Maine Gov. Janet Mills (D) learned the hard way Friday that President Donald J. Trump was serious about declaring War on Fraud during his Tuesday State of the Union Address.
Mills, unbeknownst to the rest of Maine, had quietly pleaded with the federal government for extra time to comply with a Feb. 6 demand from the Centers for Medicare & Medicaid Services for detailed records related to Maine’s administration of the multi-billion-dollar welfare program known in Maine as MaineCare.
The Trump Administration has rejected Gov. Janet Mills’ request for a 30-day extension to turn over records demanded by federal officials examining billing practices in Maine’s Medicaid, delivering a blunt message that foot-dragging will not be tolerated in President Donald Trump’s recently declared War on Fraud.
In a letter dated Thursday and addressed to Mills and the Department of Health and Human Services (DHHS) Commissioner Sara Gagné-Holmes, CMS Administrator Dr. Mehmet Oz stated that CMS is unable to grant the extension sought by the state on Feb. 19.
“After careful consideration, CMS is unable to grant the requested extension,” Oz said, according to a copy of the letter obtained by The Robinson Report. “The State’s request did not provide sufficient justification or detail regarding the specific challenges preventing timely compliance with CMS’s information request.”
The original Feb. 6 letter from CMS — the agency tasked with providing oversight to Maine’s largest welfare program, MaineCare — sent shockwaves through the Mills administration and the state bureaucracy.
26,927 Mainers get the important news first because they’re subscribers to The Robinson Report. Join them for free today!
That first CMS letter demanded detailed records and answers on MaineCare billing tied to rehabilitative and community support services for children diagnosed with autism.
It’s unclear when the Mills administration asked for extra time to comply with the federal oversight request.
Oz’s Feb. 27 denial letter stressed the urgency of CMS’s investigation.
“Meeting the original deadline is necessary to ensure timely federal oversight, avoid delays in program monitoring, and enable CMS to take any actions that may be needed to protect beneficiaries and preserve program integrity,” he wrote.
Oz added:
“CMS takes the identification, pursuit, and resolution of fraud seriously. Given the magnitude and urgency of the serious program integrity concerns identified in our February 6, 2026, letter, prompt state response is essential to fulfill our shared obligations to protect federal and state taxpayer dollars and ensure beneficiaries receive appropriate services.”
He concluded with a direct warning about the political optics.
“Delaying that important work is not aligned with the Trump Administration’s government-wide approach to crushing fraud and sends a signal to taxpayers that both the administration and the State do not take this seriously,” Oz said.
The denial comes one month after a federal audit from the Department of Health and Human Services Office of Inspector General laid bare systemic documentation failures in MaineCare payments for autism services in 2023. The OIG estimated at least $45.6 million in improper payments that year for rehabilitative and community support services provided to children with autism, with the federal share totaling $28.7 million that auditors are demanding Maine refund immediately.
The audit, issued Jan. 16 and posted publicly Jan. 22, examined a statistically valid sample of claims. Every single one of the 100 “enrollee-months” reviewed contained errors, according to the report.
Eighty-one percent of the sampled months lacked required comprehensive assessments or necessary staff and parent signatures, leaving no valid proof that care was authorized. Nearly two-thirds failed basic documentation requirements, such as supporting the number of units actually billed. In some cases, providers submitted “cloned” session notes — identical descriptions copied and pasted across different visits — that showed no unique progress for the child.
Ninety-two percent of the sample included “nontherapy time,” with taxpayers billed for lunches, breaks and naps. One out of every five sampled months involved providers who could not prove they held the required licenses or certificates to treat the children.
That’s a staggering amount of potential fraud within just one program — services for children with autism — for just one year. And that program also happens to be the same Medicaid service area exploited by Somali fraudsters in Minnesota and, allegedly, by Somali-American Abdullahi Ali’s Gateway Community Services here in Maine.
According to the CMS audit, the problems persisted even as spending on these services exploded from $52.2 million in 2019 to $80.6 million in 2023, a period that coincided with Mills’ repeated expansions of MaineCare eligibility.
Mills first action as governor in 2019 was to radically expand Medicaid eligibility to include close to 100,000 new individuals, including able-bodied childless adults. Two years later, Mills worked with Democratic lawmakers to further expand Medicaid eligibility to include a broader class of noncitizens.
