PORTLAND (WGME) — The Trump administration says it’s auditing MaineCare, looking into how the state handles funding to prevent fraud.
In a statement Friday, the Centers for Medicare and Medicaid Services said, “The audit will assess the state’s safeguards against fraud, waste and abuse, including how it identifies risks, refers suspected fraud and addresses improper payments.”
The audit comes as Maine’s Department of Health and Human Services says it’s investigating several credible allegations of MaineCare fraud, something state leaders say they were already doing without federal scrutiny.
The state has suspended payments to five providers based on those allegations.
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MANAGEMENT & CULTURE (THE “TONE AT THE TOP”)
Fraud thrives in “sloppy” environments where leadership ignores the rules.
- The Fraud Triangle: For fraud to occur, three elements must be present: Pressure (the need for money), Rationalization (thinking “I deserve this”), and Opportunity (weak controls). You can only control the Opportunity.
- Whistleblower Hotline: Provide an anonymous way for staff to report “odd behavior.” Most internal frauds are caught via tips, not audits.
- Background Checks: Conduct credit and criminal record checks for all employees in financial or data-sensitive roles.
- Annual Ethics Training: Make sure every staff member knows that the company has a Zero Tolerance policy toward “borrowing” from petty cash or fudging overtime.