Maine
A Maine cop warned of interpreter fraud 5 years ago. The state is just catching up.
The Bangor Daily News was the first to report this story. What you’re reading here would likely not be made public without the efforts of professional journalists asking questions, interviewing sources and obtaining documents.
In late 2020, a federal investigator identified a concerning pattern within MaineCare, the state’s Medicaid program: Providers were billing for suspiciously high levels of interpreter services in what appeared to be a pattern of waste, abuse or fraud.
Interpreter claims surged by 283% between 2011 and 2017, with costs rising from roughly $800,000 to over $4.1 million annually. The increase occurred even as the number of refugees and immigrants arriving in Maine declined. The investigator wrote a report for fellow police, taking a closer look at billing trends following the high-profile prosecution of two interpreters, two social workers and a counselor in 2019.
In the years since the report was written, prosecutors have not brought any additional criminal cases. Under state law, interpreters are not required to have licenses. Providers have also continued to bill MaineCare at similar annual amounts to those that raised the investigator’s suspicion.
The report, which was obtained by the Bangor Daily News along with a partial copy of a second memo from 2021 that validated the findings through an additional analysis, has never been disclosed before. The findings are coming to light in the wake of a federal inquiry by a Republican-led congressional committee into welfare fraud.
That probe began after Minnesota federal prosecutors in November charged dozens of people, largely from that state’s Somali population, with stealing hundreds of millions of dollars from social programs. The House panel’s inquiry recently expanded to include a Maine behavioral provider that serves immigrants and refugees, Gateway Community Services.
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On Tuesday, the Maine Department of Health and Human Services halted MaineCare payments to Gateway, alleging the company overbilled for interpreter services by more than $1 million. Gateway denies the state’s claim. Since May, the organization has faced allegations of overbilling from a former employee, first published by The Maine Wire, the media arm of the conservative Maine Policy Institute.
The 2020 report shows that concerns of systemic fraud in the MaineCare system among providers who serve the state’s immigrant population were raised years ago. It is unclear how state officials responded to it. Gateway was the second-highest biller for interpreter services in the past 10 years, state data show.
A spokesperson for Attorney General Aaron Frey said the office was aware of Pellerin’s memo and referred the BDN to a 2019 case as its most recent example of prosecuting MaineCare fraud. The U.S. attorney’s office has not prosecuted any healthcare fraud cases pertaining to interpreters in Maine since 2019.
The author of the report, Brian Pellerin, who wrote it while serving as an agent focused on Maine with the inspector general’s office of the U.S. Department of Health and Human Services, declined an interview. He is now the No. 2 to Cumberland County Sheriff Kevin Joyce.
His report followed Maine’s last round of prosecutions around MaineCare fraud centered on the state’s Somali community. Federal prosecutors found that two interpreters had targeted newly arrived refugees — largely from Somalia — and brought them to specific providers for care. Those providers then charged MaineCare for interpreter services that were either overinflated or never happened, then gave the interpreters a cut of the money.
One of the interpreters, Abdirashid Ahmed, was estimated to have made off with at least $1.8 million, prosecutors said. He pleaded guilty in 2019. Nancy Ludwig, Heather Borst, and Danielle Defosse-Strout, all of whom worked for Lewiston-based Facing Change, were the providers also convicted in the scam.
Pellerin suspected that the same scheme might explain the high billing levels for interpreter services he discovered across the system. His investigation looked at the number of claims filed, patients served, and the total amount of MaineCare dollars distributed by MaineCare for interpreter services each year between 2011 and 2019.
Over those years, the number of claims filed steadily rose, from 16,300 in 2011 to 43,806 in 2019, according to Pellerin’s report. At the same time, the total number of patients ebbed and flowed with a low of 2,856 in 2011 to a peak of 4,559 in 2016. Meanwhile, the number of newly arrived refugees stayed flat, then declined — a notable fact given that the scheme Pellerin suspected depended on recruiting new arrivals, according to the report.
