Letter to Editor: Fraud, Waste and Abuse with Maryland Medicaid

In December, the company contracted to manage Medicaid in Maryland changed from a company we shall call O to a new servicer we shall call C. A bare minimum of information was shared with providers in the field regarding how to manage the transition.  While both companies use the same standard form (CMS -1500)for billing, there are substantial differences in the information they want and even where on the form they want it. But no one made the providers aware of these changes (or perhaps more correctly, the means of disseminating this information was less than robust), not easy to access or easy to find and may have required many hours of online instruction that providers do not have) and claims just get denied.

I, and people that I know in this field have spent NUMEROUS hours on hold attempting to resolve delays in payment for services rendered. I, myself, on at least two occasions, sat for times in excess of 5 hours on hold to get information that ended up being entirely useless and did not resolve the problem. Multiple providers in Talbot County have not been paid for services rendered since December 20, 2024 (the date that the transition from O to C took place). Today marks 3 months without pay for them. This does an incredible disservice to our citizens, both patients and providers.

Similar issues occurred in 2020 when Maryland Medicaid, then managed by the same company as C transitioned to O. The resulting problems contributed a great deal to the demise of  agencies across Maryland, including in Talbot County.  I cannot imagine why under any circumstances anyone would switch back and forth between two entities that are either so completely incompetent or intentionally abusive of our citizens…for services that are so critical to basic human needs and rights.

This is not only inappropriate and unethical…it is criminal.  If I, as a biller, submit false claims to the insurance company, they will come at me with relatively unlimited resources. Meanwhile, they have set up an arcane and labyrinthine system to delay or avoid paying providers altogether for services. The hours required to sit on hold attempting to rectify problems represent a high cost for providers who cannot see patients while sitting on hold or pay an admin person to do so for them.