OpEd: Jonathan Bush Understands What Maine’s Medicaid Fraud Crisis Requires: Prevention at Time of Service

By Timothy Reiniger

As a former elected Chairperson of the Cape Elizabeth Town Council, I am pleased to support Jonathan Bush in the Republican primary to become the next Governor of Maine. My endorsement is grounded not in party loyalty but in a clear-eyed assessment of what Maine’s Medicaid (MaineCare) crisis demands — and in my conviction that Jonathan Bush is the only candidate who has correctly identified both the nature of the problem and the system-level solution it requires.

Maine Is Funding Industrial-Scale Fraud

Charges for Medicaid services in Maine far exceed national averages. The federal Office of Inspector General has identified programs paying five times the national average for opioid medication, three times the national average for residential care, and twice the national average for autism group-home services. These are the measurable result of a system that cannot distinguish legitimate services from phantom ones at the time of delivery. And no after-the-fact review catches what was never recorded in the first place.

The dominant policy response to this crisis has been reactive: fraud is discovered, auditors are dispatched, repayments are demanded, and the cycle begins again. This is the logic of detection after the fact — a pay-and-chase model that is structurally incapable of stopping the losses it is meant to address.

In 2023 and 2024, Maine had among the fewest Medicaid fraud investigations of any state in the country. Not because there’s less fraud or overbilling here — the Gateway Community Services state audits tells you that — but because the whole system is built to find problems after they’ve already cost Maine taxpayers millions. By the time an auditor identifies a suspect claim, the money is gone, the provider may have dissolved, and the organizational network behind the scheme has likely reorganized under a new name. You cannot audit your way out of this. The problem is structural.

The Distinction That Defines the Right Solution

Jonathan Bush is the only candidate with the knowledge, experience, and proven ability to address the problem at its structural root. He understands that the fraud devastating MaineCare is not primarily a management failure, a prosecutorial failure, or a political failure — though it is all of those things too. It is first and foremost a system design failure. Maine is operating a payment system built on an assumption of good faith at the time of service, and sophisticated organized actors have systematically exploited that assumption.

Every other candidate is promising more of the same — more auditors, more task forces, more prosecution. But these responses fail to address the fundamental architectural gap: Maine’s Medicaid program authorizes payment without proof of delivery. Until that gap is closed, detection and prosecution are not solutions.

For complex healthcare systems, Jonathan Bush has built technology and process solutions that are resistant to exploitation by design — not merely monitored after exploitation has occurred. He brings to this race an understanding of how to use technologies to close that gap today: biometric identity confirmation, GPS location tied to that identity, certified timestamps, real-time credential checks.

Before a claim is ever submitted, we can know: Was the patient there? Was an authorized caregiver there? Were the services approved? If any answer is no — no claim gets filed. That’s prevention.

Maine Medicaid Fraud Crisis Requires System Redesign

Stopping industrial-scale Medicaid fraud requires more than competent administration of a broken system. It requires the willingness and the knowledge to redesign the system itself — to move from a reactive posture that chases money already stolen to a preventative posture that makes theft structurally impossible before a claim is ever filed.

Jonathan Bush represents the right candidate at the right moment. Maine needs a Governor who understands where the fraud problem actually lives — at the time of service. Without structural reform at the time of service, the next wave of organized fraud will enter the same system and exploit the same gaps, under new names, at new addresses, billing for the same unverified services.

Timothy Reiniger

Former Chair, Cape Elizabeth Town Council (2024)Former Advisor on Digital Identity Management, Virginia Joint Commission on Technology and Science