ME Medicare system still struggling

Federal report hits state for weak spending controls in system, which still suffers glitches 18 months after launch.

Maine officials struggled to explain to state lawmakers why the state's troubled Medicaid billing system is still a mess, 18 months after in launched in January 2005. A US Inspector General's report was critical of the MaineCare system. At a hearing on the system Thursday, officials spun the good news about progress but legislators were clearly frustrated, the Bangor DailyNews reports.

"This has not been an easy process for us to go through and trying to keep a project moving forward that is actually live is one of the most difficult things to do and we’ve been here every single month explaining that to this committee," said Rebecca Wyke, commissioner of DAFS. "Every month we come here and we let the dirty laundry hang out so that all of you will know exactly where we’re at. ...We’re not trying to shove it under the carpet at all."

The federal government is displeased that MaineCare doesn't include effective controls for proper spending of $2.3 billion in state and federal funding last year. Health care providers claim at its worst point, the system had inaccurately processed nearly 600,000 reimbursement claims.

Mike Hall, deputy commissioner for DHHS, told lawmakers Thursday that the capacity of the system to process claims remains "steady and high" at the 90 percent level. Hall said the nearly 600,000 unresolved claims had been pared to 128,000. "We expect a significant decline in that number over the next few weeks and are reasonably confident we are going to bring this number below 100,000 in the near future," Hall said.
Sen. Richard Nass accused the department of stone-walling providers. He said a provider in his district who had been owed $100,000 for nearly a year was not "getting any answers" from the department in his repeated attempts to resolve the problem.
"You need to be candid with us," Nass told Hall. "If you need to say to us that the void functionality is not fixable, please say so. It seems like a year after the fact, it ought to be fixed."