Somali-American Refugee's Medicaid Agency Submitted Bogus MaineCare Claims for Years, Former Employees Allege
A former billing manager has submitted allegations to Maine's Office of the State Auditor alleging Gateway Community Services engaged in systemic fraudulent billing for at least seven years.
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.
The whistleblower allegations surfaced after a report by the Maine Wire on March 21 revealed that Gateway Community Services had previously been audited by the Maine Department of Human Services (DHHS).
That audit resulted in a Notice of Violation stating the company had over-billed MaineCare, Maine's version of Medicaid, by close to one million dollars from 2015-2017. As of at least 2022, that sum had not been repaid, according to state records, and there’s never been a public explanation as to why.
Despite the unpaid debt, the Gateway Community Services was allowed to continue billing MaineCare for a total of $28.8 million from 2019 to 2024, according to DHHS records. In addition, the company has received multiple other contracts from the Mills Administration in recent years for community health outreach work.
The Maine Wire report also disclosed that Abdullahi Ali, the CEO of Gateway Community Services and a celebrated Somali-American refugee, claimed to be financing Somali paramilitary groups during his unsuccessful 2024 campaign for an elected office in Somalia.
At the same time he claimed in Kenyan TV interviews to be funding Somali militia as part of his campaign to become the next president of Jubaland, he was receiving millions in taxpayer-funded Medicaid payments and other government payments, according to government records and Ali’s own social media posts.
Now, three former employees of Gateway Community Services, including one who has come forward publicly and reported his allegations to the Office of the State Auditor, have revealed details of Ali's roughly $5 million per year MaineCare business — details that paint a picture of systematic and coordinated fraud.
Ali did not respond to a May 8 email describing in detail the contents of this story and the allegations his former employees had made. Nor did his former Assistant Executive Director, Rep. Deqa Dhalac (D-South Portland).
The allegations submitted to the Office of the State Auditor, if true, would implicate Gateway Community Services and its leadership in multiple state and federal crimes, including Medicaid fraud, wire fraud, forgery, and other criminal offenses.
The whistleblower claims are also strikingly similar to the allegations the FBI made last year against several Minnesota-based autism care providers.
That investigation grew out of the sprawling "Feeding Our Future" scandal, a massive fraud scheme whose perpetrators stole over $250 million in federal funds allocated for child nutrition programs during the COVID-19 pandemic.
The Whistleblower Allegations
"I worked as the main biller and payroll specialist for two of the programs within the agency [Gateway Community Services]. Those being section 28, which is rehabilitative home and community supports for children with autism, and also for the personal support specialist program (PSS),” said Christopher M. Bernardini, 44, of Intercession City, Fla., said in an email.
Bernardini worked for Gateway Community Services seven years, with the latter five and half of those years in a billing position that gave him insight into how the company translated its work into payments from DHHS.
“I have suspected fraud within these programs many times, particularly over the last few months," Bernardini said.
In subsequent phone interviews, Bernardini and another Gateway Community Services employee who declined to be named for this story revealed stunning details about how the migrant services agency circumvented internal controls as well as Department of Health and Human Services (DHHS) policies to maximize profits.
Bernardini worked at Gateway Community Services from March 2018 to April 14, 2025. He started as a supervisor and later managed Medicaid/MaineCare claims processing, giving him detailed insight into how the agency prepared records to secure reimbursements from DHHS via MaineCare.
During his time working at Gateway Community Services, Bernardini said he observed manipulation of both electronic records and physical timecards, activities he initially believed were innocent mistakes but would later come to believe were fraudulent in nature and designed to inflate the company's MaineCare payments.
Bernardini told The Robinson Report that he has submitted his allegations to the Office of the State Auditor.
Two additional former employees, speaking anonymously, confirmed Bernardini’s role at the company. One offered additional details on how supervisors at the company conspired to inflate timecards and bill MaineCare for non-existent services, while the other was only briefly employed but able to confirm the positions and roles of Bernardini and the former supervisor.
The MaineCare Cash Cow
Gateway Community Services provides Rehabilitative Community Services (RCS) for children with autism under MaineCare Section 28, as well as related personal support services (PSS) and Behavioral Health Home services (BHHO), also billed under MaineCare. The nature of the services means they are provided at a client's home, and employees self-report their working hours to supervisors.
