The Attorney General's Healthcare Crimes Unit (the State's designated Medicaid Fraud Control Unit) is a federally-funded unit charged with investigating and prosecuting
- MaineCare fraud; and
- abuse, neglect or financial exploitation occurring in MaineCare facilities or committed by MaineCare providers or their employees.
We investigate MaineCare providers and their employees. For example, we investigate doctors, nursing homes, hospitals, adult care homes, and home health agencies.
The unit consists of attorneys, investigators, an auditor, and support staff.
Healthcare fraud can take a variety of forms. Common examples include:
- Billing for services not rendered or performed
- Dispensing generic drugs and billing for brand name drugs
- Billing for a higher level of service than was actually performed
- Billing for unnecessary services
- Billing using separate billing codes when the services should have been grouped together under one billing code
- Double billing
- Denial of necessary services or procedures, or denial of access to specialists
How to spot MaineCare Fraud
- If you receive an Explanation of Benefits (EOB) from MaineCare, read it carefully and tell the MaineCare office if you did not receive the listed services.
- If a provider suggests treatments or services that you do not believe are necessary, be cautious of the recommendation. Ask for a second opinion.
- If you have a relative in a nursing home, regularly check their funds account for unauthorized withdrawals.
If you suspect that healthcare fraud has occurred, please contact the Healthcare Crimes Unit promptly.
Abuse, Neglect or Financial Exploitation of Patients
Abuse can be physical, emotional or sexual. Abuse can result in physical injury such as:
- Burn marks
- Redness and/or swelling
Assaultive acts are almost always abuse. Examples of assaultive acts include, but are not limited to:
Neglect is a pattern of conduct, engaged in without the patient's informed consent, resulting in deprivation of food, water, medication, medical services, shelter, cooling, heating or other services necessary to maintain minimum physical or mental health.
Examples include, but are not limited to:
- Pressure sores
- Unsafe, dangerous or unsanitary living conditions
- Untreated medical problems
If you suspect that a vulnerable adult has been abused or neglected, report it immediately to the Healthcare Crimes Unit. You may also contact the Elder Abuse Hotline by calling 1-800-624-8404.
Reporting to the Healthcare Crimes Unit
If you suspect that MaineCare fraud has occurred, or abuse, neglect or exploitation has occurred in a MaineCare facility or by someone working for a MaineCare provider, immediately report the incident to the HealthCare Crimes Unit by calling 207-626-8870, or by filling out an on-line form.
Our mailing address is:
Healthcare Crimes Unit
Maine Office of Attorney General
State House Station 6
Augusta, Maine 04330
If the incident needs immediate attention, call 911 immediately.
Links of Interest
- Office of Inspector General Exclusion Database This site, of the federal Department of Health and Human Services, contains a searchable database of providers (businesses) and individuals who have been disqualified from receiving federal Medicaid (MaineCare in Maine) funds because of fraud, abuse or neglect.
- Office of Adult Protective Services This is the state Department of Health and Human Services's site for Adult Protective Services. If you suspect that an adult (age 18 and above) is being abused or neglected (including financial exploitation), or is in danger of abuse or neglect, you can report your suspicions to Adult Protective Services.
- Maine Board of Nursing This is the site of the Maine State Board of Nursing, a division of the Department of Professional and Financial Regulation. This site allows you to look up the license of a nurse (RN or LPN), provides links to laws and regulations relating to nursing, and provides information on filing a complaint against a nurse.
- Department of Professional and Financial Regulation This Department provides the public with the ability to look up license and registration information from over 40 regulated occupations and professions (including disciplinary actions for most occupations/professions).