AUGUSTA, Maine — Staff members at the state Department of Health and Human Services were aware of a technical flaw in the state’s new MaineCare claims and payment system in August 2010, a month before the system’s launch.
However, the flaw wasn’t resolved until March 2012, after the state had made $10.6 million in payments to health care providers for patients who were no longer eligible for services from the state’s MaineCare program. And while some staff were aware of the flaws before the system was launched, Health and Human Services Commissioner Mary Mayhew didn’t become aware until near the end of 2011. She wasn’t able to quantify the cost for several months after that.
Those are among the findings of a report from the Legislature’s investigative arm delivered to lawmakers Thursday concerning computer system errors at DHHS that led to the state making MaineCare payments to providers for 7,730 patients who were no longer eligible for services. The director of the Office of Program Evaluation and Government Accountability, or OPEGA, presented the report to members of the Legislature’s Government Oversight Committee.
Lawmakers had requested the review in April, about a month after Mayhew told them about the overpayments made between September 2010 and March 2012. The news about the overpayments came as legislators were considering measures to address a $121 million MaineCare funding shortfall.
Democratic lawmakers had accused Mayhew and Gov. Paul LePage’s administration of withholding information from the Legislature. The OPEGA report, however, found Mayhew spent several weeks pressing DHHS staff members to quantify the financial impact of the computer system errors. She told LePage about the systems error at the end of February 2012 and told lawmakers less than two weeks after that without knowing the full financial impact. The financial impact didn’t become clear until the end of April.
The new MaineCare payment system was a replacement for a system that never functioned properly and resulted in health care providers not receiving the payments to which they were entitled. DHHS officials were so focused on making sure the new system addressed the provider payment issues that other issues were downplayed or overlooked, the report found.
“We could see in the system it was given a high priority and rated as severe, but there was a whole slew of other issues,” OPEGA Director Beth Ashcroft said of the computer system error.
The overpayments occurred because the bill-paying computer system did not communicate properly with the system with MaineCare eligibility data, so about 19,000 individuals who were no longer eligible for benefits weren’t removed from the billing system.
When DHHS staff members first discovered the issue, they filed a request with Molina Medicaid Solutions, the contractor, to fix it. However, the issue didn’t end up on the highest-priority list for several months, and it was competing for attention with hundreds of other issues, Ashcroft said. In addition, Molina was given a high degree of latitude to address the problems it saw as the highest priorities, based on the direction it received from DHHS.
“Here’s an issue where, if someone is ineligible and getting benefits anyway, we’re wasting state dollars that could be going someplace else. We’re running the risk that we’ll have to pay back federal dollars,” said Sen. Roger Katz, R-Augusta, a Government Oversight Committee co-chairman. “How can our vendor not think this is a priority to get fixed?”
“They were focused on certain kinds of problems, namely being able to get providers paid,” Ashcroft said of Molina. “Somehow, other types of risks either did not get recognized or did not get the same priority.”
OPEGA did not interview Molina officials as part of its review. Laura Hart, a Molina spokeswoman, said the company is working closely with the state to address MaineCare computer system issues.
“Over the past several months, together we have implemented a process to address and prioritize change orders, controls for more effective governance and increased the frequency of communication between DHHS and Molina Medicaid Solutions,” Hart wrote in an email.
Mayhew also said the system is functioning more smoothly and DHHS has improved its working relationship with Molina.
“This is a very good system, and we have made significant progress,” she told Government Oversight Committee members Thursday. “Our relationship with Molina has improved greatly. There is always room for further improvement, but I believe we are on the right path.”
Government Oversight Committee members wondered how it was possible for a staff member to know about a problem in August 2010 and for the department’s commissioner — who changed during that time following LePage’s inauguration in January 2011 — not to find out about it for more than a year.
“Obviously, there’s a failure to communicate here,” Katz said.
Ashcroft said the department had no firm system in place that dictated which technical issues were communicated up the chain of command from staff members working to implement the new system to managers and the commissioner’s office.
Mayhew told lawmakers that has changed. Today, she said, more issues reach the steering committee that oversees MaineCare computer systems and committee members evaluate them based on the potential financial impact and other risks.
“As we prioritize, we are prioritizing based on a much more comprehensive view based on the impact,” she said.
Sen. Bill Diamond, D-Windham, said legislators who were eager to see DHHS put a new MaineCare system in place hold some of the blame for the malfunctions.
“The pressure was there, and I don’t think [DHHS] would have dared to come back to us in September [2010] before the committee and said, ‘We need to extend this for another couple months,’” he said. “They moved prematurely, and as a result we got a system that didn’t work properly.”
Ok, so doctors are getting caught over billing Mainecare for millions, the system itself caused over payment of millions, but it is the people on Mainecare that are the frauds… Do I have that right Governor?
So, in other words “What we have heah is a failuh to communicate.” (Cool Hand Luke, in case you are wondering).
