BANGOR (BDN) — Maine’s Medicaid program lacks the proper controls to manage the billions of dollars going to health providers across the state, according to an audit released Thursday.

The findings from State Auditor Matt Dunlap’s office come amid a torrent of calls for increased scrutiny of how the state spends its MaineCare dollars and allegations of fraud, which has prompted another battle between President Donald Trump’s administration and Gov. Janet Mills.

Front and center in the growing debate is the embattled Portland health care provider Gateway Community Services, which is currently under investigation for potentially defrauding MaineCare largely through overinflated and underdocumented claims for interpreter services.

Dunlap’s report doesn’t mention either Gateway or interpreter services, but it does warn the state that inadequate monitoring of MaineCare could lead to federal regulators finding Maine out of compliance with its regulations. The state disputed that, but the watchdog’s words could add heat to a tense dispute between the Mills and Trump administrations.

Republicans stretching from top Medicaid regulator and former TV personality Dr. Mehmet Oz to the Maine Legislature are pressuring Mills on the issue during her heated U.S. Senate primary. Dunlap himself is running in a Democratic primary for Maine’s open 2nd Congressional District.

The Maine Department of Health and Human Services paused MaineCare payments to Gateway in December while it investigated “credible allegations of fraud.” The pause came as a result of an audit by DHHS that included a review of 15,000 claims made by Gateway between March 2021 and December 2022.

Dunlap’s report said the Program Integrity Unit, MaineCare’s internal auditing arm, “may not provide adequate monitoring of all Medicaid services. Medicaid programs are jointly funded by states and the federal government, but administration of the programs are mostly left to states.

In recent months, Oz has taken an increasing interest in how Maine is overseeing its program. He sent a letter demanding detailed information regarding the state’s oversight of Medicaid spending, outlining concerns and mentioning a federal criminal case against two interpreters who are charged with defrauding the federal government by filing false tax returns.

The case alleges that two interpreters filed false tax documents with the federal government showing their companies were paid for interpreter services that didn’t happen. The third defendant in the case was an employee of the Lewiston-based Bright Future Healthier You, who died after she was charged.

Bright Future Healthier You was the largest biller of MaineCare for interpreting services in the last 10 years. The company itself has not been accused of any wrongdoing.

The case is the first case the federal government has brought in Maine since a 2021 report by a federal investigator that outlined a suspicious billing pattern for interpreter services. The report highlighted that the billing patterns seemed especially prominent among providers working with Maine’s Somali community and indicated widespread fraud within the MaineCare system.

Gateway was the second-highest biller of interpreter services in the last 10 years and has been the subject of numerous fraud allegations dating back to May 2025, when The Maine Wire, the media arm of the conservative Maine Policy Institute, first reported on claims from a former employee that Gateway falsified records.

Oz’s letter followed an audit performed by the U.S Department of Health and Human Services that found that Maine had made at least $45.6 million in improper Medicaid payments for support services for children with autism in 2023.

In November, widespread federal fraud prosecutions began in Minnesota, and with them, the employee, Chris Bernardini’s claims resurfaced in national conservative news outlets. Then, in December, U.S. Rep. James Comer of Kentucky, the top Republican on the House oversight committee, sent a letter to the U.S. Treasury that identified Gateway, along with its founder Abdullahi Ali, as targets in a broader welfare fraud investigation.

The Maine Department of Health and Human Services disagreed with Dunlap’s finding, saying it resulted from a “misunderstanding” of the federal regulations and how the department is structured. The department also said Dunlap’s findings discounted the regular ongoing checks the Program Integrity Unit undertakes on a more regular basis.

Dunlap said his office wasn’t persuaded by the department’s criticism and that the department “did not provide evidence of utilization control review procedures.”