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\t\t\tSenate Minority Leader Sen. Harold ‘Trey’ Stewart, R-Presque Isle, center, speaks during a news conference Dec. 30, 2025 at the Maine State House Welcome Center in Augusta. Stewart is flanked by House Minority Leader Rep. Billy Bob Faulkingham, R-Winter Harbor, left, and House Assistant Minority Leader Rep. Katrina J. Smith, R-Palermo. Republican legislative leaders spoke about alleged MaineCare fraud at Gateway Community Services. (Joe Phelan\/Staff Photographer)<\/p>\n
Maine Republican lawmakers began the 2026 legislative session with a signature issue in mind: Cracking down on Medicaid fraud. <\/p>\n
Earlier this month, conservative members from a key legislative committee asked the state\u2019s government watchdog to investigate fraud by Maine vendors. Official audits of MaineCare, the state\u2019s Medicaid program, may not be catching enough wrongdoing, the lawmakers contended.<\/p>\n
The call came weeks after state officials halted payments to Gateway Community Services<\/a>, a Portland-based health care provider led by a Somali American. The state\u2019s health agency referred the matter to the attorney general for alleged fraud. Company officials have denied wrongdoing. <\/p>\n The Gateway controversy comes amid a series of fraud investigations involving Somali immigrants in Minnesota that have been highlighted by President Donald Trump. The national narrative about immigrant crime, pervasive in conservative media, has Republicans asking questions about one of the state\u2019s largest social services programs.<\/p>\n \u201cI believe what we\u2019ve uncovered is only scratching the surface of fraud here in Maine,\u201d Assistant Senate Minority Leader Matt Harrington, R-Sanford, said at a news conference last month. <\/p>\n In order to better understand how prevalent Medicaid fraud in Maine is, the Portland Press Herald\/Maine Sunday Telegram reviewed data on the state\u2019s fraud investigations from the past 10 years. We asked top officials about the process the state uses to build these cases, and whether they believe criminal activity is going undetected. <\/p>\n Neither the Maine Office of the Attorney General nor the Department of Health and Human Services agreed to make staff available for interviews. A spokesperson for DHHS did not answer questions this week about how much MaineCare fraud is typically found across the department \u2014 or about what the state might be missing. <\/p>\n Our review found that state officials typically look into dozens of complaints similar to those surrounding Gateway each year. Prosecutors, alongside federal authorities, recover millions of dollars annually through criminal convictions or civil settlements.<\/p>\n In the last 10 years, the state\u2019s Medicaid Fraud Control Unit has investigated an average of 76 cases per year and recovered about $5.2 million annually, according to the most recent federal data<\/a>. <\/p>\n MaineCare currently has a budget of $5.4 billion, of which $1.5 billion comes from state general funds.<\/p>\n The state\u2019s investigations cover numerous types of fraud, including overbilling \u2014 as is alleged in the Gateway case \u2014 and allegations of abuse and neglect in health care facilities. The largest financial recoveries in recent years have come from civil cases related to pharmaceutical companies. <\/p>\n Republicans say there\u2019s more to find. They have highlighted an ongoing tax fraud case in which two people are facing charges of filing false claims for counseling and interpreter services in connection with a Lewiston-based behavioral health agency. <\/p>\n Democrats, who have the majority in both the state House and Senate, have said they support investigating the Gateway case and allegations of fraud generally. But Republicans have made fraud their top concern.<\/p>\n \u201cThey\u2019ll either find something or find nothing, but if you don\u2019t ask, you don\u2019t know,\u201d said Sen. Jeff Timberlake, R-Turner, a member of the committee calling for the state to do more. \u201cIt\u2019s important to ask, in my opinion.\u201d<\/p>\n DHHS PROCESSES IN PLACE<\/p>\n Investigators with the MaineCare Program Integrity Unit in DHHS are among the state\u2019s first line of defense against fraud.<\/p>\n Bill Logan, who oversees the unit \u2014 the same one that recently audited Gateway and found evidence of overpayments<\/a> \u2014 said overbilling is a common type of fraud. DHHS has said it has found $1.7 million in overpayments to Gateway as the result of three different audits.<\/p>\n \u201cA vast majority of our recoupments are related to what we would call overpayments,\u201d Logan said during a briefing before lawmakers Thursday. <\/p>\n The Program Integrity Unit refers cases to the attorney general\u2019s office if it suspects fraud or other criminal activity. Logan said they typically make three to five such referrals per year.