Everyone makes mistakes. Despite their best efforts, doctors, hospitals and other health care providers make their share. So do government bureaucrats. But there's a big difference between an error and a deliberate act of fraud. Those who knowingly and deceptively create a false medical claim in order to bilk the government out of large sums of money deserve no sympathy whatsoever.

That's why one of the bigger errors made by members of the Maryland General Assembly last year was to reject a bill that would have helped the state crack down on Medicaid fraud. Legislation submitted by Gov. Martin O'Malley last January would have given the state the authority to seek triple damages in such cases.

The federal government already has similar power, and it's proven helpful to reducing false claims, but the 10-year backlog of cases is daunting. Maryland's fraud investigations are now hampered: Without some form of punitive damages, perpetrators end up returning their ill-gotten gains as if it was all little more than a no-interest loan.

But the legislation died on the Senate floor by a single vote, the victim of an onslaught of lobbying from the medical community and business interests that claimed it would increase health care costs. Never mind that the complaint was like saying some level of crime is fine because it keeps insurance companies in business.

Specifically, providers complained that provisions in the law meant to protect whistle-blowers would lead to disgruntled employees (and their lawyers) filing costly actions against health care providers with no legitimate cause. But that hasn't been the experience at the federal level. Meanwhile, about half the states - including some of the most politically conservative in the nation - have adopted anti-fraud laws with similar provisions.

That's because the more the state collects from the perpetrators of fraud, the less that must come from taxpayers, providers and beneficiaries. Thanks to the Senate's failure, the state was denied the estimated $11 million in penalties it likely would have received this fiscal year.

In the midst of a severe economic recession, Maryland has had to reduce both services and reimbursements. As much publicity as it generated, the choice to close an Eastern Shore mental health facility was just a small part of the budget reductions. Last year, the total health budget was reduced by more than $271 million to keep pace with falling tax revenues.

With the state facing a projected $1.8 billion deficit in the next fiscal year, Maryland can ill afford to go easy on Medicaid fraud yet again. Governor O'Malley says he will re-introduce the legislation, and we urge the legislature to pass it this year.

Still, there's room for other forms of savings in the $6 billion program. As a recent legislative audit indicated, the Department of Health and Mental Hygiene needs to keep a more accurate accounting of payments to providers made under the program. No doubt a proposed $50 million computer system would help, but there are interim steps that can be taken.

With talk in Congress of further expanding Medicaid as part of President Barack Obama's health care reform effort, Maryland needs to get its fiscal house in an efficient order. Governor O'Malley must not only convince lawmakers to give the state health department the tools to stop fraud this year, he must also ensure that Medicaid isn't mired in waste and sloppy accounting practices that can be just as costly. Readers respond A noble, yet mis-targeted initiative. Although punitive measures help, prevention and use of technology are far superior in reducing this problem. States cannot afford to prosecute frauds below $50,000, and this leaves an umbrella for criminals to operate under. The issue is that lawmakers think in terms of catching criminals and punishing them, rather than cost-effective prevention. Such tools are in use today, and I will be pleased to appear before the legislature on how to implement them. Jeff Leston   Why are fraudulent claims processed as legitimate and paid in full? What kind of ID numbers do the fraudulent claimants use? Are they IDs stolen from participating providers? For electronic remittances to be made, Medicaid needs bank account numbers. For remittances to be mailed, physical addresses are needed. Fraud can only occur if claims processors are asleep at the wheel, if databases with provider information are incomplete or inaccurate or if spurious providers, absent from the databases, are treated as participating in Medicaid and sent checks for services never rendered. Outrageous. The cleanup should occur at the level of data entry, with frequent updating of information already in the system. Incompetent claims processors should be weeded out, and vigilance should be the rule when it comes to remittances. What constitutes a suspicious claim should be clearly defined, and all such claims should be red-flagged. Random audits and requests for documentation will keep the fraudsters at bay, but none of this seems to be happening. The attitude in the hallways of Maryland Medicaid is lackadaisical. Claims are processed and paid in full with nary a thought expended on all the details that will thwart the cheats. Therein lies the problem - and you want to go after the thugs after they have whistled all the way to the bank. Providers are right. Knowing the kind of people who run Maryland Medicaid, they will for sure target providers for innocent errors made while the humbugs sit pretty. A Provider