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Laurel Libby is a Republican state representative, representing Auburn and Minot, and executive director of Lead Maine.
On Aug. 19, the Maine Department of Health and Human Services announced it is initiating formal rulemaking on the MaineCare accountability petitions Lead Maine delivered on June 23, signed by more than 1,700 Mainers. The question needs to be asked: Will Augusta finally treat provider oversight seriously?
I am a mom, a nurse, and a state representative. I talk to families who need MaineCare to work, and to taxpayers sick of finding out about multi-million-dollar failures years after the checks cleared. Everyone loses when the state pays first, and we wait for the federal government and the media to discover the mess later.
MaineCare is enormous. It accounts for roughly one in four state budget dollars, with billions more in federal funds flowing in, enrolling about one in three Mainers. The fact is that it has not been properly stewarded. It needs real rules to ensure accountability to taxpayers and the vulnerable patients it serves.
The public record is already ugly. In January, the federal Health and Human Services Office of Inspector General estimated Maine made at least $45.6 million in improper Medicaid payments for services for children with autism, including about $28.7 million the feds want refunded. Maine had not run a statewide postpayment review of those payments since 2010, the entire existence of the service line.
This lack of accountability is simply unacceptable.
We’ve seen several concerning provider cases as well, demonstrating a pattern of unaccountability. DHHS audits of Gateway Community Services identified roughly $1.7 million in questionable billings across multi-year reviews. Separately, emergency terminations hit residential providers after inspectors documented filth, empty kitchens, and medication failures. These audits and terminations came much too late.
Pay first; ask questions later. This system is clearly not working for the vulnerable patients who rely on MaineCare.
That is why Lead Maine is calling for real accountability controls in MaineCare. We submitted 3,524 signatures across two rule change petitions, more than 10 times the legal threshold to force department rulemaking.
First, DHHS should ensure real on-site inspections happen. A phone call should not count as a site visit. These kinds of shortcuts are how we get issues with ghost providers, where several MaineCare services are housed in the same small, cold, dimly lit office building. Providers billing MaineCare should be verified in person, full stop.
Second, payments should be paused during active billing issues. If a provider is under investigation for improper billing, they should not keep receiving tax dollars like nothing is wrong. Providers cleared of wrongdoing can easily and quickly be made whole.
These rule changes will help not only MaineCare members and taxpayers, but honest providers as well. Honest providers gain when others cannot take advantage of program loopholes. Patients gain when funds follow real care. And taxpayers deserve accountability measures that match the size of the program.
The public comment period is now open, and Mainers have the opportunity to speak up on the record with their stories and perspectives. DHHS has to read and account for everything it receives during the comment period in its response, so it’s worth submitting. Draft and submit yours today on the DHHS website. Learn more at www.LeadMaine.com/MaineCare.
Everyday Mainers spoke up to force Augusta to confront its waste. Now let’s finish the job!