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Policy: Entitlements

Examiner Local Editorial: Medicaid overbilling in Maryland? Round up the usual suspects

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Opinion,Maryland,Local Editorial,Entitlements

Federal auditors once again reported that Maryland has failed to comply with the basic requirements of the taxpayer-funded Medicaid program and must now reimburse the federal government $10.9 million.

A recent review of Medicaid claims for home health care aides that were filed between 2008 and 2010 showed that up to 20 percent were not eligible for reimbursement. Anybody who's been following Maryland's Medicaid history for the past decade knows that this is not just a bookkeeping problem.

The Maryland Department of Health and Mental Hygiene, which administers the Medicaid program for low-income residents, has been making the same "mistakes" over and over again. For example, between 1998 and 2001, federal auditors reported that Maryland improperly reimbursed providers for nearly $1 million in medical services after Medicaid patients had already died. State officials promised to initiate "corrective actions."

Those "corrective actions" included disabling computerized "edits" specifically designed to prevent inappropriate Medicaid reimbursements. Federal auditors reported in 2008 that unnamed state employees had inexplicably turned off computerized safeguards that would have prevented the improper payment of more than $98 million and did not have a system in place to reject claims that did not meet federal requirements. State officials blamed an "antiquated" computer system and promised to do better and reassured state legislators that the $98 million blunder didn't necessarily mean that fraud was involved.

However, two years later, as the latest audit report noted, Maryland still did not have such a system in place or it would not have sent money to Medicaid providers who did not did not meet basic program criteria. They were paid even though they hired unqualified caregivers, some of whom did not even have valid criminal background checks, billed the state for unauthorized services and did not submit the required documentation.

Maryland also paid $2.5 million for more than 300 Medicaid patients who were already dead, including some who died in other states. When federal auditors checked Maryland death certificate records against the Social Security Administration's Death Master File, they found more than 1,000 Social Security numbers that matched but had different names and dates of birth.

Maryland's deputy secretary for health care financing, Chuck Milligan, who previously blamed Social Security for not keeping accurate records, reiterated the state's contention that the latest problems with Medicaid overbilling are "not necessarily" an indication of fraud.But after more than a decade, this isgetting harder and harder to believe.

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