Editor’s Note: CMS Administrator Dr. Mehmet Oz met with Maine Wire reporter Jon Fetherston in Maine on Monday to discuss the federal government’s ongoing review of MaineCare oversight, home health care spending and suspected Medicaid fraud. Less than 24 hours later, Oz publicly expanded on those concerns during a Department of Justice press conference in Philadelphia.
Less than 24 hours after meeting with Maine Wire reporter Jon Fetherston in Maine to discuss concerns over suspected Medicaid fraud, Centers for Medicare and Medicaid Services (CMS) Administrator Dr. Mehmet Oz publicly revealed that federal investigators have found what he described as widespread irregularities in MaineCare-funded home support services for adults with autism.
Speaking Tuesday during a Department of Justice anti-fraud press conference in Philadelphia, Oz referenced his Maine visit while announcing an expanded federal crackdown on Medicaid fraud nationwide.
“Yesterday I was in Maine,” Oz said. “We’re investigating home support services, just like you’re seeing here, for adults, in that case, who have autism.”
During his visit to Maine, Oz met with Maine Wire reporter Jon Fetherston, where the two discussed concerns over home health care fraud, the rapid growth in MaineCare spending and the federal government’s ongoing review of providers billing the state’s Medicaid program.
The comments came during a press conference announcing criminal charges against 19 defendants accused of participating in home health care fraud schemes that allegedly generated more than $4 million in fraudulent Medicaid claims in Pennsylvania. While much of the event centered on Pennsylvania, Oz repeatedly pointed to Maine as another state receiving heightened federal scrutiny.
According to Oz, Medicaid spending among Maine’s ten highest-paid home support providers has increased dramatically over the past six years, prompting federal investigators to closely examine billing records and service documentation.
He then delivered what may be his strongest public assessment yet of what investigators have found.
“We have massive increases that have grown to the kinds of numbers you could not imagine being able to show on a clipboard, with 90 percent of services billed and paid for ā in Maine in particular ā where there is no justifiable backup for it,” Oz said.
“Nine out of ten services, you can’t justify they should have happened. It’s the opposite of what you’d normally expect.”
Oz did not identify the providers under review, specify the total amount of claims being examined or announce any criminal charges connected to Maine. He also did not allege that every unsupported claim constituted fraud. Instead, he said the findings demonstrate the need for significantly greater oversight of Medicaid-funded home support programs.
Nevertheless, his remarks represent a major escalation in the Trump administration’s examination of MaineCare spending.
Federal officials have spent months reviewing Maine’s administration of Medicaid-funded autism and developmental disability services. Earlier this year, federal auditors questioned tens of millions of dollars in payments involving rehabilitative and community support services while requesting additional records from the Mills administration concerning providers and billing practices.
Oz argued that programs originally designed to help disabled Americans remain safely in their homes have become increasingly attractive targets for fraud.
“We have no tolerance for anyone who invents hours, invents a disability, invents a workforce at the expense of people who depend on these programs,” Oz said. “And if you love these most vulnerable Americans, you should care as well.”
The CMS administrator attributed much of the nationwide surge in questionable billing to policies adopted during the COVID-19 pandemic.
“What happened in 2020 that has catalyzed this?” Oz asked. “COVID appears to have unleashed massive fraud because criminals knew the federal government would not follow up on the money that was being sent out.”
Oz said the Trump administration has adopted what he described as an “all-of-government” strategy involving the Department of Justice, the Department of Health and Human Services, the FBI, the Drug Enforcement Administration, the IRS Criminal Investigation Division and state attorneys general to identify and prosecute Medicaid fraud.
Assistant Attorney General Colin McDonald announced that 19 defendants have been charged in Pennsylvania for allegedly submitting fraudulent Medicaid claims through home health care programs. Prosecutors allege some caregivers billed Medicaid while they were incarcerated, hospitalized, working other jobs, traveling overseas or otherwise unable to provide the care they claimed to have delivered.
U.S. Attorney David Metcalf said Pennsylvania’s home care program expanded from approximately $120 million in annual billings in 2019 to roughly $8 billion in 2025, growth he attributed not to increased demand but to what he called systematic exploitation of the Medicaid system.
Federal officials also unveiled several new anti-fraud initiatives, including expanded Medicaid Strike Forces, new investigative toolkits for states and enhanced data analytics designed to identify suspicious billing patterns before taxpayer money is paid.
While Tuesday’s criminal charges were filed in Pennsylvania, Oz left little doubt that Maine remains a major focus of the federal investigation.
“They’re not just stealing money,” Oz said of alleged fraudsters. “They’re stealing our trust. And that’s a much more difficult thing to replace.”
While Tuesday’s criminal charges were filed in Pennsylvania, Oz left little doubt that Maine remains a major focus of the federal government’s expanding Medicaid fraud initiative.
“They’re not just stealing money,” Oz said of alleged fraudsters. “They’re stealing our trust. And that’s a much more difficult thing to replace.”
The comments build on the discussion Oz had with the Maine Wire during his visit to the state and signal that the administration intends to continue closely examining MaineCare spending as its nationwide Medicaid fraud initiative expands.
Assistant Attorney General Colin McDonald closed the nearly two-hour press conference with a direct warning to anyone defrauding government health care programs.
“The era of getting rich off the backs of our programs for our sick, elderly and disabled is over,” McDonald said. “Your time is up.”
