Stopping MaineCare Fraud 

Betty Balderston has been investigating Mainecare fraud for the past 10 years. She says not only is Medicare fraud a lucrative business, but it’s easy to do. “People are billing those systems for services or supplies that were never provided or perhaps services or supplies were provided but they bill at a higher level then what the services or supplies are valued at,” says Balderston.State officials say Medicare fraud is everywhere and the secretary of Health and Human Services here in Maine calls the Maine Senior Medicare Patrol the boots on the ground in this battle but Balderston says the consumers, especially seniors, are the front line of defense. She says all they have to do is look at their statements closely. “They should take a look at them and make sure everything that medicare paid for is a service or supply they actually received,” she says. “A lot of people receive those statements and particularly if they don’t pay any money, if they have insurance that’s picking up the tab they tend to not look at it because it’s not money out of their pocket or so they think.”Balderston points to a recent case of Mainecare fraud as an example of how big of a business this type of crime actually has become. Last December a woman from Harrison, who provided services for children with mental disabilities, pleaded guilty to over charging Maincare by $4 million. But Balderston says stealing from the system is about to get a lot more difficult. “That’s not going to be as easy any longer. Part of healthcare reform is now requiring more background checks and a much more stringent process for people to be able to bill medicare so I think is becoming much more proactive about preventing fraud than what we’ve ever seen before,” Balderston says.Balderston says if this fraud isn’t reigned in it could have some serious long term ramifications on the medicare system. Including higher costs for those in the program but could continued fraud spell the end for the medicare system? “I don’t know that’s the million dollar question isn’t it?” says Balderston. “I hope not and i certainly don’t see that in the foreseeable future.”Balderston does want to note that President Obama has called for a 50% reduction in lost dollars due to Medicare fraud by next year.If you want to report a possible case of Mainecare fraud the toll free number is: 1-877-353-3771