When certain MaineCare providers became reliant on immigrants, the interpreters started making demands, Pellerin found. They would ask providers to bill MaineCare for more units of interpreting services than they actually did and negotiate illegal kickbacks outside the MaineCare fee structure. If providers wanted to continue making money, they would have to listen to the interpreters or else they would lose their patients, the report found.
Pellerin’s report did not mention the names of the specific providers whose billing levels indicated potential fraud, waste or abuse. He noted that the scams not only defrauded Maine’s taxpayer-funded health system but also hurt vulnerable refugees, saying bad actors were taking advantage of fellow members of the state’s Somali community by treating them as a “harvested commodity” with little regard for their actual health needs.
“These MaineCare beneficiaries are often newly arriving immigrants who are potentially receiving lifesaving or life-altering medical treatment,” the report said.
Instead, they were potentially receiving poor quality services, or none at all, he concluded. Ludwig’s trial presented examples of that potential harm. A Somali refugee testified that Ahmed had brought him to see Ludwig, a social worker, to treat a toothache and asthma, according to federal court documents. Another testified he didn’t know why he was brought to Ludwig.
It is not clear what happened after Pellerin completed his report. But the spending trends observed in Pellerin’s report remain true, according to a BDN analysis of MaineCare data obtained in a public records request.
In the last 10 years, providers filed more than 45,000 interpreter claims, totaling more than $41.4 million. Half of that money went to only a few providers. The BDN contacted the top 10 providers and asked if they had ever been contacted by federal law enforcement. Only two responded, with one of them saying they had not. (The BDN is not naming that provider because it has not been charged with a crime.)
The other, Gateway, said through a lawyer that it also had not been contacted in the last 10 years by federal law enforcement. The audit that prompted state officials to pause MaineCare payments to the company on Tuesday began in early 2023 and looked at claims submitted between 2021 and 2022, according to a notice of violation.
Prior to the announcement that the organization’s MaineCare payments had been suspended, the provider’s lawyer, Pawel Bincyzk, denied allegations of fraud or being aware of Pellerin’s report.
“Gateway stands by its previous statements on this issue and will continue to cooperate with the state as it has in the past,” Bincyzk said.
Maine is one of 18 states in the country that provides direct reimbursement for language interpreters under Medicaid. The state pays $20 per 15 minutes for interpreting, according to the MaineCare manual. Interpreters don’t bill the state directly. Instead, a provider such as a doctor or mental health counselor bills MaineCare for services rendered, as well as interpreting. The provider then pays the interpreter, according to state regulations.
When Pellerin’s report was written and still today, MaineCare’s manual says interpreters must hold a state license. DHHS reminded providers in 2021 that they were supposed to provide the interpreter’s appropriate certification and licensure, along with other documentation to prove their qualifications.
However, the state’s licensing office doesn’t oversee interpreters except for those focused on American Sign Language. In 2019, the Maine Legislature approved a measure that eliminated the licenses that governed other interpreters, getting rid of the mechanism to license foreign language interpreters despite the requirement in state regulations.
Maine DHHS follows the procedures outlined in the MaineCare manual and can do reviews after a payment is made, department spokesperson Lindsay Hammes said. That review typically includes documentation related to qualifications, date, time, and duration of service, language used and costs.
But the agency did not specifically answer questions about how many times its internal auditing unit has found billing violations for interpreter services. It also did not clarify how interpreters are supposed to be licensed as required by MaineCare when no specific foreign language licensure exists in Maine, other than saying it was under the purview of the budget department.
To address the issues, Pellerin’s report included several things the state could take to correct the programmatic weaknesses identified. Those included incorporating similar requirements and qualifications used by courts for interpreters and requiring interpreters to become MaineCare providers so they could bill directly. At a minimum, it could enforce the regulations in the benefits manual, the report said.
Even among the 18 states that directly reimburse interpreters, every state has slightly different regulations around qualifications, said Mara Youdelman, the managing director of federal advocacy for the National Health Law Program. After spending nearly two decades studying the issue, she helped create the only group in the country that can certify foreign language interpreters for work in healthcare. The certification has been available since 2009.