The OIG traced the lapses in cost-management observed in the audit to a decade-long oversight vacuum: the state has not conducted a statewide post-payment review of these providers since the child autism program began in 2010.
Notably, the Mills administration hasn’t even bothered to rebut the audit’s damning findings.
Maine officials “potentially concurred” with the demand to refund the $28.7 million federal share and said they would review the flagged claims and update state rules to address the oversight gaps that persisted for 15 years.
In other words, they admitted that the CMS audit had flagged real lapses in oversight but lacked any basis to respond to the audit — in part because there’s been no oversight of the program.
Oz’s Feb. 6 letter set a 30-day deadline — a deadline the state apparently believes it won’t be able to meet.
In a public X post on Feb. 6, Oz referenced Minnesota’s Medicaid fraud issues and stated: “Maine also needs to clean up its act.” He noted the OIG report identified at least $45 million in improper payments to the state’s Medicaid-funded treatment program for children with autism and warned that CMS was ready to act if unsatisfied with Maine’s response.
Oz’s report is only a small part of a much bigger crisis within Maine’s Medicaid program, a program that comprises the largest single spending item in every biannual budget.
The autism billing dispute does not exist in isolation. MaineCare, the state’s largest welfare program, faces multiple layers of federal scrutiny.
A congressional investigation led by House Oversight Committee Chairman Rep. James Comer (R-Ky.) is examining whether Mills administration officials improperly used federal Medicaid funds to cover benefits for noncitizens, including those without lawful immigration status. The Oct. 3, 2025, inquiry targeted Maine and seven other states that provide some Medicaid benefits to noncitizens using state funds and asked whether costs were improperly shifted to federal reimbursement. The Robinson Report submitted a Freedom of Access Act request for DHHS records on the state’s response; DHHS acknowledged receipt but has not provided a timeline or cost estimate as required by state law.
As detailed extensively at The Maine Wire and by The Robinson Report, Medicaid payment data obtained through a Freedom of Access Act request, and federal provider payment data released this month by the federal Department of Health and Human Services, have revealed explosive growth in spending on high-risk health care sectors like “personal care services.”
The data have also revealed that Maine’s most suspect Medicaid providers are charging, 3x, 4x, and even 5x the national average for the exact same services. As another example, federal Medicaid data shows Maine is paying roughly $120 per claim for Methadone/Suboxone treatments while providers in the rest of the country receive just $20 per claim.
The Medicaid spending data also shows improbably rapid growth in billing among hundreds of MaineCare agencies that have popped into existence since 2020, including home health agencies that are suspiciously clustered at identical addresses where they maintain “ghost suites” — aka single room offices that are almost always vacant.
The federal investigation and the congressional probe further certify reporting from The Maine Wire and The Robinson Report, which last year exposed more than $1.6 million in improper payments to Gateway Community Services. The Robinson Report was also the first outlet to raise the testimony of former Gateway employee Christopher Bernardini, a billing specialist who laid out in detail how Gateway supervisors systemically defrauded Medicaid at the direction of CEO Abdullahi Ali.
Ali has since fled to Africa where he’s believed to be living on an estate he purchased shortly after receiving nearly $700,000 under the PPP loan program.
Subscribe to the only news publication in Maine that doesn’t get no-bid contracts from Janet Mills…
Yet Gateway is far from the only Medicaid/MaineCare firm that’s raised eyebrows with sky-high billing figures and no obvious services.
At 75 Bishop St. in Portland, multiple home health agencies operate from the same address, including 5 Stars Home Health Care. A DHHS audit found that agency over-billed MaineCare by nearly $400,000 after failing to produce required documentation despite multiple extensions. The agency’s sign remained on the door when reporters visited in January 2026. By Feb. 2025, DHHS stopped payments to 25-year-old CEO Mostafa Alahmedi, but there’s no indication he was investigated criminally after walking away from the Medicaid program with more than one million dollars.
