Lead Maine Backs Rule Changes to Block Medicaid Fraud
Rep. Laurel Libby's Lead Maine initiative is using a little-known rulemaking power to force DHHS to take Medicaid fraud seriously.
When a small group of far-left environmentalists almost forced the entire state to drive electric vehicles in 2024, many Mainers were shocked to learn that a 150-signature petition could, under Maine law, compel a state agency to consider adopting a rule.
That rulemaking effort failed, much to the chagrin of the trust-fund kiddos and baby boomers in coastal Maine.
But Lead Maine, a new group led by Rep. Laurel Libby (R-Auburn), is invoking the same rulemaking process to combat out-of-control Medicaid fraud.
Lead Maine announced Tuesday that it had secured the necessary petition signatures to force the Maine Department of Health and Human Services to consider two rules that it said would bring integrity to Medicaid, known in Maine as MaineCare.
The first rule would require on-site inspections of Medicaid providers. DHHS commonly performs what are known as “desk reviews.” With a desk review, a DHHS employee conducts the “inspection” by phone, and the Medicaid entrepreneur can be located anywhere in the world when it is performed.
The second rule would require DHHS to suspend payments to MaineCare providers that are issued Notices of Violation or Recoupment Orders for overbilling MaineCare. In practice, this rule would have prevented Gateway Community Services, the migrant agency run by Abdullahi Ali, from continuing to bill taxpayers close to $5 million per year despite three consecutive audits finding improper billing.
“Maine spends more than a billion dollars a year on MaineCare. Every one of those dollars belongs to a taxpayer, and every one is supposed to reach a vulnerable Mainer who needs care,” Rep. Libby, founder and executive director of Lead Maine, said in a press release.
“If the state says it inspected a provider, an inspector should have actually been there. And if the state catches a provider billing for money it wasn’t owed, it should stop writing checks until the matter is settled. More than 1,500 Mainers signed on to each of these common-sense ideas,” she said.
According to Maine law, DHHS must now initiate rulemaking on both petitions within 60 days. That process will include a public comment period and a public hearing.
Read our reporting of MaineCare fraud in Maine:
Maine Boots Autism Provider After $16M in Medicaid Billing, Allegations of Fraud and Abuse Emerge
Maine health officials have terminated a Portland-area autism residential care company from the state’s Medicaid program, citing “serious deficiencies” in its operations, after the company billed taxpayers nearly $16 million in three years while charging more than twice the national average for the same service.
Somali-American Refugee's Medicaid Agency Submitted Bogus MaineCare Claims for Years, Former Employees Allege
Former employees of Gateway Community Services, a migrant-run social services agency with offices throughout Maine, have alleged in interviews with The Robinson Report that the company artificially inflated Medicaid billing for at least five years.
Maine Officials Fear Congressional Subpoena Amid House Oversight Probe of Medicaid Spending on Illegal Aliens
The U.S. House Committee on Oversight and Government Reform is investigating Maine’s provision of Medicaid benefits to illegal aliens.
BROKE: Mills Quietly Freezes MaineCare Provider Payments Until July 1 as Fraud Probes Close In
Gov. Janet Mills’ Department of Health and Human Services (DHHS) is once again withholding payments from MaineCare providers, delaying some claims by roughly two months until the next fiscal year begins on July 1.
7,616 Pages of MaineCare Audits Show How Easily the System is Gamed
The Shawn Ryan Show episode on Somali welfare fraud in Maine, among other things, is available now on Spotify. Listen here:
Maine Democrats' Billion Dollar Omnibus: Higher Taxes for Medicaid Fraud Bonuses, Abortion Clinics, Vote Buying, and Checks for Non-Citizens
Maine Democrats are looking to knock out top legislative priorities in a $1.2 billion omnibus bill packed with tax hikes, Medicaid bonuses, funding for Planned Parenthood, raids on the Rainy Day Fund, and — of course — another round of $300 checks to the voters Gov. Janet Mills (D) hopes will stay loyal to her and her party in 2026.
Iraqi Medicaid Swindler Who Claimed Defense Department Clearances Flees Maine for Turkmenistan $1M Richer: The Maine Wire
Seamus Othot’s investigative scoop at the Maine Wire today would read like a hilarious parody if it wasn’t all true.
Thank you,Laura Libby. This has got to stop immediately. This is unforgivable.
And the perpetrators must be punished harshly, especially government officeholders. Hopefully something meaningful will come of this:
https://www.theepochtimes.com/us/hundreds-charged-in-6-5-billion-healthcare-fraud-crackdown-doj-6052046