After months of GOP criticism, Maine shares details of Medicaid fraud enforcement

Following months of accusations from national and state Republicans that Gov. Janet Mills’ administration had not done enough to combat fraud in the Medicaid program, the state on Wednesday announced it had suspended payments to five providers based on allegations of fraud.

The Department of Health and Human Services’ program integrity unit, which is responsible for addressing fraud, also said it terminated two providers’ contracts due to credible complaints of serious health and safety risks and disenrolled 28 providers that did not submit a claim within one year of enrollment.

The announcement came two days after Mehmet Oz, administrator of the U.S. Centers of Medicare and Medicaid Services, visited Maine. During the visit, he did not meet with state officials to discuss fraud, which he has repeatedly said is an issue for the state, but instead appeared in a video alongside Republican U.S. House nominee and former Gov. Paul LePage.

“We think there might be $100 million owed back to us,” Oz said in the video with LePage. “That is the tip of the iceberg.”

Lawmakers question Maine’s health department after federal audit 

Oz also said that, based on a federal review, 90% of the home care services for adults with disabilities billed under the state’s Medicaid program, MaineCare, had “no justifiable backup” — a claim that was challenged by the state health department.

“Although the Department’s review is ongoing, our preliminary findings do not support the claim that 90% of services were inappropriately paid,” spokesperson Lindsay Hammes told the Portland Press Herald.

The state’s oversight of MaineCare has been heavily scrutinized by state lawmakers and the federal government in recent months. After the state suspended payments to a Portland-based health provider for alleged fraud, Republican lawmakers questioned health department leaders about anti-fraud protocols. They also referenced a federal audit that found $46 million in potentially improper payments to dozens of providers, which they said underscored a lack of adequate oversight, despite the health department stressing that the audit did not indicate fraud.

When Vice President JD Vance visited Bangor in May, he listed Maine among a few larger, Democratic-led states that “are just impossible to work with, because it’s clear they don’t want to go after the fraud,” he said. 

The outline released by the health department Wednesday emphasized the updated licensing standards and enforcement tools Maine has used since Mills took office in 2019.

“Protecting MaineCare from fraud and abuse is essential to making sure that healthcare remains available for the people and families who rely on it and that taxpayer dollars are invested responsibly,” the release said, noting the the department utilizes “audits, licensing requirements, a health provider registration process, compliance checks, and other safeguards.”

The release also highlighted licensing enforcement action being taken against 15 personal care agencies, with some subject to more than one enforcement action.The health department has issued six conditional licenses, decided not to renew six licenses, assessed financial penalties against 12 agencies and referred one agency to law enforcement, the release said.

The department did not share any identifying details about the affected agencies and providers. Hammes did not respond to requests for comment on additional details of these investigations.