Portland provider accused of fraud has not appealed suspension of Medicaid payments
Gateway Community Services did not appeal the state’s decision to suspend Medicaid payments over fraud allegations, according to an official with the Maine Department of Health and Human Services.
Lindsay Hammes, a spokesperson for DHHS, said in a statement Tuesday that the agency “has not received anything appealing the suspension or requesting a hearing.”
DHHS first suspended payments in December for Portland-based Gateway Community Services, which provides Medicaid services for people with disabilities, after the provider was accused of falsifying billing records. DHHS conducted an informal review of the suspension at Gateway’s request, and upheld its suspension in May.
Gateway had 60 days to file an appeal by requesting a DHHS administrative hearing, but did not do so by the July 17 deadline, Hammes said.
Gateway attorney Maureen Sturtevant, of Drummond Woodsum, declined to comment when reached Tuesday.
In May, Sturtevant said in a statement that Gateway “stands by its denial of the allegations of fraud.” Sturtevant also said in May that Gateway was going to review the decision and consider its options.
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In a May 12 letter to Sturtevant, DHHS upheld the payment suspension, saying evidence supported that there was a “credible allegation of fraud.” A state audit found there had been $1.1 million in overpayments to Gateway from March 2021 to December 2022, state officials previously confirmed. DHHS had also identified nearly $663,000 in overpayments made to the provider between 2015 and 2018, from earlier audits.
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Hammes said DHHS continues to investigate allegations against Gateway. The agency is investigating whether Gateway should be permanently prohibited from providing Medicaid services, according to the May letter.
“The suspension remains in effect until the investigation into fraud has concluded, including any criminal or civil cases that might come from those investigations,” Hammes said.
The Gateway investigation comes amid a crackdown on fraud by the Trump administration, which announced Tuesday that it was freezing over $1 billion in Medicaid payments in California and Minnesota.
A federal audit released in January reported that Maine made at least $45.6 million in improper Medicaid payments for support services for autistic children in 2023.
Hammes said in January that the audit did not include fraud allegations.
“The audit identified potential documentation and compliance issues,” Hammes said in an email.
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Tagged: maine department of health and human services, medicaid
Joe Lawlor writes about health and human services for the Press Herald. A 24-year newspaper veteran, Lawlor has worked in Ohio, Michigan and Virginia before relocating to Maine in 2013 to join the Press. More by Joe Lawlor