<\/p>\n DHHS\u2019 Division of Audit also reviews programs that receive MaineCare funding, and can make referrals to the AG\u2019s office or other authorities if fraud is suspected.<\/p>\n Asked if his unit has seen an increase or decrease in fraud recently, Logan said Thursday that referrals have been constant. <\/p>\n \u201cOverpayment amounts, both collected and identified, can vary,\u201d he told lawmakers. \u201cIt really depends.\u201d<\/p>\n Also present at Thursday\u2019s hearing was DHHS Commissioner Sara Gagn\u00e9-Holmes. She declined a request for an interview as she was leaving the meeting, saying she was late for another engagement. <\/p>\n In a statement later that day, a spokesperson said the department takes all allegations of fraud seriously. <\/p>\n \u201cThe Department\u2019s work is governed by a clear legal framework of audit, review, and compliance monitoring,\u201d the statement said.<\/p>\n MAINECARE FRAUD UNIT<\/p>\n The AG\u2019s Medicaid Fraud Control Unit<\/a> investigates and prosecutes fraud by Medicaid providers, as well as abuse or neglect of residents in health care facilities. Similar units are also in place in other states<\/a>.<\/p>\n The Maine unit employed 10 people as of 2024, according to the most recent federal data. It investigated 58 cases that fiscal year, most of which were fraud-related. Those investigations resulted in eight indictments and seven convictions, including one fraud conviction and six abuse and neglect convictions. There were also four civil settlements. <\/p>\n Authorities recovered just over $236,000 that year, a drop in the bucket of Maine\u2019s multibillion dollar Medicaid program.<\/p>\n Nationally, Medicaid fraud control units investigated more than 16,600 total cases in fiscal 2024, resulting in $1.4 billion in recovered funds. There were 817 fraud convictions. <\/p>\n In the last 10 years, cases in Maine have been brought against both individuals and companies, with the most money being recovered in civil cases centered on pharmaceutical companies and laboratory or medical equipment, data from the attorney general\u2019s office shows.<\/p>\n In 2016, the state recovered $7.7 million in a national settlement<\/a> with the drugmaker Wyeth and its parent company, Pfizer, over allegations that the company overcharged Maine and other states for drugs used to treat gastric acid.<\/p>\n And in 2020, Maine clawed back $5 million<\/a> as part of a settlement with the pharmaceutical distributor Reckitt Benckiser Group after the company allegedly improperly marketed and promoted the drug Suboxone, costing the state Medicaid dollars.<\/p>\n<\/p>\n Convictions and settlements by Maine\u2019s Medicaid Fraud Control Unit that resulted in restitution for the state. Source: Maine Office of the Attorney General.<\/p>\n LEWISTON INTERPRETER SCHEME<\/p>\n The fate of the Gateway case may rest with the attorney general\u2019s office. DHHS said in December that it had referred the case there. However, the AG\u2019s office has not confirmed whether it is looking into it. The office does not typically comment on active complaints. <\/p>\n The recent separate case involving the alleged false claims for counseling and interpreter services in Lewiston is being prosecuted as a tax fraud matter. The AG\u2019s office declined to say if it is also looking into that case as a health care crime.<\/p>\n The provider at the center of that case, Bright Future Healthier You, was the state\u2019s largest biller of MaineCare for interpreting services in the last 10 years, the Bangor Daily News<\/a>\u00a0\u00a0reported earlier this month. <\/p>\n An attorney for Bright Future Healthier You did not respond to a phone message seeking an interview this week. An attorney for one of the defendants, Rakiya Mohamed, declined to speak about the case while an attorney for another, Abdifitah Abdi, did not respond to a phone message or email. <\/p>\n A similar case unfolded in Maine in 2018, when two Lewiston men who came to the city as Somali refugees were indicted in federal court for their roles as interpreters in a health care fraud scheme that bilked MaineCare out of more than $1.8 million. The interpreters claimed to serve agencies that offered mental health and substance abuse counseling. <\/p>\n Abdirashid Ahmed and Garat Osman pleaded guilty to charges against them in 2019. In 2021, they were ordered to pay a collective $2.5 million in restitution. The cases are the most recent convictions for MaineCare fraud involving interpreter services, according to the AG\u2019s office. <\/p>\n![\"\"](\"https:\/\/www.newsbeep.com\/us\/wp-content\/uploads\/2026\/01\/ph.mainecare.0111_2.jpg\")
<\/a>This chart shows the amount of money recovered annually by Maine\u2019s Medicaid Fraud Control Unit. The money includes recoveries for both state and federal entities.<\/p>\n![\"\"](\"https:\/\/www.newsbeep.com\/us\/wp-content\/uploads\/2026\/01\/ph.mainecare.0111_1-1.jpg\")
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