Doctors and other health-care workers who treat Medicaid patients in Maine may have been overpaid as much as $51 million. And unless the state can recoup the money soon – by relying on the honesty of the health-care providers – other providers may go unpaid.

The overpayments started in January with the installation of a new computer system at the Department of Health and Human Services. A glitch in the software bogged down the system and triggered a logjam of claims, said State Controller Ed Karass.

The faulty computer, operating at about half-speed, failed to process more than 300,000 of the billings, leaving many of the state’s roughly 7,000 MaineCare providers unpaid for their services.

“The system is very unstable,” Karass said, explaining there is a problem with the computer’s ability to sort the claims logically.

State workers at DHHS began estimating the amount those unpaid providers should have gotten and sent out checks. But many of their calculations, based on average bills from last year, were overestimates.

The estimated payments were only expected to last for a matter of weeks until the computer glitch was cleared up. Now, three months and more than $200 million in estimated payments later, it still hasn’t been fixed, said Becky Wyke, who heads up the state’s Department of Administrative and Financial Services.

“It was set up as a stopgap measure,” Wyke said. “It has, in effect, become the norm.”

Because it is near the end of the fiscal year, which ends June 30, she fears the department could run out of money needed to pay those providers who have been underpaid or not paid at all.

“If this were November, we wouldn’t have to do this at all,” she said.

State officials met at the end of the week to plan a course of action. Fewer than 200 providers were identified as having possibly been overpaid by $100,000 or more each, Wyke said.

Those are the providers the state workers will go after first.

It’s a gamble.

Officials will be relying on providers to be forthcoming about whether they were overpaid, Wyke said.

“We’re largely dependent on their information at this point,” she said.

These actions are not intended to take the place of final reconciliation, when the accounts are audited to make sure all state and federal money was properly spent, she said. That will happen later, once bugs are worked out of the computer system and all the accounts settled.

No one knows when the computer system is likely to be running glitch-free.

“The outlook is, we have a lot of work ahead of us,” Karass said.

Meanwhile, state officials are expected to hire the accounting firm Deloitte and Touche to start reviewing the accounts in question, he said.


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