Youdelman helps track how the 18 states across the country utilize interpreters and the regulatory framework those states use. While the state of Maine is spending millions of dollars each year on interpreting, she cautioned that it can be hard to tell if something nefarious is going on. In fact, Maine’s model of having providers bill MaineCare for interpreting is common among the 18 states, she said.
While she’s looked at interpreting services for many years, Youdelman said she’s never heard of interpreters defrauding the system. She worries that some will use instances of fraud as an excuse to cut language services.
“The competency of interpreters is critical,” she said. “We really do need to make sure that interpreters are actually qualified to do the job, because if not, and we have ineffective communication, then medical errors occur, negligence occurs, malpractice occurs, and people literally die.”
Bangor Daily News investigative reporter Sawyer Loftus may be reached at sloftus@bangordailynews.com.
Almost exactly one year ago, Graham Platner, who has no political experience, was cherry-picked by out-of-state political activists.
According to a person familiar with the campaign, Daniel Moraff and Leanne Fan, who have made a name for themselves by recruiting populist candidates across the country, traveled to Maine and rented a house near Platner’s home in Sullivan to convince him to run for the US Senate. Throughout the process, Moraff became Platner’s “right-hand man”, the person described, speaking on condition of anonymity for fear of backlash.
But homing in on Platner as a newcomer to oust long-serving Republican Susan Collins came at a cost. The Wall Street Journal recently reported that Moraff asked for an expedited, cheaper background check to be completed in a matter of days. The firm Moraff and his team contracted with also did not do a candidate interview or questionnaire, per the Journal’s report.
The fallout of those decisions happened on a colossal scale. In a midterm year with record spending across the country, the Democratic party had come to pin its hopes on Platner to help clinch Senate control with his meteoric campaign and ability to unite independent and progressive voters alike with a clear, anti-establishment message.
Controversies ensued, bringing with them straight-to-camera videos of Platner explaining and denying various scandals. Finally, an allegation that broke the dam this week: a woman he dated accusing him of sexual assault, of drunkenly forcing her to have sex with him after coming to her house uninvited. Asked in an interview on CNN whether Platner raped her, the woman, Jenny Racicot, replied: “By definition, yes, absolutely.”
His support collapsed. Platner waited days as calls grew for him to withdraw. Then on Wednesday, he released an 11-minute video announcing the end of his campaign that left Maine voters scrambling and betrayed, and the country wondering: how did this happen?
“It feels like some of the first rules of politics may have been broken here,” said Andrew Feldman, a national progressive strategist. “We were seeing rookie mistake after rookie mistake, and now we find ourselves in this situation.”
David Farmer, a Democratic strategist based in Maine, said the vetting process for Platner was tantamount to “malpractice”.
“I’ve had to have these conversations with candidates in the past – where you sit down and you ask them really tough questions,” Farmer said. “What drugs have you used? Have you ever had an affair? You ever cheated on your wife? You ever cheated on anybody? It’s really uncomfortable and probing, and a miserable event for everybody involved.”
The person familiar with the campaign said that Moraff and Fan “fell in love with an aesthetic without knowing the state” that ultimately did a “disservice” to Maine’s working-class voters.
Platner’s campaign did not respond to the Guardian’s request for comment on the methods used to check the former nominee’s background.
A rising star and an early redemption arc
Platner’s early campaign days – after he announced his run in August of last year – saw a rare rush of grassroots excitement as he criss-crossed the state for town halls, with backing from Bernie Sanders and an ad produced by Zohran Mamdani’s 27-year-old media strategist, Morris Katz.
An oyster farmer and marines veteran, Platner issued plain-spoken warnings that Maine’s working class had been hollowed out – healthcare was unaffordable, young people couldn’t buy homes – and said he’d survived only because of the veterans’ benefits he receives from being “blown up” too many times in combat. His searing indictment of the political establishment matched the anti-Washington mood and anger many Democrats felt toward their party’s leaders.