A similar pattern emerged at 203 Anderson St. in Portland, where five home-care businesses — Holding Hands Home Health Care (also known as Holding Care), Maine Connect Care, ACME Care, Engility Enterprises and Morning Light Care — collectively received $13,774,554 in MaineCare payments from 2019 to 2024, per DHHS records reviewed by The Maine Wire. The concentration of providers at single addresses has drawn questions about oversight and potential over-billing risks. Likewise, the presence of a Dahabshiil Somali money wiring service operating in the same building — managed by one of the Medicaid agency directors, Abdikadir Noor — has also raised questions about whether taxpayer dollars are flowing through MaineCare to Mogadishu.
[RELATED: Portland Office Becomes a Hub for Medicaid “Home Health” and Somali Money Transfers…]
The Mills administration’s response continues a pattern of Mills and her allies acting like they’ve got something to hide when it comes to MaineCare spending.
On Jan. 10, 2025, just days before President Trump was inaugurated to his second term, Attorney General Aaron Frey’s office sent a secret directive to DHHS employees to refuse cooperation with Justice Department lawyers if contacted and to refer such inquiries to supervisors and state counsel.
In a separate email, obtained by The Robinson Report under a Freedom of Access Act request, DHHS Commissioner Gagné-Holmes expressed fear of a congressional subpoena in connection with the House Oversight Committee’s review of MaineCare finances, according to earlier reporting.
“The goal here is to avoid a congressional subpoena,” Gagne-Holmes told top leaders at DHHS, including Ian Yaffe, Bethany L. Hamm, and Emily A. Cathcart.
Frey’s paranoid attempt to block contact with Justice Department officials and Gagné-Holmes’s ham-handed subpoena email combine to paint a portrait of a state bureaucracy deathly afraid of the transparency that would result when investigators who cannot be controlled or intimidated by the Mills Administration gain access to state records.
But the multiple federal investigations into Maine’s multi-billion dollar welfare program could have far more severe consequences for the state than exposing corruption or embarrassing Democrat loyalists. The dispute between Washington, D.C., and Augusta over Maine’s program could have far-reaching consequences for the state’s financial future.
Medicaid is jointly funded by the state and federal governments, with the federal government picking up the larger share of the cost, especially in states that expanded Medicaid eligibility pursuant to the Affordable Care Act, aka ObamaCare. Because the Feds pay the bills, they also get to set the rules. One of those rules is that states like Maine that provided Medicaid benefits to noncitizens may not reimburse themselves from the federal coffers, i.e. the Feds refuse to pay for noncitizen welfare.
Because Maine offers abundant welfare benefits to noncitizens, including Medicaid benefits, the state must differentiate between noncitizen welfare payments and citizen welfare payments, because only citizen welfare payments can be offloaded onto the Feds. If, however, the Mills administration tried to make Maine’s stretched budget work by shifting non-citizen welfare costs onto the federal government, Maine could be on the hook for hundreds of millions of dollars in illegal reimbursements.
That’s just one example of Medicaid money the Trump administration could clawback from Maine if a deeper investigation finds that the Mills administration skirted federal rules for administering the welfare program.
The autism audit alone threatens a significant fiscal hit. Maine must repay the $28.7 million federal share immediately, while another $22.4 million ($14.2 million federal) was flagged as potentially improper due to unverifiable documentation. With the legislative session underway, the Mills administration and Democratic lawmakers face a fiscal straitjacket as they confront not only the refund demand but the broader implications for program integrity.
Considering that Medicaid spending typically comprises 25% to 30% of every biennial budget, a moderate clawback from the federal government could send state government reeling.
If Mills is feeling the pressure of a potential budget crisis caused by increased federal scrutiny, she did not show any signs of it in her recent State of the State speech, which the candidate for the Democratic U.S. Senate nomination used primarily as an opportunity to pose for her campaign videographers.
In her speech, Mills said she would repeat her 2022 pre-election ploy of sending $300 checks to potential voters just prior to the election.
Depending on how the CMS audit goes, Maine’s “Rainy Day Fund,” the pool of money Mills intends to raid for her vote-buying payouts, may get sucked back into Washington, D.C., to repay the Feds for Mills’ mismanaged Medicaid program.
Oz’s letter closes insisting on expeditious compliance.
“CMS values its partnership with the State of Maine in meeting federal oversight requirements and ensuring the receipt of high quality, timely information,” he said. “We look forward to receiving your complete response within 30 days from the receipt of our February 6, 2026, letter.”
That would give the Mills admin ten days to comply — but six days if we’re counting days when government employees are actually at their desks.
