After arrests, Republican leaders outline steps they want state to take to combat MaineCare fraud

Republican leaders are doubling down on their call for greater legislative oversight of MaineCare following several arrests earlier this week.

During a Thursday press conference in Augusta, Maine Senate Minority Leader Trey Stewart and House of Representatives Minority Leader Billy Bob Faulkingham accused the state’s Democratic leadership of failing to investigate possible fraud in the state’s Medicaid program. 

“MaineCare should be paying for healthcare, not healthcare that doesn’t happen, and that’s what’s happened,” said Faulkingham, who represents District 12.

“How long has it been since we started talking about this stuff?” asked Faulkingham, adding, “it’s been at least a solid two years of beating the drum.”

The leaders specifically outlined three steps they wanted to see the state take, including an independent third party review of MaineCare focused on waste, fraud and abuse; full public accounting from the state health department about what officials knew about possible fraud and what actions were taken; and a status report on MaineCare providers under payment suspension or investigation. 

Stewart, who represents Aroostook County, said that if millions weren’t going to “fraudsters,” that money could be used to increase the state’s Medicaid reimbursement rate for struggling healthcare providers and help close the projected $1 billion budget gap.

The U.S. Attorney’s Office for the District of Maine announced Tuesday that it had arrested six individuals who had been indicted by a grand jury for healthcare fraud conspiracy. Two of the defendants are also charged with obstructing an investigation while a third is charged with making false statements.

Community Home Health Care, a licensed personal care agency headquartered in South Portland, was also charged in the indictment, which followed the Maine Department of Health and Human Services suspending payments to the agency in August.

The parties, who have not been convicted, are accused of submitting false claims to MaineCare for personal care services that had not been performed, according to the U.S. Attorney’s Office. The indictment further alleges that since 2020, the company and its owner, who was among those arrested, submitted numerous claims to MaineCare for services purportedly provided to a single client totaling more than $600,000.

Noting that Community Home Health Care had charged the state a total of $50 million, Stewart asked, “How many other entities around the state are doing the same thing?” 

State and federal Republicans have for months argued the administration of Gov. Janet Mills, a Democrat, was not doing enough to combat fraud. 

Mills administration health officials earlier this year briefed multiple legislative committees on their fraud investigation protocols. Republicans said at the time that they were not sufficient to crack down on what they believed was a rampant problem. In August, the Maine Department of Health and Human Services suspended payments to four providers in addition to  Community Home Health Care and terminated two providers’ contracts due to credible complaints of serious health and safety risks.

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

“Protecting the integrity of all our federally funded health care programs for those who really need them is paramount,” said U.S. Attorney Andrew B. Benson. 

The investigation was conducted by the FBI, the U.S. Department of Health and Human Services’ Office of the Inspector General, Homeland Security Investigations, and IRS’s Criminal Investigation unit, with assistance from Maine’s Medicaid Fraud Control Unit. This prosecution is part of the Homeland Security Task Force initiative established by a sweeping Jan. 2025 executive order aimed at immigration enforcement. The task force increases state and federal collaboration in investigating foreign gangs and transnational criminal organizations. 

In the statement, Maine Attorney General Aaron Frey commended “the sustained diligence of both our federal law enforcement partners and the Maine Medicaid Fraud Control Unit in the effort to bring these cases to this point.”

“I hope today’s announcement serves as an important reminder that federal and state officials are working continuously to protect public dollars for the intended beneficiaries,” he added. 

In June, Lead Maine, a group run by Republican Rep. Laurel Libby of Auburn, submitted a petition to prompt the health department to pass tougher MaineCare oversight rules, including reinstating in-person inspections of providers and suspending payments to providers suspected of improper billing, instead holding their reimbursements in an interest-bearing escrow account until investigations are complete. 

In a statement following the arrests, Libby said, “This indictment is exactly why MaineCare needs real accountability. Every dollar lost to fraud is a dollar taken from a Mainer who depends on this program for care.” 

At a September public hearing, providers and advocates cautioned that the proposed rule changes may put patients’ privacy at risk and make it difficult for healthcare agencies to stay in business.

Eesha Pendharkar contributed to this story.