“His tone, his look, his voice, his message captured a frustration with Washington, a frustration with economic injustice,” Farmer noted.
Democratic leaders had someone else in mind: the 78-year-old term‑limited governor Janet Mills. But Mills hadn’t yet announced her run. In the meantime, 41-year-old Platner positioned himself as the gruff local businessman hardened by tours in Iraq and Afghanistan, pushing for generational change. Once Mills entered, he quickly framed her as emblematic of the status quo, arguing that a Chuck Schumer‑backed candidate would mirror Collins‑style “fake moderation”.
The Democratic establishment was skeptical of Platner from the outset, concerned that he brought too much baggage to the race against a seasoned incumbent. But progressives say the party is also to blame for pushing Mills as an alternative. If she had been elected, Mills would have been the oldest freshman in Senate history.
Platner brushed off his earlier scandals: Reddit posts from 2013 to 2021 where – among other things – he called white rural Americans “stupid” and “racist”, questioned why “Black people didn’t tip” and said sexual‑assault survivors should “take some responsibility … and not get so fucked up”. While apologetic, he characterized the posts as side-effects of severe PTSD and disillusionment from combat.
He tried to get ahead of more controversy by revealing a covered-up skull-and-crossbones tattoo that resembled a Totenkopf, a symbol known for its use by the Nazi SS. Platner said it came from a night drinking with military buddies in Croatia 18 years earlier. “I’m not a secret Nazi,” he told the Pod Saves America hosts.
Platner and his allies in Congress argued the uproar was overblown. At the time, Platner told the Guardian that Mainers related to his struggle and didn’t see the posts or tattoo as disqualifying. Many voters also said they could look past his mistakes and viewed his redemption arc as genuine. “If what the voters wanted were people who were grown in vats and had never done or said anything that they might regret their entire lives, we’d have a very different country,” Moraff told the Journal in May.
But inside his campaign, cracks had started to appear. In October, Platner’s political director, Genevieve McDonald, and his finance director both left his team. The latter, Ronald Holmes III, said his “professional standards” no longer “fully aligned with those of the campaign”. McDonald said Platner’s failure to fully disclose the extent of his Reddit posts led to her departure. She went on to question whether Platner really didn’t know the meaning of his tattoo.
Bracing for the worst
There was lingering concern among Maine locals and political operatives that more would come out about Platner’s past. One voter at a town hall in April asked him – point‑blank – if there were examples of sexual misconduct in past relationships that could emerge and endanger his chances. Another said that she was extremely wary about how untested Platner was.
Ultimately, his star continued to outshine the septuagenarian governor’s lackluster campaign. Mills, citing dwindling financial resources, eventually dropped out of the race, giving Platner a glidepath to the nomination.
And then – 10 days before the Democratic primary – reports revealed that Platner’s wife, Amy Gertner, had confided in McDonald about sexually explicit messages he’d sent outside their marriage, disclosures she made in an attempt to get ahead of any opposition research.
In extraordinary fashion, Platner was summoned to Washington DC to answer lawmakers’ questions about the latest controversy. Shortly after the meeting, the New York Times reported that previous partners described “unsettling” and “toxic” behavior. One of the women, Lyndsey Fifield, a conservative operative who dated Platner from 2013 to 2015, alleged he frequently grabbed her by the shoulders, once yanked her out of a taxi by her wrist, and during one argument twisted her arm behind her back, shoved her into a bedroom and held the door shut until she was “calm”. Fifield also cast doubt on Platner’s claim that he was unaware that his tattoo was a Nazi symbol, telling the Times that he referred to it as “my Totenkopf”.
Platner rejected Fifield’s claims and branded them as “politically motivated”.
While some voters were deterred, Platner still ended up clinching more than 70% of the vote in the primary. National Democrats, however, were left to grapple with a catch‑22: what would be an insurmountable scandal? And would it be worse than if Collins, who had helped overturn Roe v Wade and backed several key Trump policies, was re‑elected to a sixth term?
