MaineCare provides critical health coverage to about one in three Maine people – including more than half of all Maine children. Protecting MaineCare from fraud and abuse is essential to making sure that health care remains available for the people and families who rely on it and that taxpayer dollars are invested responsibly.
That’s why the Department of Health and Human Services (DHHS) works to protect MaineCare through audits, licensing requirements, a health provider registration process, compliance checks, and other safeguards. When DHHS identifies or is made aware of a credible allegation of MaineCare fraud, it refers the matter to appropriate law enforcement, including the Office of the Attorney General’s Medicaid Fraud Control Unit, for investigation and possible prosecution. DHHS’ Program Integrity Unit refers all credible allegations of fraud to the HealthCare Crimes Unit in the Office of the Attorney General for investigation and does not publicly provide specific information about those referrals in order to protect the integrity of potential investigations, preserve the confidentiality of investigative records, and uphold due process.
This work, known as program integrity, helps to make sure MaineCare funds are used responsibly and that health providers follow the rules.
Through regular oversight activities, the Department identifies and responds to compliance concerns. For example, in June 2026, DHHS:
- Implemented two emergency provider terminations due to credible complaints of serious health and safety risks.
- Imposed five provider payment suspensions based on credible allegations of fraud.
- Disenrolled 28 agencies that failed to submit a claim within one year of enrollment, consistent with program requirements.
Under Governor Mills’ leadership, Maine has strengthened its ability to protect people who depend on MaineCare and hold fraudsters accountable by implementing new licensing requirements and expanding existing requirements and enforcement tools. Since 2019, the Mills Administration has established new licensing standards for agency group homes, personal care agencies, and home and community support service agencies that serve adults with intellectual disabilities, autism, related conditions, or acquired brain injuries, which provide State government with new tools to hold health care providers accountable and provide higher standards of care for Maine people.
The Department is addressing allegations of fraud. As of June 2026, the Department has taken licensing enforcement action involving 15 Personal Care Agencies (PCAs), with some agencies subject to more than one enforcement action:
- Issued six conditional licenses;
- Refused to renew six licenses;
- Assessed financial penalties against 12 agencies;
- Voided one incomplete license application; and
- Referred one agency to the appropriate law enforcement agency.
The Department also declined to renew the licenses of two mental health agencies that provide Rehabilitative Community Services. Agencies and providers are entitled to due process and may appeal these actions, as allowed by law.
DHHS is committed to sharing as much information as possible so the public can understand how seriously it takes fraud prevention and provider oversight. At times, state and federal laws limit what the Department can share in order to protect ongoing investigations, licensing and enforcement actions, and the rights of those involved.
To learn more about the Department’s comprehensive approach to oversight, compliance, accountability, and program integrity, read our previous blog, “Stewardship and Integrity in Public Programs.”