MaineCare... Got FRAUD? | Episode 12 with Steve Robinson

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 Chapters: 00:00 Introduction: who is Steve Robinson 10:16 The leaked Gateway audit and "recoupment" 15:00 The two sets of victims 19:45 When a "site inspection" is a phone call 23:00 Autism services and the human cost 36:54 The "structural gap" that was a fraud gap 40:25 Why your private insurance keeps going up 48:55 The two rules, in plain English 54:28 The quiet crackdown already underway 01:10:08 Protecting the people for whom MaineCare exists Subscribe to Speak Up with Laurel Libby: ▶ YouTube:    / @laurel_libby   ▶ Spotify: https://open.spotify.com/show/75Y2G40... ▶ Apple Podcasts: https://podcasts.apple.com/us/podcast... Follow Laurel: ▶ X: www.x.com/laurel_libby ▶ Facebook: www.facebook.com/laurellibbyMEhouse Learn more about Lead Maine at www.leadmaine.com #SpeakUp #LeadMaine #Maine #MaineCare #DHHS #MainePolitics