Until 2020, hours were recorded only on paper timecards. To reduce potential fraud, the federal government began mandating the use of an Electronic Visit Verification (EVV) app. The app was soft-launched within Gateway Community Services in 2020, but it was later made mandatory statewide for Section 28 and PSS in 2021.
Bernardini was trained by the state on how to use the system and later trained others at the company. Although the EVV system was designed to reduce billing errors and make it harder for providers to fraudulently bill MaineCare, Bernardini witnessed just the opposite.
"We found a lot of fraud at first...we fired a lot of people," Bernardini said, recalling instances where employees’ EVV records conflicted wildly with their paper timecards, including an instance where an employee was 20 miles away from a client he claimed to be servicing.
Initially, Bernardini’s reports on these discrepancies led to employee terminations. But the issues with EVV records not aligning with paper timecards persisted. His role in reconciling EVV and timecards was later changed, but he continued noticing significant irregularities in both the physical timecards he received and the EVV records he could see on the backend.
From 2021, Bernardini could see plain as day using the EVV system when billable hours were created by a staff worker in the field as opposed to entered at a different date by a supervisor in one of Gateway Community Services’ offices.
"What I had noticed, and began noticing a lot more lately especially, was not having those visits match up with the physical time cards staff were turning in," Bernardini said.
"These people were supposed to be using the [EVV] to check in, and they were not, and all of those logs were just created on the back end by the supervisors," he said. "And a lot of times the time cards did not match up with the visit logs. They'd always have an excuse, 'Oh, we have to train them better. We have to do this.'"
"Well, this is, this is borderline fraud," he recalled saying. "I told them a long time ago, this is, this is borderline," he said.
“I made certain to train everyone to the best of my ability on how to use the system the right way. It's really not hard,” he said. “People use their phones for everything these days so there was no reason why any of these staff couldn't get the hang of it. But they just never did. They just kept creating the logs on the back end rather than holding the staff accountable in the field.”
Despite his suspicions, Bernardini was instructed by his supervisors to continue submitting claims to MaineCare and assured that the hours entered into the EVV system by supervisors were legitimate.
Bernardini said the issues with suspected fraud were particularly acute with immigrant staff servicing immigrant clients, frequently within the same families, primarily in Lewiston and Portland, coinciding with increased asylum seeker arrivals starting around 2019.
The time period Bernardini described also coincided with moves the Democrat-controlled legislature made to expand the eligibility of non-citizens for MaineCare coverage on July 1, 2021 as part of Gov. Janet Mills’ (D) biennial budget.
While non-citizens are generally ineligible for federal Medicaid, Maine is among a handful of states that allows a certain segment of non-citizens to receive MaineCare benefits. Those benefits come at state taxpayer expense, and the state is prohibited from seeking reimbursement for these services from the federal government.
The July 2021 MaineCare changes expanded MaineCare coverage to non-citizens under the age of 21 and some other qualified non-citizens.
Amid COVID-19 and harsh government lockdowns, Bernardini and his family relocated to Florida. However, he maintained his position remotely, processing Gateway Community Services' client visit records and submitting them to MaineCare for reimbursements.
Being in Florida, as opposed to in Maine, is part of the reason why Bernardini was willing to come forward to blow the whistle. He also alleges that Gateway Community Services owes him significant backpay, and he’s enlisted an employment attorney to pursue what he’s owed.
Over time, but especially in recent months, Bernardini described seeing increased irregularities in the records he was being asked to submit to DHHS. He described physical timecards that appeared to be whited-out, EVV records manipulated by supervisors rather than submitted by employees in the field, and other abnormalities that always seemed to increase the amount Gateway Community Services could bill MaineCare.
"I had to take their word that this was all legit, and I'm just getting the time cards, and I'm seeing the EVVs not matching the time cards, and the time cards are whited out and changed, you know, things like that," he said. "And I'm like, 'Holy s***, you guys, what is this?'"
"As far as I knew, paper time cards being whited out and altered was a huge no-no," Bernardini said. "I began seeing this more and more over the last several months. There were frequently timecards that were completely changed."
