Vice President JD Vance visited Bangor on Thursday to tout the federal government’s crackdown on Medicaid fraud, singling out Gov. Janet Mills for failing to take the issue seriously.
The Democratic governor fired back shortly after with her own account of the state’s record on fraud prevention in the state’s $4.7 billion MaineCare program, which is roughly 60% federally financed.
Vance embellished details of a fraud case and overstated what federal auditors found in a review of Maine, while Mills ignored critical findings from the state auditor and underplayed the state’s crucial role in rooting out fraud.
Vance likened a critical audit of autism services to fraud.
Vance overstated the findings of a January report from the U.S. Department of Health and Human Services inspector general, which flagged about $45.6 million in Medicaid payments for children with autism in Maine.
“Talk about something we’ve seen in Minneapolis, but also in Maine: We’ve seen people go out there and say that they’re providing services to autistic children, when, in reality, they maybe don’t have any children at all, or they certainly don’t have autistic children,” he said.
But that report expressly did not call those payments fraud or even indicative of fraud. Auditors called them “improper” or “potentially improper,” tying the problem to lack of documentation and oversight and not fabricated patients. They also noted they did not use a medical reviewer to assess whether services were medically necessary, which would be required to establish fraud.
Maine was also not uniquely targeted. The review was part of a multi-state effort that found at least $56 million in improper payments in Republican-led Indiana and at least $18.5 million in Wisconsin, which has a Democratic governor but a Republican-led Legislature. This effort to review the program began under former President Joe Biden.
Vance said the woman at the center of a fraud case is “an illegal immigrant.”
She is a U.S. citizen, according to court filings and her attorney.
Vance was referring to Rakiya Mohamed, an Auburn resident charged last February along with her mother and another individual for allegedly billing MaineCare for interpreter services that never happened. The case against her was first reported by the Bangor Daily News.
The scheme, according to a federal indictment, involved billing for interpreting hours through a healthcare provider and paying fictitious employees at interpreting companies for those services. The provider, Bright Future Healthier You, has not been accused of wrongdoing. Mohamed initially pleaded not guilty but signed a plea agreement in January and pleaded guilty to two of three charges.
“She is a citizen, graduated from Bates College with honors, and earned a graduate degree from the University of Texas,” her lawyer, Richard Berne, wrote in an email. “The Vice President’s statement is just another example of the Administration’s blatant, irresponsible use of inaccurate information.”
Vance also claimed Mohamed collected $15 million in fraudulent payments. That is also not accurate. That roughly equates to the total amount that Bright Future Healthier You billed MaineCare between 2019 and 2024, according to data obtained by the BDN.
The initial estimated tax loss due to Mohamed’s conduct was more than $456,000, court records show. Under her plea agreement, she owes $51,000 in restitution. She faces up to six years in prison and fines up to $500,000, though her plea agreement will likely reduce both.
In her response, Gov. Mills understated the state government’s role in fighting back against fraud and overstated its efforts.
Shortly after Vance’s remarks, Mills issued a statement of her own, calling Vance’s comments “nothing but a weak attempt to distract from [Trump’s] failing agenda.” The state refers credible fraud allegations to the attorney general’s office, and investigations are often coordinated with the federal government, she said.
While that is basically true, State Auditor Matt Dunlap, found in a March report that the state’s internal Medicaid fraud prevention is lacking. His report said the Program Integrity Unit, the state’s internal auditing arm, “may not provide adequate monitoring of all Medicaid services.”
The department disputed that assessment, but Dunlap stood by it by saying it failed to provide evidence of required oversight procedures.
Over the last five years, the Program Integrity Unit averaged 144 cases a year and referred 22 cases to the attorney general’s office. Attorney General Aaron Frey’s office secured 11 criminal convictions related to MaineCare fraud over that same span. Federal prosecutors, meanwhile, have not brought a criminal healthcare fraud charge in Maine since 2019.
One number cuts in Mills’ favor: Maine’s improper payment rate is 2.4%, less than half the national average of 6.1%, according to the state’s response to federal oversight questions.
Bangor Daily News investigative reporter Sawyer Loftus may be reached at [email protected].
