In fact, Martins admits, what DHHS calls "consumer fraud" — that committed by people receiving public benefits — is far smaller than "provider fraud," most common in Medicaid, in which doctor's offices (or their employees, unbeknownst to the bosses) overbill the state, or bill for services never provided, and pocket the extra. One single case in 2010 resulted in an order for $4 million in restitution from a lone defendant who pled guilty to overbilling that much money from the state's Medicaid program over the course of several years.
"That's really where the money is," Martins says. But it's certainly not where the rhetoric and political attention are.
"If the discussion is only about fraud, we miss the entire conversation we need to be having," says Christine Hastedt, public policy director at Maine Equal Justice Partners (a nonprofit working to address poverty and related issues). She believes fraud here is "much less than in most states," and observes that LePage's railing against fraud seems most virulent when targeting the working poor and low-income people. Certainly LePage railing against corporate fraud and excess is so rare that even the idea of it seems laughable.
Hastedt says that at all times — but most urgently in a recession where one in six Americans is either unemployed, working less than they want to be, or has given up even searching for a job — we need to look at whether our welfare programs are working, and fix them when they're not.
This is where the divide happens. To be sure, everyone wants to be confident that taxpayer money meant to be spent on helping people is actually helping those in need. But similarities stop there.
Conservatives tend to think the problem is that too many people are on welfare, so they should be made to get off public assistance. They do this by setting time limits for benefits, restricting eligibility, and terminating benefits abruptly once a recipient begins earning money — even cutting off all benefits if a person earns a single dollar more than a program's income threshold.
Progressives, in contrast, tend to think the problem is that too many people have too many needs, and want to help them meet more of their own needs over time. They do this by expanding eligibility for certain programs beyond those who are extremely poor, offering supplemental services to help people stay off welfare, and providing transitional support for people who have been on welfare and are moving back into the work force.
LePage, for example, took his cues from the 2010 MHPC report last legislative session when he proposed eliminating state subsidies and admission into the Medicaid program for families earning between 133 and 200 percent of the federal poverty level. That cut didn't get through the Republican-dominated legislature, but is already being discussed for reconsideration in the 2012 session.
Taking the conservative line, the MHPC calls that subsidy — which can help provide health insurance coverage to families where parents are working but earning low wages and not getting any employer benefits — a "middle class entitlement" that "encourages dependency."
Maine Equal Justice Partners, by contrast, calls Medicaid eligibility for the working poor struggling to escape poverty an important support that encourages people to get off welfare by reducing their fears of losing insurance once they find work.