A former supervisor at Gateway Community Services, who declined to be named for this story, confirmed much of Bernardini's account, as well as his role within the company. They recalled being trained by Bernardini and explained how physical timecards were manipulated at the staff and supervisor level to inflate the hours Bernardini would later bill to Maine taxpayers.
How the Scheme Appears to Work
The scheme worked in a few different ways, according to the former supervisor.
First, employees were instructed to leave boxes blank on client visit records if clients refused services, rather than entering an "R," which would indicate that the service had been refused. Both the employee and the client then signed off on the blank card following the visit. Then the supervisors could later check off at least one box per week for a given service.
In other words, the supervisor and the field worker would coordinate to falsely indicate that services had been provided, rather than refused, according to the former supervisor.
According to the former supervisor, the reason for checking at least one box per week per service was to maintain billing levels. If a client refused a given service—like assistance with bathing or groceries—for several consecutive weeks, then that service would fall off their plan. If a given service was removed from a client's plan, then Gateway Community Services' payments would be reduced. By leaving the timecards blank and later doctoring them after the client had signed, Gateway Community Services could ensure that billing for a client never shrank, regardless of the services provided.
The second method used to inflate billing numbers was to round client time up, rather than down, as is required by MaineCare.
The former supervisor said that they witnessed and participated in such stretching of billable hours on physical timecards.
The former supervisor alleged that Ricia Sawtelle, Gateway’s Chief Operations Officer, instructed them to handle timecards in this manner and explained that it was how Ali, the CEO, wanted client records handled.
In addition to stretching billable hours, the company would also cut corners to ensure that no revenue was left on the table.
For example, the former supervisor said Gateway staff would forge client signatures to documents in cases where a field worker forgot to get a client signature or when getting a signature would be inconvenient.
"I was also instructed to say, for instance, a staff member forgot to get a client signature and I wasn't able to get there to get it personally, they would want that billing to go in that week, so they would ask that I find an older timesheet with [the client's] signature, cut the bottom off it, tape it to the current timesheet, and photocopy it so that there was a signature on the page," the former supervisor said.
Despite voicing discomfort, the supervisor participated in cooking the timecards due to job security concerns, describing the company as offering a competitive wage and good benefits.
The former supervisor claimed that Sawtelle pressured them to create the forged timesheets and, on at least one occasion, even performed the forgery herself when the employee said they were not comfortable doing so.
"I told her, I'm not comfortable with that, and she said, 'I'll do it.' And she did it for me. But then it was the expectation that that would be happening, that we would have signatures one way or the other, so that we could submit it for billing," the former supervisor said.
Sawtelle did not respond to a request for an interview.
The third former employee corroborated the roles that Bernardini and the supervisor held at the company but provided fewer details, noting only inadequate training and a rushed onboarding process.
While the former supervisor observed the stretching of billable hours by small amounts, Bernardini said the suspect EVV and timecard manipulations eventually turned into entire days. He described seeing significant alterations to both electronic and physical records to the point that he could never be certain, especially working remotely, whether the services Gateway was billing for were actually provided.
"I was seeing hours upon hours added to time cards," he said. "Staff would only work 32 hours and then all of a sudden a time card would be changed to fill the entire 40 hours that a client had for example."
"There's no way that should have been happening at all and yet it was happening every single week sometimes with multiple staff and clients," Bernardini said.
At the same time Bernardini was handling MaineCare billing, he was also handling some of the processes for hiring new employees. He said that on several occasions he was asked to onboard an employee who had migrated to the U.S. within the past six months and therefore did not have federal work authorization.
New employees, including asylum seekers, were being paid a $2,000 signing bonus at Gateway during much of the COVID-19 pandemic, Bernardini said. In some cases, he saw records showing “New Mainers” accepting the large signing bonuses and later only recording a few hours of work for the company.
In some instances, Bernardini said the company became aware that staff members and their clients, typically family or friends, were conspiring together to create false MaineCare claims.
“Sometimes the fraud comes from the family making arrangements with the staff.” he said. “For example there was one time I remember where staff had quit due to personal reasons and the client was wondering what would happen to the hours the staff ‘owed’ to them. When probing further we discovered that the client and staff had some sort of arrangement where the client would sign for hours the staff hadn't completed but they would come by odd times of the day outside of their scheduled and logged time to complete hours. They would essentially barter their hours worked. This is the kind of thing that EVV was supposed to prevent, but it seems people always just found a way around it. Especially when they're working cousins and family friends.”
