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It is easy to take a few high-profile cases and use them to chastise government for a perceived failure. The recent Sun Journal editorial (Dec. 23) in the wake of a fraud investigation of a Norway agency does just that, tweaking the public’s anti-government sentiment, painting the Maine Department of Health and Human Services as a poor steward of public funds, and laying the financial mismanagement of non-profit agencies at the department’s doorstep.

For the record, the DHHS, Division of Audit, referred the case of the Living Independence Network Corp. in Norway to the HealthCare Crimes Unit in the Attorney General’s office on July 31, 2009, long before an alleged “tip” to the AG’s office, which the editorialist cites as the beginning of the investigation.

In that case, like several fraud cases in the past, the DHHS cannot stop payment for legally submitted claims, jump to the conclusion of impropriety or share its findings during an investigation. The reality is that the system worked exactly as it should have in this case to identify fraud, collect evidence and prosecute to the fullest extent of the law. To suggest anything different is unfathomable.

The facts also show that in state fiscal years 2009 and 2010, the Program Integrity Unit in the Department of Health and Human Services identified more than $45 million in overpayments in the MaineCare program and is recovering those funds. This work is done quietly, efficiently and effectively on a daily basis.

Possibilities Counseling and Richardson Hollow, the two other high-profile cases cited in the editorial, are both private companies which provided health care services. In both cases, DHHS paid claims for services provided to eligible MaineCare members. In both cases, the companies mismanaged their finances to the point that they became insolvent and failed to pay their bills. They soon became unable to continue providing services so MaineCare payments ceased, but employees, contractors and other creditors were left unpaid.

The issues at stake in both of these cases are legal issues between the company and its creditors and must be resolved in a legal forum. There was no lack of appropriate supervision or audit control over the claims paid in these two cases and it is simply incorrect to characterize them as examples of MaineCare fraud.

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Make no mistake — there is a great level of empathy for the providers who have not been paid by their employer and subcontractors who have not been paid what they are owed. At the same time, holding the state responsible for assuring that providers who contract with an agency are paid is like holding a customer responsible if the owner of the auto repair shop fails to pay the mechanic who fixed the customer’s car.

Nobody wants to see taxpayer funds misspent. DHHS auditors review more than 600 cost reports, representing more than $1 billion in MaineCare payments every year. They review claims data constantly, looking for evidence of possible irregularities. They investigate every report of possible fraud. And, as the news pages have accurately reported, when suspected fraud is discovered, it is investigated fully and, when warranted, charges are brought. If guilt is determined, people pay restitution and go to jail.

It appears that the very facts that appear on the Sun Journal’s news pages offer strong evidence contrary to their expressed opinions on the editorial page.

Brenda Harvey is commissioner of the Maine Department of Health and Human Services in Augusta.

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