private business can work together to create a prosperous America but you’ve got to get your Republican buddies in congress to help pass some real job bills instead of trying to get re-elected by sitting on their hands.
But the GM bailout wasn’t needed because GM wasn’t really in any trouble at all.
See? I can write nonsense as flat statements, too.
The big monster picks on the little guy. You realize that many who make the decisions to allow those benefits to be collected are Liberals who want to lend a helping hand or they just can’t say “no”. I’ve seen examiners give advice on how to get the benefits to people who are border line. Those Liberals have to be charged with Fraud as well. It is not a Liberal or Conservative phenomena, it is a human phenomena.
If someone is borderline does that mean they are not eligible or they may be eligible? If they are legaly eligible but they need help navigating the system that doesn’t make anyone a criminal. If you thought that you witnessed someone doing something illegal did you report it? If you didn’t report it then we can only assume that you weren’t sure about what you saw.
I did report it and I doubt anything was done about. I think employees knowingly assising someone who is borderline to find the few extra expenses and/or a way to circumvent the process is criminal.
I don’t suppose that it might have crossed your mind that these damned Liberal,caring individuals were only guilty of pissing you off and it may actually be their job to go the extra mile to help people who are borderline. How dare they extend a helping hand without your permission.
Personal attack is on, repub are alive again:)
What? The suits are stealing us blind? Whoda thunk it?
PCHC sees Maine Care Patients, Rev Carlson was given a car where do you think that money came from?
Shhh, don’t tell Landslide LePage about this. He might have to change his emphasis surrounding Mainecare fraud. He actually might have to go after some of his friends, R. Nutting for example. Opppa I forgot, little Bobby Nutting used the bankruptcy laws to escape restitution. Oh well, we’re a country of laws not men after all. The thought just occurred to me that ordinary people who are convicted of welfare fraud not only have to make restitution but get jail time. What happened to Nutting?
We as a State and Society offer too much to help people and they become dependent on it for their sole income. There are too many people needing/wanting/taking drugs (you can call them medications if you want but no one is responsible for actually taking care of themselves anymore so they get medicated). It’s epidemic. Everyone needs counseling and meds and such. TRY taking care of yourselves and limit hospitalization, medications and other health related issues.
People from the County are wicked Smart, Right on houltonborn!
while taking care of yourself and limiting medications, hospitalization and other health related issues sounds like a great idea what about those with chronic health issues. Severe Asthma for example does not just go away. It actually takes a lot of medication and doctor visits to keep under control. How about stopping coverage for smokers who refuse to quit?
The taxes on cigs in this state brings in 100’s of millions a year.
Have you ever been poor or homeless? Till you fall into those shoes you know not of which you speak.
anything for lepage to get what he wants
My healthcare provider being one of them. I only go when I have to, but they won’t even speak to me unless I make a appointment to go in and discuss what is going on!
It’s not at all surprising that fraud runs rampant when DHHS puts more effort into hiding their own mistakes than they do to ensure computer payment and eligibility systems are in sync and payments are accurate. That doesn’t excuse people or providers from milking the system, but it sure makes it easier.
The $1.6 million in Mainecare payments fraudulently collected by Speaker of the House
Rep. Robert Nutting, R-Oakland was “an honest mistake” or so he says.
After he declared his company bankrupt so he wouldn’t have to pay the money back, he took his list of customers (an undeclared asset) over to Walmart where he has been handsomely rewarded.
Republican ethics.
When is she going to recover trillions of tax payer money and repeal the fraudulent Obamacare.
I Thought Everyone new that? Dosen’t the right hand talk to the left hand up there? I’m not in POLITICS and I new that, read about all the time, suspected that in my own health care encounters….Duh!
And so many people claim that “fraud” is on the recipient end. But poor people don’t make campaign contributions . . .
The fraud is on both ends of this monster, and the only way to eliminate this fraud is to eliminate MaineCare. We have social security and disablity for those who cannot help themselves. We don’t need more programs to allow everyone to become so dependent on the state.
So you must also think that the only way to eliminate fraud in the defense industry is to eliminate our national defense? Or do you reserve the budgetary axe for the programs you personally dislike?
Hack away! We’re spread out all over the world. Most of it cannot be categorized as “defense” anyways.
I reserve the ax for those programs that are not necessary for the role and function of a Federal government determined by a Constitutional Republic of States.
… in the late 1700s.
1970 will do.
That’s Vatican-vs.-the-Cathars logic. “The only way to eliminate the heresy in this region is to kill everybody who lives there. The ones who weren’t heretics will go to Heaven and be better off anyway. Problem solved!”