Eventually, Bernardini discovered evidence that led him to believe claims had been submitted under his name without his knowledge after he’d once again complained about potential fraud. That prompted a confrontation with his supervisor, Alicia Black, the Director at Gateway whom Bernardini believes submitted claims under his name.
Following his complaints, his responsibilities were reduced, and his exposure to certain records was limited.
In the wake of the Maine Wire's first report on Gateway Community Services, Bernardini learned for the first time that many of the activities he had suspected were fraudulent had been flagged by DHHS auditors before he started with the company. He was never told that Gateway had received a Notice of Violation from DHHS for erroneously billing MaineCare. Nor was he informed that the company had yet to repay that money as late as 2022, as evidenced by state records.
In light of the Maine Wire's reporting, he once again raised his concerns with Black, the person he suspected of submitting claims to MaineCare under his name.
Bernardini said he was terminated shortly thereafter, a firing that he believes was retaliation for blowing the whistle internally on what he now views as a massive and systemic MaineCare fraud.
Black did not respond to an email asking for an interview.
"I don't understand how they've gotten away with it for as long as they have," Bernardini said. "Looking back I don't know how I didn't see how much of it was really fraud. I thought I was doing good by weeding out anything I thought was fraud."
"It is painfully obvious to me now how wrong I was then," he said.
One clue to Gateway Community Service's success — even despite receiving multiple Notice of Violation letters from DHHS for erroneous reimbursements from 2015 to 2022 — may be their policy of exclusively serving MaineCare clients and not accepting privately insured patients.
Clients with MaineCare never have to pay a bill or a co-pay. If the clients, rather than the taxpayers, were picking up the tab, then Gateway Community Services might have had to answer questions about payments for services not rendered.
Political Connections
Another clue to Gateway Community Services’ seeming immunity could be the company's top-tier political connections within the Maine Democratic Party.
In addition to state funding, Gateway Community Services has received a smattering of federal contracts and grants, the largest of which was a nearly $700,000 COVID-19 payment via the Paycheck Protection Act.
State records indicate, and the former employees confirmed, that Gateway Community Services did not suffer any revenue loss because of COVID-19 or the government lockdowns. So it’s unclear why the company sought a PPP loan or how that money was used.
Although there was speculation amongst employees that the large federal payment would lead to employee raises or bonuses, that never panned out.
Instead, Ali — who was notorious at the company for donning expensive Gucci attire and alligator skin boots — began making frequent trips abroad. Those trips would later turn out to be a prelude to his failed 2024 campaign to become president of Jubaland in Somalia.
Following the initial Maine Wire report, Gateway leadership sent an email labeling the publication of government records -- and videos of Ali himself bragging about his financial support for Somali militiamen -- "fake news."
That email, unbeknownst to Ali, would lead the former employees to contact this reporter and divulge what they witnessed while working at Gateway.
Although neither Ali nor Dhalac responded directly to the Maine Wire's inquiries for this story, they did offer a response of sorts via BoundlessMedia.me.
It's not disclosed on the website or the story, but the website is owned by Ali and the author of the story, Ridwan Ali, is a former "Youth Mentor" for Gateway.
The post on the website Ali owns describes Ali as "not only a successful immigrant but also a community leader whose made significant contributions to Maine."
"Gateway Community Services is a respected organization that has earned the admiration and gratitude of the people of Maine," Ali the publicist wrote.
"The baseless attacks from the MaineWire cannot diminish the profound impact that Dr. Ali and his team have had, nor can they rewrite the truth. In fact, it is time for us all to stand together and reject the fearmongering, discrimination, and baseless accusations that MaineWire continues to push forward," he argued.
This story is the first investigative report from The Robinson Report, a new project of the Maine Wire. The Robinson Report will include investigative reporting, video podcasts, mini-documentaries from Maine Wire Editor-in-Chief Steve Robinson. Subscribe below to join our mailing list and receive our regular newsletter and alerts. Read more here about why we’ve chosen to start The Robinson Report.