Maine\u2019s Medicaid program lacks the proper controls to manage the billions of dollars going to health providers across the state, according to an audit released Thursday.<\/p>\n
The findings from State Auditor Matt Dunlap\u2019s office come amid a torrent of calls for increased scrutiny of how the state spends its MaineCare dollars and allegations of fraud, which has prompted another battle between President Donald Trump\u2019s administration and Gov. Janet Mills. <\/p>\n
Front and center in the growing debate is the embattled Portland health care provider Gateway Community Services, which is currently under investigation for potentially defrauding MaineCare largely through overinflated and underdocumented claims for interpreter services. <\/p>\n
Dunlap\u2019s report doesn\u2019t mention either Gateway or interpreter services, but it does warn the state that inadequate monitoring of MaineCare could lead to federal regulators finding Maine out of compliance with its regulations. The state disputed that, but the watchdog\u2019s words could add heat to a tense dispute between the Mills and Trump administrations.<\/p>\n
Republicans stretching from top Medicaid regulator and former TV personality Dr. Mehmet Oz to the Maine Legislature are pressuring Mills on the issue during her heated U.S. Senate primary. Dunlap himself is running in a Democratic primary for Maine\u2019s open 2nd Congressional District.<\/p>\n
The Maine Department of Health and Human Services paused MaineCare payments<\/a>\u00a0to Gateway in December while it investigated \u201ccredible allegations of fraud.\u201d The pause came as a result of an audit by DHHS that included a review of 15,000 claims made by Gateway between March 2021 and December 2022.<\/p>\n Dunlap\u2019s report said the Program Integrity Unit, MaineCare\u2019s internal auditing arm, \u201cmay not provide adequate monitoring of all Medicaid services. Medicaid programs are jointly funded by states and the federal government, but administration of the programs are mostly left to states. <\/p>\n In recent months, Oz has taken an increasing interest in how Maine is overseeing its program. He sent a letter demanding detailed information regarding the state\u2019s oversight of Medicaid spending, outlining concerns and mentioning a federal criminal case against two interpreters<\/a>\u00a0who are charged with defrauding the federal government by filing false tax returns.<\/p>\n The case alleges that two interpreters filed false tax documents with the federal government showing their companies were paid for interpreter services that didn\u2019t happen. The third defendant in the case was an employee of the Lewiston-based Bright Future Healthier You, who died after she was charged.<\/p>\n Bright Future Healthier You was the largest biller of MaineCare for interpreting services in the last 10 years. The company itself has not been accused of any wrongdoing. <\/p>\n The case is the first case the federal government has brought in Maine since a 2021 report by a federal investigator that outlined a suspicious billing pattern<\/a>\u00a0for interpreter services. The report highlighted that the billing patterns seemed especially prominent among providers working with Maine\u2019s Somali community and indicated widespread fraud within the MaineCare system. <\/p>\n Gateway was the second-highest biller of interpreter services in the last 10 years and has been the subject of numerous fraud allegations dating back to May 2025, when The Maine Wire<\/a>, the media arm of the conservative Maine Policy Institute, first reported on claims from a former employee that Gateway falsified records.<\/p>\n Oz\u2019s letter followed an audit performed by the U.S Department of Health and Human Services that found that Maine had made at least $45.6 million in improper Medicaid payments for support services for children with autism in 2023. <\/p>\n