2 Maine healthcare providers accused of violations by state
The Maine Department of Health and Human Services took action against two Portland behavioral health companies that receive federal funds through MaineCare, according to records from the agency’s program integrity unit.
DHHS suspended Medicaid payments to Maine Connect Care earlier this year and another company, USA Family Wellbeing, has received violation notices for alleged overbilling, according to letters sent to the providers.
Both providers were included in a confidential list of criminal division cases the Office of the Maine Attorney General accidentally sent on Oct. 8 to reporters and other recipients outside the office. Neither company appears to have been charged in state or federal court, according to a review of online records. A spokesperson for the attorney general’s office said Thursday that she had no information to share about either company.
Neither company responded to calls and emails on Thursday seeking comment.
The attorney general’s document says the office got not response to “multiple inquiries” it made to federal prosecutors about whether these two matters, “along with a group of other matters/investigations with similar allegations,” would be pursued federally. A spokesperson for the U.S. Attorney’s Office in Maine said he could not comment under federal policy.
The U.S. Centers for Medicaid and Medicare announced this month that it was auditing the state for fraud; its administrator, Dr. Mehmet Oz, and Vice President JD Vance have both accused Maine officials of turning a blind eye to fraud.
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Maine has suspended payments to at least five providers this year, according to information the state shared in August. DHHS spokesperson Lindsay Hammes said in an email Thursday that the department refers cases to law enforcement, including the attorney general’s Medicaid Fraud Control Unit, any time it’s made aware of a credible allegation of MaineCare fraud.
She said the department doesn’t provide information about those referrals to protect the integrity of the investigations.
DHHS suspended Medicaid payments to Maine Connect Care on Jan. 30, according to a letter the agency sent via certified mail. The letter stated that DHHS is required to suspend payments when there’s been an allegation of fraud, and that the suspension will last either until it’s been determined there was no fraud, or until any criminal or civil prosecutions have resolved.
The letter said there have been “general allegations” of billing for services not rendered, billing for individuals who aren’t eligible for MaineCare reimbursements, and billing for services provided by unlicensed individuals.
USA Family Wellbeing, meanwhile, has appealed a notice of violation that it received from DHHS in July. The state is seeking more than $1.7 million for overpayment it made, citing a review of MaineCare claims between March 1, 2021, and Dec. 31, 2022, according to a letter the agency sent to the provider. The claims included payments for community support services, competency evaluations, behavioral health counseling and language interpretation services.
USA Family Wellbeing had also received a notice of violation in 2024, which resulted in the company paying back more than $71,000 over the following year, according to DHHS.
USA Family Wellbeing has not had its payments suspended, according to DHHS.
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The allegations raised in the DHHS documents appear to match similar accusations made in the confidential report inadvertently released by the attorney general’s office, which stated that Maine Connect Care and USA Family Wellbeing face allegations that included “phony billing” and “billing for noncovered services.”
That report, which the office has declined to discuss, also included homicide cases, alleged healthcare crimes, drug investigations and appeals. Most of the matters match what’s been filed publicly in court, but it appears some have not been made public.
The description in the report for a matter involving USA Family Wellbeing included an allegation of services being provided by an unlicensed person, and that the company was accused of a “potential theft of $1.58 million.”
The loss described in the description about Maine Connect Care “looks to exceed about $400,000,” the document stated.
Staff Writer Joe Lawlor contributed to this story.
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Tagged: DHHS, mainecare, medicaid
Emily Allen covers courts for the Portland Press Herald. It's her favorite beat so far — before moving to Maine in 2022, she reported on a wide range of topics for public radio in West Virginia and was. More by Emily Allen