Nice and apt movie line, but I don’t remember the speech impediment.
So, to what extent is Molina Healthcare responsible for the cost to the State of Maine. Let me guess, not at all, we the taxpayers will foot the bill and the company is probably still being paid large sums of money for a failed system. What about the DHHS employees that were aware of the problems with the computer system and failed to notify agency leadership?
You are probably most correct. The software in place, in that sort of system, should be able to “speak” to other software (the list of eligibles), the vendor seems to be at fault. Through the whole history of “computer nightmares” at DHHS – it goes way back – not one vendor has been asked to repay anything to my knowledge.
It is not up to the vendor to ensure that their software can cooperate with other software systems. It is up to the end user to ensure that the software package can meet their needs. They aren’t picking names from a hat, selecting a software package is usually a lengthy process that takes months or even a year before they go through with an implementation process. Before they even get to that phase though, its up to the end users to express their needs of the software–companies providing this stuff cannot read minds. Its up to the end users again to ensure that this new product has a way to extract the data and how it can be used in their existing systems. It continues to get more complicated from there, but anyone familiar with databases, IT, and software knows what I am getting at. Its not this big unknown.
The error here is completely on DHHS–user error, not vendor error for not communicating with the competition or other software packages. Most software does essentially speak to other software, through using import/export data features within the software or going straight to the source, the database, and manually pulling the data from one location, finding the similar tables/fields, and uploading it to the other. Still, this would be a job of someone in their IT department, and something usually covered before the implementation of the potential software package to ensure that they can communicate with other systems in some form. It sounds like the ball was dropped well before they even starting using this new software.
Outrageous. All those people out there living in needless angst!
Once again DHHS just proves how inept its leadership is on a daily basis. What is more aggravating is how lame of an excuse they are coming up with as a reason for this mess. They must have absolutely nobody with any computer, database, or server skills whatsoever. Many places deal with multiple software packages that do not communicate, but there is one common thing between any piece of software like this–the data must be stored somewhere. If that data exists, then there is a way to compare information, even if its through separate systems. No, its not easy, and its not going to take 5 minutes to figure out–but it won’t take 2 years either.
I guess I shouldn’t be surprised. Why should we expect anything different out of DHHS but poor excuses and a waste of money?
Search your memory…very similar headlines about Mainecare and DHHS under Baldacci.
Who’s running that department? Mary Mayhew. Who appointed her to do that job? Paul Richard LePage. And folks are wondering why they can’t get the job done? The blind leading the blind across a busy highway is never going to end well.
LePage also created and appointed the job of Chief Operations Officer to see that someone was actually running the department because he knew the areas in which her skills were lacking. Haven’t heard that man’s name mentioned in a long time.
So a single position that should have gone to one competent person went to hiring two incompetent people who still can‘t get the job done? For the first time in two years I’m beginning to see what Mr. LePage’s jobs plan might be. Please if that other person’s name was LePage, don’t tell me. I’ve heard enough bad news for one day.
Did you even read the article? It clearly stated that DHHS employees were aware of the flaws in the system in 2010 and did not make agency leadership aware of the problems until 2012. Under what administration was Molina Healthcare contracted to design and implement this new computer sytem? Baldacci’s would be my guess. Does Mayhew hold a level of responsibility, yes. Refer to my post below. To what extent is Molina Healthcare responsible for paying for the mistake? What about the employees at DHHS that knew about the problem and said nothing, are they still employed?
Yes I did. “Improper payments were made between September 2010 and March 2012.” When did Lepage come into office? January of 2011. Hired Mary and many other incompetents (lets take a moment now to say goodbye to those who’ve already been forced into early retirement) shortly thereafter. Then what did they do for two solid years? Continue griping about the poor and needy. Maybe if they knew or cared about what they were supposed to be doing instead of griping about those they are supposed to serve they could have caught this error in 2010. Ya think? Who knows, maybe via showing they can do something positive they may not have been wiped out in the last election cycle. Good work is usually paid in kind, bad work gets you fired.
They did catch the error in 2010, but it seems nobody did anything about it and now its finally caught up with them. I am not saying Mayhew or Lepage are completely innocent here, but there has to be more to the story here. Who within the department kept this a secret for nearly two years? I mean the top people of any private company have absolutely no idea what goes on with the majority of their employees…that is what management is for. So I’d say while the top deserves the blame, I think middle-upper management is the true problem here and should be removed from their cushy jobs.
Then logic would dictate that lots of folks in middle management would have been fired. I haven’t heard anything about such firings. Therefore I’d guess that upper management (We all know who’s in charge now, right?) knows that they are truly at fault here. They also know that they can’t fire the folks they’d like to simply “blame” because in the end it would only result in worsening the public’s and the court’s perception of how incompetent they have been. Their only real option is to try not to be so incompetent in the future, and so far that’s clearly been more of a challenge than they’re prepared to handle.
