Maine
Maine DHHS data shows recent spike in cases of alleged fraud
PORTLAND (WGME) – New numbers from the Maine Department of Health and Human Services are revealing a recent spike in cases of alleged fraud, waste and abuse in Maine over the past few years.
The state released the data after CBS13 filed a public records request.
The Maine Department of Health and Human Services Fraud Investigation and Recovery Unit is responsible for looking into allegations of fraud within major state assistance programs.
That includes MaineCare, SNAP and temporary assistance for needy families.
We looked back eight years to get a sense of just how many cases the state has seen.
According to data CBS13 obtained through a public records request, in 2018, the unit received more than 1,400 fraud complaints.
In 2019, it was more than 1,000.
Amid all those complaints, investigators found 77 were “intentional program violations.”
Many more over those two years were referred to the Attorney General, local district attorneys and even federal prosecutors for review.
We don’t know the outcomes of those cases.
Fast forward to 2024, where complaints reached close to 1,000 again. This time, the unit found 164 intentional violations.
Fifty-one were referred to local DAs, five to the AG and three to the federal government.
Last year, there were still hundreds of complaints, and investigators found only 52 intentional violations, with 38 cases referred for prosecution on some level.
New numbers from the Maine Department of Health and Human Services are revealing a recent spike in cases of alleged fraud, waste and abuse in Maine over the past few years. (WGME)
And as of February of this year, the unit has received 94 complaints and found three program violations.
So far, no cases have been referred for prosecution.
Maine DHHS also has a program integrity unit, focused on waste, fraud or abuse within Maine’s Medicaid program.
Complaints have risen there, too, from 153 in 2023 to 183 in last year, a nearly 17 percent increase.
About a dozen of those cases were referred to the U.S. Inspector General’s Medicaid Fraud Control Unit, which accepted all for investigation or prosecution.
The Maine Attorney General’s Office says when a complaint is referred to them, it’s reviewed, and the AG then decides whether there is enough evidence to move forward.
We’re still waiting on a response from the U.S. Inspector General about how they handle these case referrals.