I’m writing regarding the Maine House Republicans’ recent press release about a federal audit finding $45.6 million in improper MaineCare autism payments from the state of Maine.

As a retired physician, I can see from the details provided that the great majority of this so-called “fraud waste and abuse” comes down to simple documentation problems. These include “comprehensive assessment missing” and “absence of staff and parental signatures.” These sorts of documentation issues are usually the result of excessively complex documentation requirements that are not picked up by humans or medical software before being submitted for reimbursement.

It’s highly probable that the appropriate service was actually rendered and the request for reimbursement was “above board.” Such documentation issues are frequently used by public and private insurers to make medical billing excessively complex so that payments for bona fide services can be denied.

In my opinion, Republicans (Democrats, too!) should focus on making the claim submission process less complex, time-consuming and wasteful. Our care providers should concentrate on just that, providing care, not having to become experts in leaping bureaucratic hurdles that are erected by insurers to reduce bona fide reimbursement for services.

Greg D’Augustine, MD
Greene