There are many young people working at places like McDonald’s or WalMart who will not hire them full time so they don’t have to provide any benefit like health care. They don’t pay well either. Almost anyone working even almost full time, with one or more children is eligible for MaineCare by virtue of what they earn, or more specifically, don’t earn. These are not the only large corporations taking advantage of people. In this area, full time work is almost non existent, because part time workers are so much cheaper for the corporation. Many of these people would love just a few more hours so they would be full time, but that is NOT an option for them. Instead there exception lists which further limit the amount of hours they will be assigned. Do you really think someone earning less than ten dollars an hour at not more than thirty five hours a week can afford decent health care for themselves and children?
Hotham, knew where the money was going.
One medication creates 5 side offects that require 7 more medications to fix. Why is that?
Because cannabis, the safest therapeutically active plant in the world, is illegal.
Latest wonder cure? For everything?
At this point, I’m ready to give legalization a whirl.
Biochemistry is complicated.
Good training:)
Funny how the ones spending most of the time demonizing and accusing others turn out to be the guilty ones themselves.
Th—–
>>>>the bulk of the financial hit Maine suffers from health care fraud comes from health practitioners and drug companies tied into MaineCare, the state’s Medicaid program.<<<<<<<<<
That isn't true. . The biggest heathcare fraud comes from people over chargeing private heathcare services. In fact all of the 400 million Maine still owes to the Hospitals has already been collected from the state and our insurance compaies in the form of higher billings.
Back in the 70’s when Medicare was initiated, they were, an they do now, only paying a percentage of the total bill, with the remainder, not the patient’s responsibility. Because many providers could not afford to write off the losses, they raised their “Medicare” prices. The government immediately put a stop to the practice of have separate prices for Medicare, private insurance, and cash payments. So the rates went up, and insurance and cash payers all had to pay the higher rates. This was the only way many single provider offices and hospitals could survive.
In the 80’s HMO’s, seeing how successful Medicare was at only paying a percentage of the bill decided to do the same. Providers were allowed to negotiate, to a degree, how much they would or would not accept for reimbursement. Corporations with the larger number of employees could negotiate a better rate than the smaller businesses for premiums and providers who accepted a deal were listed to bring in more insured clients. As insurers tried to pay less and less prices simply went up. As prices went up so did premiums until now even most large employers have required employees to pay a share of premiums. Almost every insurance has some form of co-pay.
Now premiums have become prohibitive for most lower paid employees and for small businesses. Today there are more uninsured people than ever, and the cost of medical care is at an all time high. The average office visit is around 100 dollars for about 15-20 minutes of the doctor’s time. I am not accusing the profession of anything because today most providers are forced to work in groups in order to manage the high cost of insurance and billing as well as other overhead. We either need social medicine or other affordable alternatives so those at or only just above the poverty level can obtain decent care. We should not have to choose between groceries or heat and medical care, as well as the cost of prescription meds.
Ask Health and Human Services Secretary Kathleen Sibelius what her California cronies did to Liya “Jessie” Lu, a nurse, after saving the life of her patient on January 31, 2005 at Kaiser Permanente Sunset hospital in Los Angeles. For acting to perform her duty of care, Liya lost her life. Liya’s superior was involved in what took place that day!
Also ask L.A. City mayor Antonio Villaraigoza why his city’s police department NE division refused to take the complaint of the patient and why the mayor did not respond when the patient asked for assistance related to the attempt on his life by medical personnel. Ask the mayor if he has received any favors that were dispensed by the corrupt and convicted Kaiser representative Leland Wong to L.A. City officials.
What happened to this patient and to Liya “Jessie” Lu reveals the real side of healthcare and also displays how legislators have handed the people to be enslaved and abused for life by healthcare providers.
So Friggen What
Charlie Rangel- Scammed taxpayers for years, and totally got away with millions in tax fraud-
Barney Frank- Used insider information, but when caught, unprecedentedly furthered that shock on the floor of Congress, by admitting to a gay relationship with his insider boyfriend-
What the hell is wrong with all of you posters who want to make this a class or partisan issue? Theft and criminal activity is just that, and it knows no ideological bounds. How about just demanding from our elected officials (both D’s and R’s) that they fix it. How about really checking out candidates for office to see if they have showed integrity BEFORE you cast a vote.
I would vote for that-
At least I did with Baldacci’s first term…
Once again, LePage and Republicans are choosing to go backward rather than forward. The income from this park is critical for the entire park system. Interest rates are at all time lows. This would be a great investment for the people of this state. Vote for Democrats in November.
Sebelius conveniently forgot to mention the most costly component of healthcare fraud: illegal immigration.
it
Count me among those who take a scoffing tone at the right-wingers who raise the hue and cry about those fraudulent welfare recipients when it turns out that the drug companies and health care providers are the ones lugging off cartloads of money. And I, like more than a few readers, think it is ironic that our very own Speaker of the House, Robert Nutting, is the poster child for abuse.