By Sen. Marianne Moore

(Editor’s Note: This column originally appeared in the Machias Valley News, The Calais Advertiser and The Quoddy Tides)

Maine people deserve a government that safeguards vulnerable citizens while also being a careful steward of taxpayer dollars. On MaineCare, this obligation has not been met.

For years, warning signs were there. A federal investigator found interpreter claims in MaineCare surged by 283% between 2011 and 2017, while annual costs climbed from roughly $800,000 to more than $4.1 million. This happened even as refugee and immigrant arrivals in Maine declined. Those numbers alone should have triggered sustained scrutiny and decisive action.

Instead, what followed was a pattern that should trouble every taxpayer in this state: delayed accountability and a system appearing to react only when public pressure becomes impossible to ignore.

The question Mainers should be asking is simple: Why did it take a whistleblower speaking out publicly in late 2025 for the state to finally suspend payments to Gateway Community Services, despite problematic prior audits and state knowledge of problems? If a whistleblower had not sounded the alarm, would anything have changed at all?

The most disturbing part of this story is that we are not talking about a one-time oversight or an isolated billing error. Audits in 2017, 2019 and 2023 reportedly identified major overbilling, and payments continued until the state finally shut them off in January. Nearly a decade of overpayments is not just a mistake. It is a systemic failure.

The Department of Health and Human Services (DHHS) describes Maine’s program integrity system as “comprehensive and mature.” The facts tell a different story. When an inspector general finds a 100% failure rate in an audit and when the administration itself says Maine must spend millions more and hire nearly 100 additional people just to bring the program into compliance, this is not evidence of a mature oversight system. It is evidence of one that has fallen badly behind.

The problem is not hard to see. MaineCare is now a $5.4 billion program. The number of providers has ballooned to around 5,000. Yet DHHS has told lawmakers its fraud unit has only four investigators to oversee that universe of vendors. The imbalance is staggering.

Even worse, fraud investigations have declined in recent years. DHHS says 22 cases were referred to the attorney general’s office over the last five years, but reporting has shown Maine ranks near the bottom nationally in fraud investigations in recent years. Over the last six years, the department says it has discontinued payments to only three providers, including Gateway. This is certainly not an aggressive defense of public funds.

To be fair, DHHS points to 290 notices of violation and $37.5 million in identified overpayments. However, last year, despite the highest number of complaints or leads, the department issued the fewest notices, identified the fewest overpayments and recovered only $1.2 million. Those are not the results of a system getting ahead of the problem.

Meanwhile, Maine taxpayers are being asked again and again to put more money into a program already facing repeated shortfalls. Last year, lawmakers had to add hundreds of millions more to MaineCare funding. Now, the administration is asking for more. With enrollment down from its 2024 peak, taxpayers have every right to ask why the budget pressures keep growing.

Here is the uncomfortable truth: You can budget for enrollment, service costs and utilization. What you cannot, responsibly, ignore is fraud. If fraud is not being aggressively detected and stopped, taxpayers will keep footing the bill.

Mainers should not have to rely on whistleblowers, national media attention or congressional scrutiny to force action. Oversight should be constant, transparency should be standard and accountability should be immediate.

MaineCare is too important to fail, but public confidence in it will continue to erode unless state government proves it can protect both the people who depend on the program and the taxpayers who fund it.

Senator Marianne Moore is serving her fourth term representing the citizens of Senate District 6, which includes all of Washington County and 16 communities in Eastern Hancock County. She serves as the Senate Republican lead on the Legislature’s Health and Human Services Committee.