The Department of Health and Human Services is suspending MaineCare provider payments to Gateway Community Services over suspected fraud.
A spokesperson for DHHS said the move follows a recently completed and previously unreported audit in which the Portland-based provider was found to have overbilled MaineCare by more than $1 million. The spokesperson also said that suspending MaineCare payments is imposed when there is suspected fraud, a determination that also triggers a referral to the Office of Attorney General for an investigation.
A spokesperson for the Office of Attorney General would not confirm that it’s investigating Gateway. Nevertheless, the new developments will bring fresh scrutiny for a company already under the microscope for two previously released audits that showed it overbilled MaineCare, the state’s Medicaid program, by more than $660,000.
The two previous audits were completed in 2018 and 2024. The third audit was initiated in 2023, according to DHHS. The company’s billing for interpreter services, services not covered by MaineCare, and a failure to properly document services provided were among the "serious" irregularities identified in the latest audit.
Overbilling in Medicaid is distinct from fraud and is often appealed. An investigation by the attorney general would be aimed at proving actual fraud — the intentional act of deception — occurred so that it can be prosecuted.
Pawel Binczyk, an attorney for Gateway, said that the company stood by its previous statements denying fraudulent activity.
“We are not aware of what information caused the state to change their approach in this case,” he said Tuesday. “But we'll certainly continue working with them as we have in the past."
In response to questions about the DHHS letter citing credible allegations of fraud in its decision to cut off MaineCare payments, Binczyk said, “Whatever information the department has hasn't been shared with Gateway, so we don't know what information that they're referencing.”
The notice of violation and payment suspension were dated Tuesday.
The company has denied allegations made by a former employee that Gateway falsified records and said it had been working with the state to reconcile overbilling uncovered in the previous audits.
DHHS previously steered clear of suggesting wrongdoing by the company, saying only that recoupments exceeding $100,000 are generally considered “higher than normal.”
The move to suspend Gateway’s provider license marks a significant escalation. The company can appeal the suspension.
The new sanctions against Gateway come as some conservative activists attempt to connect the company to a social services fraud scheme that has rocked Minnesota and engulfed Democratic Gov. Tim Walz, who is seeking reelection next year. Federal prosecutors there recently said it uncovered “staggering industrial-scale fraud” worth billions of dollars. Most of the people charged in the Minnesota provider scheme are of Somali origin and naturalized U.S. citizens by birth or naturalization.
The scandal has drawn the attention of the White House. President Donald Trump recently called Somali Americans “garbage,” drawing condemnation in Maine and nationally.
Gateway Community Services was founded by Abdullahi Ali, a Somali American. Binczyk, the company’s attorney, recently defended Ali and Gateway in a lengthy response to allegations by Chris Bernardini, a former employee who has asserted in conservative media interviews that the company falsified billing records and bilked Maine taxpayers.
The company described Bernardini as a disgruntled employee who never raised questions about billing practices despite his “end-to-end insight into every stage of the billing process.” Gateway went on to describe Bernardini as “territorial” about the workflow process up until he was laid off by the company in April.
The company also said the previous overbilling discoveries were largely routine findings and that the company had been working with DHHS to reach a recoupment settlement.
Overbillings in Medicaid are distinct from fraud and the result of provider audits by state program integrity units. Notices of violation can be appealed and recoupments can be adjusted during the process. It’s unclear how often violations result in fraud investigations. DHHS has previously said it doesn’t track the percentage of audits that lead to a violation.
Each of the three recoupments sought from Gateway are well above the $100,000 threshold DHHS has called "higher than normal."
The latest developments could bring more political and regulatory scrutiny of Gateway, a company formed in 2015. The overbilling uncovered in Gateway’s third audit represents a fraction of the alleged fraud in Minnesota, but the company is already facing scrutiny by the U.S. House of Representatives Committee on Oversight and Government Reform.
On Monday, the committee asked the U.S. Treasury to turn over any Suspicious Activity Reports connected to Gateway officers. Such reports are produced by banks and other financial institutions that flag transactions suspected of money laundering or fraud. The request is part of the oversight committee’s investigation of the Minnesota fraud scheme.
Medicaid, the health program for more than 83 million low-income people in the United States, is a federal program administered by states. Auditing and fraud prevention is largely overseen by units operating within the states’ social services agencies. In Maine, that’s DHHS. The federal government also plays a prevention and enforcement role.
According to DHHS, the initial audits of Gateway Community Services covered the period between 2015 and 2018 when the state bureaucracy was controlled by Republican Gov. Paul LePage. The first audit was completed in 2018, while LePage was still governor. The second was completed in 2024 during the administration of Democratic Gov. Janet Mills.
According to DHHS, the third audit was initiated in 2023 in "response to internal data analytics," not a complaint. It covered March 2021 through December 2022.
Mills is in her second and final term as governor. She’s seeking to unseat Republican U.S. Sen. Susan Collins in a high-profile contest that could determine control of the U.S. Senate.
The governor has blasted Trump for his comments about Somali Americans. She did not attend a recent rally in Lewiston denouncing Trump and conservative activists for using the Minnesota provider fraud prosecutions, as well as Bernardini’s allegations against Gateway, as a broader attack against Somali Americans. In Minnesota, such rhetoric has been in conjunction with the Trump administration’s targeted immigration raids.
Several Democratic candidates for governor, as well as Mills’ leading Democratic primary rival, Graham Platner, attended the Lewiston rally.
According to the nonpartisan Kaiser Family Foundation, there are no comprehensive, reliable measures of Medicaid fraud. However, provider fraud is more prevalent than beneficiary fraud and most costly to taxpayers.