They have clearly proven over the years that they basically excel at only one thing, incompetency.
The public perception of DHHS cannot get much lower–in fact my opinion of them would improve significantly if they fired the incompetent people who kept this from being fixed for almost 2 years. It would be one thing if Mayhew said she learned about the problem when she started in 2010 and did nothing about it, but that does not seem to be the case.
Of course when these middle management people worked under the Baldacci administration they were probably considered by folks like yourself, as the the cream of the crop. How can the agency leadership be at fault for a problem that they were not made aware of for two years. The problems were detected by these agency employees while Baldacci was still in office, I do not see you casting any blame upon that administration. Why?
Ah, because they’re in charge, are supposed to know what the heck their doing and had TWO solid years to figure out there was a 10.6 million dollar discrepancy! Competent leaders don’t blame others for their own shortcomings. Thankfully for this group Keystone leaders they’ve got a few folks bedazzled and defending them. I’m not too sure the public as a whole is gullible enough to jump on that bandwagon. Good luck in the battle ahead, it looks like it’s going to be a rough one for you.
I wonder what you would be saying here had any middle management person lost their job over this.
Should we be entertaining such fantasies only to make those at fault feel a little better or perhaps look a wee bit better to those among us that are not very inquisitive? Middle management didn’t screw up and no one got fired. What does that tell you about who’s really at fault for this massive screw up? That’s right, the folks at the top who if they had any professional decency at all would fire themselves.
Maybe you did not even take the time to read my post before you started whining about LePage and Mayhew. It was not brought to the attention of agency leadership until 2012!!! As ‘Fennis’ replied, it sounds like mid level management within the agency, you know the career agency employees, that failed in this instance. Maybe if you would listen to the context of the problem you would understand that it was not the fault of either LePage or Mayhew. How about the agency holds Molina Healthcare accountable for the problems with the software design flaws in the system they sold the Baldacci administration on. By the way check out Molina MMS, they seem to have more prblems than just faulty computer systems, they seem to like to get rid of American workers in favor of utilizing foreign workers here on H1B visas. Nice company that the Baldacci administration chose to do business with.
I read it. You just don’t present a logical explanation as to why “leadership” couldn’t find their you know what from their elbow for two solid years. Wasn’t anyone interested in looking at the balance sheets during those years? Math isn’t my thing but I think even I’d have noticed a 10.6 million dollar discrepancy. Why didn’t they fire someone (ANYONE!) if they thought they were holding out information for “whatever” reason they would like “you” to believe? Logic suggest that they know who’s to blame, they just don’t want to fire themselves.
LePage was elected in November of 2010. He came into office in January 2011.
Yep, I made a mistake there. See Mr. LePage and Mrs. Mayhew, admitting to a mistake isn’t so hard to do. Corrected thanks to your help Buddy.
It doesn’t matter that the system was set up under Baldacci and the people running it kept the problem a secret for two years. You might also want to ask why the state employees kept it a secret. Still got to be Gov. LePage fault. The attacks just don’t stop. LOL
If you read the article, the new system was supposed to correct the old system. That was in 2010. Log on now, just as, during the presidential election you commented on how the President “blames” Bush……you, my friend are doing the same exact thing, but incorrectly. The fact of the matter is: the old system didn’t work, and the new system didn’t either.
In other words, total incompetence by DHHS and greed by private contractor. This is a calamity of Bob Nutting proportions!
Back to the old the left hand didn’t know what the right hand was doing! I guess to update that it was the payment computer didn’t know what the eligibility computer was doing. In some organizations the messenger of “it is not working” leads to termination.
So the “you take care of it” mentality of the state has resulted in 10.6 million dollar overpayment. Who is running the show? It seems that the folks in DHHS don’t have a clue when it comes to dealing with computers nor are they capable of hiring people who do have the capability to efficiently set up a system. The ship of fools has left the dock and are sailing in choppy waters.
here we go election is over lepage is still trying to do his thing
Just wondering where all these armchair quarterbacks were for the decades when Augusta couldn’t give money away fast enough. Nouveau righteous is even more obnoxious than nouveau rich.
I guess that i find the most disgusting thing about all of this is the public opinion that it is the people recieving Mainecare that are most at fault for the problems with MaineCare, which this proves, it is not. The state has had accounting problems all over the place for a very long time and the average person is getting the shaft by having their benefits reduced or eliminated while nothing happens, either criminally or socially to these people making the screwup at the state and national level. If any of us performed this way on our taxes, we would surely be seeing time in jail, yet these corporate and state and federal government workers just recieve the proverbial slap on the wrist. I wish i had a solution but it just seems to be a situation when things like this happen, they might as well say, “Listen up, Middle Class and Poor, time for you to bend over again”>(
Some “business” administration we’ve got, eh?
Just never occurred to any of the bumbling bureaucrats to just close up this hole before the program started? Nah, they ran out and opened little companies to get in on the 10M gravy train instead. LOL