“It’s like a frog being in a pot of boiling water. If you raise the temperature slowly, you don’t know it’s boiling until it’s too late,” said Farmer.
The final straw
When Politico published their story on Monday, outlining Jenny Racicot’s claims that Platner raped her nearly five years ago, the condemnation came hard and fast. Endorsements evaporated and calls for Platner to withdraw were immediate. As he denied the allegations in a lo-fi self tape, it became clear this would be the red line for those who had stood by him until this point.
“The messenger was not the right person to match the inspiring message,” said Adam Green, executive director of the Progressive Change Campaign Committee. “It is really unfortunate for the overall project of trying to challenge corporate power and shake up a broken political system.”
It would be another two days before Platner published another video announcing his decision to end his campaign, claiming the allegations against him were part of a coordinated political attack.
Troy Jackson, who campaigned alongside Platner while running for the Democratic nomination in the Maine gubernatorial race, and is now one of several candidates running to replace him, told MS Now: “Graham told me point-blank that there was nothing in his past that I had to worry about. And he lied to me. And he lied to a lot of us.”
Now, as Democrats battle with the feeling of deja vu from Joe Biden’s withdrawal from the 2024 presidential race, it’s left some unnerved about whether the Maine Senate race is still winnable. “It’s so upsetting because it feels like we’ve been completely bamboozled by a candidate that so many people believe in,” said Feldman.
LEWISTON (WGME) Nearly three years after the Lewiston mass shooting, the Maine Resiliency Center is asking the public to share how the tragedy has affected them and the community.
The nonprofit has launched a survey to better understand the impacts of the mass shooting in October 2023 and to help guide future support efforts.
The director of the Maine Resiliency Center said the ripple effects have spread widely and the organization wants to hear from anyone who has been affected.
“You could have been a service provider who is providing therapy or counseling for people; you could have been a funeral home director or city employee; you could be someone who lives in this community and knows somebody who is directly impacted or you could be directly impacted yourself. All of those opinions and information are really valuable to us as we look to support the broader community moving forward,” the director said.
To take part in the survey, go to maineresiliencycenter.org.
Politics
Our political journalists are based in the Maine State House and have deep source networks across the partisan spectrum in communities all over the state. Their coverage aims to cut through major debates and probe how officials make decisions. Read more Politics coverage here.
AUGUSTA, Maine — The Maine Supreme Judicial Court on Friday upheld Secretary of State Shenna Bellows’ decision to keep a referendum banning transgender girls from female school sports off the November ballot.
The high court ruled Bellows was “not only authorized but was constitutionally bound” when she moved in May to throw out more than 1,500 signatures gathered by out-of-state circulators who never agreed to submit to Maine’s jurisdiction.
The unanimous ruling from the six-justice panel closes out a monthslong legal fight that began when Bellows’ office invalidated more than 12,000 signatures submitted by Protect Girls’ Sports in Maine, leaving the petition 532 signatures short of the 67,682 needed to qualify.
The group, backed heavily by Republican megadonor Richard Uihlein, had argued Bellows overstepped her authority by enforcing a settlement that ended a 2023 First Amendment lawsuit over Maine’s ban on out-of-state circulators, rather than letting Maine voters decide whether to loosen the state’s residency rules for petition circulators.
The court rejected that argument, finding Bellows was bound by the Maine Constitution’s residency requirement for circulators except where a federal injunction narrowly excused her from enforcing it, and that four nonresident circulators who never checked a box consenting to Maine jurisdiction fell outside that carveout.
Justices also rejected the campaign’s fallback argument that one circulator’s belated affidavit, filed months after the Feb. 2 filing deadline, should have salvaged her roughly 61 signatures, citing a state law requiring circulator affidavits to be filed when the petition is.
The decision effectively ends the campaign’s bid for the 2026 ballot, though the court noted proponents could still gather the roughly 500 additional signatures needed to try again for the 2027 ballot.
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