AUGUSTA — Republicans grilled state Department of Health and Human Services officials on Friday, pushing them to answer questions about allegations of improper payments in the MaineCare program.
During a briefing on how DHHS conducts audits, members of the Government Oversight Committee discussed two recent, but separate, instances of problems in MaineCare, the state’s Medicaid program.
In December, Maine DHHS referred what it described as a “credible allegation of fraud” to the Maine Office of the Attorney General involving Gateway Community Services LLC of Portland.
DHHS documents show the company is accused of billing for services not rendered and billing for non-covered services totaling more than $1 million.
Then last month, a federal audit identified nearly $46 million in improper MaineCare payments related to autism programs. It did not describe the payments as fraud, but said the paperwork did not “fully comply with federal and state requirements.”
It asked the state to refund $29 million to the federal government.
On Friday, Rep. Chad Perkins (R-Dover-Foxcroft) accused DHHS officials of “blowing smoke” by describing the $46 million as paperwork errors.
“When they consistently bill for things they know they can’t bill for, that’s not a paperwork error, that’s fraud,” Perkins said. “For you to sit up there and say ‘it’s paperwork errors, it’s no big deal’ that’s ridiculous to me.”
DHHS Commissioner Sara Gagne-Holmes said the department makes payments to over 4,000 providers and is not able to audit all of them each year.
“Rep. Perkins, we’re not saying that this is not important or that it doesn’t deserve to be looked at carefully,” she said.
Perkins then asked why federal auditors picked up on what appear to be billing irregularities — and DHHS didn’t.
Gagne-Holmes responded: “To question the credibility of civil servants is not appropriate. We are not the ones doing the improper billing. We are doing our jobs.”
She said they are going through the federal audit and checking with providers to follow up on any mistakes. She said the department will recover the funds from the providers and repay the federal government.
In addition, the state has put additional safeguards in place so similar problems will not happen in the future, she said.
“I understand why you are upset,” she said. “It is a big dollar amount, and it is taxpayer dollars. We take that seriously.”
The back and forth came five days after Centers for Medicare and Medicaid Services Administrator Dr. Mehmet Oz told Maine officials they have 30 days to comply with a directive to explain how they track MaineCare fraud or the federal government “is ready to take action.”
In response to Oz’s threat, Gov. Janet Mills said she believes his comments are a “pretense to send ICE and other weaponized federal agents” to the state.
In his statement, Oz also appeared to link Medicaid fraud in Minnesota to Maine.
“Somali fraudsters in Minnesota stole millions from a similar program, and we’re seeing all the same red flags in Maine,” he wrote.
Those “red flags” include rapid growth in payouts, insufficient documentation and lack of state oversight, according to Oz.
In the Gateway case, the company was founded by Abdullahi Ali, who, according to a press release sent by his attorney, maintains ties to Somalia.
“Mr. Ali has been involved in politics in Somalia and has run for local office there, as he has remained as committed to serving the community that he came out of as he has been serving the community here that took him in,” according to a Dec. 12 statement.
Gateway denies that it committed fraud and said it “maintains strict billing, documentation, and compliance protocols.”
On Dec. 23, the state suspended all MaineCare payments to Gateway while the AG’s investigation is pending.
In response to Oz’s statement and his specific reference to Somalia, Spectrum News asked CMS if it has additional information about Somali-led groups in Maine. A spokesperson responded with three links posted to the social media site X.
One was the statement from Oz and the other two showed the formal letter sent to Mills and Gagne-Holmes.
“These findings, combined with national trends and prior OIG and CMS reviews, underscore the need for immediate corrective action and enhanced transparency,” the letter reads.
At the end of Friday’s meeting, legislators on the oversight committee said they would continue discussions on whether to launch an investigation into DHHS at a later date.
Rep. Adam Lee (D-Auburn) called on his colleagues to be careful in how they describe what’s in the federal audit.
“I think we’re all concerned about overpayment and certainly the recoupment is the priority here,” he said. “We’re entitled to be frustrated. We’re not entitled to make things up. I’ve read every single page of this report from OIG. And not in it is an allegation of fraud.”