Maine Auditor Matt Dunlap’s Congressional Bid Amid Medicaid Fraud Concerns

Maine’s state auditor, Matt Dunlap, a Democrat running for Congress in the 2nd District, released a concerning report earlier this year. The report highlights a significant gap in the oversight of the state’s MaineCare program, especially in the utilization control by the Program Integrity Unit (PIU).

The report states that the PIU failed to provide documentation of its methods for identifying projects and post-payment reviews related to Medicaid services. This lack of documentation followed reports of healthcare fraud in Maine, brought to light by federal investigators and a local whistleblower. The release of this report has intensified scrutiny on Dunlap’s performance as auditor amid a highly competitive congressional race.

To ensure compliance with federal standards, the PIU selects cases for review based on data analytics. Yet, the report pointed out a weakness: the absence of documentation justifying the selection of these cases and the neglect of potential misuse by patients or billing companies.

The PIU, according to the report, “does not document consideration of misutilization practices of beneficiaries or providers,” potentially leading to noncompliance with federal regulations. Although this reporting issue was new, the report indicates no prior findings of a similar nature.

When questioned, Dunlap’s campaign stated that the report focused solely on this particular weakness and that Dunlap had earned praise for identifying other issues. Campaign spokesperson Harry Burke mentioned that changes flagged by the auditor depend on state departments for implementation. For instance, a recommendation led to the arrest of a procurement fraudster, saving tax dollars.

Despite praise, Dunlap has faced criticism from Republicans for not stopping fraud schemes that gained national attention. Vice President JD Vance visited Maine, pointing out the state’s struggles with fraud and questioning Dunlap’s qualifications. Vance argued that Dunlap’s record disqualifies him from Congress.

Dunlap was initially appointed in 2021 despite lacking auditor credentials, resigning after failing certification exams twice. He resumed the role in late 2022 after passing the exams. Republicans have focused on his track record, especially after a report from the U.S. Health and Human Services Office of Inspector General highlighted $45.6 million in improper Medicaid payments for autism services.

Whistleblower Christopher Bernardini reported fraud at Gateway Community Services, accusing the contractor of submitting false records for non-existent services. These issues have captured attention, with Vance and others questioning Maine’s ability to guard against fraud under Dunlap’s oversight.

Reports from before Dunlap’s tenure indicated increased fraud investigations that exceeded the office’s capacity, and the current lack of resurging concerns suggests a continued oversight challenge. Dunlap, having secured the Democratic nomination, will face former Governor Paul LePage in the general election on November 3.