Posted on 09/28/2005 8:14:08 AM PDT by SheLion
AUGUSTA - Maine state government is at risk of losing hundreds of millions of dollars in federal Medicaid matching funds due to profound failures in the state's new claims-processing computer system, according to a leading Republican legislator.
After the system went active last January, problems surfaced almost immediately for the 7,000 Maine health care providers who depend on it for payment. Now, missed federal deadlines for matching funds could shred Maine's Medicaid safety net.
"It could create a monster hole in the state budget, because we have claims now already a year old," said Rep. Kevin Glynn (R-South Portland), a member of the Health & Human Services Committee. "As we approach January, the number will increase exponentially.
"They have taken so long to work on the computer problem, and made so many mistakes, that Maine's entire Medicaid system - or MaineCare - is in jeopardy," Rep. Glynn said. "We could be out literally hundreds of millions of dollars."
In 2005, Maine will spend nearly $2.6 billion on Medicaid for approximately 300,000 low-income residents. The federal government would contribute more than $1.4 billion of the total if the claims management process worked smoothly. But the system has been plagued by serious software and hardware problems from the start. While thousands of providers are not getting paid for handling Medicaid patients, others have been overpaid by about $51 million. Moreover, thousands of claims have simply gotten lost in the confusion.
The potential of a devastating loss of federal matching funds took center stage during a September 21 meeting of the legislature's HHS Committee. It was revealed at the meeting that the state also owes Maine hospitals more than $100 million as a result of the computer debacle. Mary Mayhew, vice president of government affairs for the Maine Hospital Association, presented a letter to the committee outlining the situation.
"The Maine Hospital Association estimates that hospitals have submitted over 500,000 claims since January," Mayhew wrote, "with approximately 160,000 properly processed but with 360,000 still unresolved. MHA estimates that these unresolved claims represent well over $100 million in MaineCare payments."
Mayhew added that hospitals now fear that many claims will never be found and they will never be paid for treating those patients. Moreover, she wrote, the computer failure at the Department of Health and Human Services could cost Maine hospitals more than $20 million in federal reimbursements for Medicare, as distinct from Medicaid. "The administrative expense of re-filing and accounting for hundreds of thousands of missing claims will be many millions of dollars," she added.
Hospital officials make no secret of their frustration with the situation. In a comment to the Ellsworth American, Maine Coast Memorial Hospital executive Kevin Sedgwick said this is no simple computer glitch. "This is Chernobyl," he said. "This is a meltdown."
At the root of this chaos is the so-called MECMS - Maine Claims Management System - which went live in January. Rep. Glynn, an information technology expert in the private sector, said the Baldacci administration blundered badly by activating this new, untested computer system without running a parallel system as a backup.
Following the HHS Committee's meeting on September 21, staff analyst Jane Orbeton sent a list of Rep. Glynn's follow-up questions to DHHS Commissioner Jack Nicholas and Deputy Commissioner Mike Hall. Several of them address the clear possibility that the federal government could deny Maine matching funds for claims filed late, claims awaiting adjustments, and claims that lack records showing that providers were paid.
Another possible problem could be that Maine's federal Medicaid matching rate will decrease on October 1, the start of the federal fiscal year. One question from Glynn asked if 2005 claims that have not yet been submitted will be matched at the 2005 rate or the lower 2006 rate.
Another inquiry is aimed at retribution from CNSI, the Maryland-based company that built the $22-million MECMS system. Orbeton asked on behalf of Rep. Glynn: "What are the options or plans for recovering some or all of the costs of the malfunctioning system from the vendor, CNSI? What person or entity has responsibility for making the decision about pursuing liability against the vendor? What is the estimated cost of damages, lost revenues, and extra consulting fees/equipment purchased as a direct result of the computer conversion over and above planned expenditures prior to the conversion?"
To attempt to fix the problem, DHHS has brought in Deloitte Consulting of New York on a $4-million contract.
Copies of the letters from Mayhew and Orbeton are available at the House Republican Office in the State House.
I was asked to forward this to our fellow republicans. Interesting stuff.
Steven Scharf Secretary, Cumberland County Republican Committee 207-774-9393 SCSMedia@aol.com
FOR IMMEDIATE RELEASE For more information:
it probably exposed FRAUD -- no!? Politicians, lawyers, and judges commiting fraud? < GASP! >
Yikes! The population of the whole dang state is 1.2 million.
BTW good to see you moving around.
And Newt and Hitlery are planning for all our medical records to be computerized....so they can save us?
Actually, government here in Maine is either pretty clean or pretty clever about covering its tracks; we get the odd embezzling town clerk and that's about it.
Yep! Second poorest state in the Union next to Tennessee.
The damn idiot and all that voted for this jerk deserve all the crap he is throwing at them. I sure hope his constituents LOVE him. He is nothing but a little Hitler!
BTW good to see you moving around.
Thank you so much. Still painful to sit here, but by gawd, I am. LOL! Get me mad enough over an article and here I sit. hehe!
Oh yes! One chip at a time! 
Thanks so much for your input postcolonialman ! Always helps to get an educated view on the issue. I could go on myself, but I am afraid the Admin Mod would pull my remarks. heh!
Looks can be deceiving
I wonder if this will cause Dirigo Health to crash and burn ahead of schedule?
My line of business also, and you make valid points.
But don't assume the older, bigger players aren't innovating. I work for one of them (needless to say, I can't identify it), and we're constantly updating and improving our product to use new technology such as j2EE, .NET, xml, etc. If I could be more specific, you'd find that contrary to what you describe, we offer web-based applications, real-time processing, and a sophisticated DSS.
Be assured that contrary to your concern, the entry of newer companies is having the desired effect of stimulating innovation at the older players, not stifling it. And as you probably know, the business in any given state is only in place for 3-5 years before being put up for new bids, so even without the newer companies, the established players can't afford to be fat, drunk, and happy. There are enough of us competing for business to keep each other on our toes and constantly looking for ways to be better than the others.
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