Maine spends $1.4 billion a year on MaineCare, one of every four dollars the state spends. When a provider overbills, the state often calls it an “improper payment”… even if there is fraud involved… and lets the provider pay it back out of future claims.
Steve Robinson of The Maine Wire explains how that works, and the two rules Lead Maine is asking DHHS to put in place.
In this episode:
- How MaineCare became the largest and fastest-growing line item in the state budget
- “Recoupment”: how providers found to have been overpaid can repay out of future claims, with few criminal referrals
- Why low cost-sharing drives ER overutilization, longer waits, and lower quality for everyone
- The cross-subsidy in your paycheck: how low MaineCare rates push private insurance premiums up
- The two rules Lead Maine is proposing: in-person verification before billing, and a payment pause with escrow when improper payments are found
Lead Maine is submitting petition signatures to DHHS to begin rulemaking on these two rules, with a public comment period coming this fall.
Sign up at www.leadmaine.com/mainecare to be notified when it opens.
About Steve Robinson: Editor-in-Chief of The Maine Wire, the leading source of investigative reporting on MaineCare fraud, waste, and abuse in Maine. www.themainewire.com
The Robinson Report on Substack: www.AsMaineGoes.com
Follow Steve Robinson on X: www.x.com/SteveRob