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Data scientist uncovers massive scale of “personal care” Medicaid fraud in Maine (thread)
Posted on 2/14/26 at 2:53 pm
Posted on 2/14/26 at 2:53 pm
I’d love for tboy, euro cat, and other people on here who insist Medicaid is amazing to explain away this data. It’s damning.
LINK
Here are the top T1019 providers by cost per claim (minimum 50 claims to filter out noise):
There is a lot more data in the article.
This is infuriating. It’s blatant. It’s a massive risk with having Medicaid cover in-home personal care services.
NYC is seeing same thing
LINK
quote:
Before I get into the details, I want to be clear about a few things. Every dollar amount below comes from public records. Every business name is pulled straight from the federal provider registry. Every address was filed with CMS by the providers themselves. I didn't hack anything or access anything non-public. I just downloaded some files and started asking questions.
This post covers a tiny sample of what I found, specifically one procedure code (T1019, personal care services) and a handful of providers in THREE cities in Southern Maine. There's a lot more in the data that I haven't dug into yet. But I think what's here is worth sharing.
quote:
I zeroed in on one procedure code: T1019, personal care services. This is hands-on home health stuff. Bathing, dressing, feeding, helping someone get around. It's billed in 15-minute increments and Maine explicitly prohibits billing T1019 via telehealth. Meaning someone has to actually, physically show up.
110 providers billed T1019 statewide over this period. The average cost per claim: $223.
I sorted by cost per claim, filtered to the Portland/Lewiston/South Portland and that's where things got more interesting.
Here are the top T1019 providers by cost per claim (minimum 50 claims to filter out noise):
quote:
See that green dashed line? That's the statewide average. $223 per claim.
Decent Health Care is billing at $1,292/claim, or 5.8x the average.
Anywhere Care Service, which operates out of apartment 706 in a Portland residential building, charges $1,177/claim (5.3x).
Northeast Transit, a transportation company, bills home health services at $894/claim (4.0x).
Providers are charging 3-5x what everyone else in the state charges for the same service!
It gets worse. 27 of 36 T1019 providers in the Portland/Lewiston/South Portland area bill only that one code. No nursing visits. No therapy. No case management. Just T1019, over and over, often at multiples of the statewide rate.
If you know anything about healthcare fraud, single-code billing is one of the first things investigators look for. Real home health agencies bill a mix of services. These don't.
quote:
Here's the thing that really got me. When a company bills millions in taxpayer money, you'd expect to find... something. A website. A Google listing. Some Yelp reviews. A LinkedIn page. Just basic evidence that this is a real business operating in the real world.
I went looking. For a lot of these providers, there's nothing there.
There is a lot more data in the article.
This is infuriating. It’s blatant. It’s a massive risk with having Medicaid cover in-home personal care services.
NYC is seeing same thing
13
Posted on 2/14/26 at 2:54 pm to HailHailtoMichigan!
quote:
I zeroed in on one procedure code: T1019, personal care services. This is hands-on home health stuff.
AKA, the gold mine of Medicaid/Medicare fraud
Posted on 2/14/26 at 2:58 pm to HailHailtoMichigan!
More fraud is being exposed. Remember when Trump said the fraud in california was even worse than minnesota.
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Posted on 2/14/26 at 3:04 pm to HailHailtoMichigan!
Do you know how to fix this?
1) start perp walking as many as you can round up and give them max sentences. Make it all live TV for all to see.
2) Do random audits on as many of these clinics and healthcare businesses as possible. Make them show you the customers. Get out there and meet the patients. This should be part of any gvt assisted healthcare. If the tax payer pays, then they deserve to know if their money is being spent on actual services.
3) Audits should be handled by state and federal agencies, and they shouldn’t work together.
4) phase out Obamacare, Medicare and Medicaid all together.
1) start perp walking as many as you can round up and give them max sentences. Make it all live TV for all to see.
2) Do random audits on as many of these clinics and healthcare businesses as possible. Make them show you the customers. Get out there and meet the patients. This should be part of any gvt assisted healthcare. If the tax payer pays, then they deserve to know if their money is being spent on actual services.
3) Audits should be handled by state and federal agencies, and they shouldn’t work together.
4) phase out Obamacare, Medicare and Medicaid all together.
Posted on 2/14/26 at 3:10 pm to Ailsa
quote:
California caught sending over $3 billion dollars to dead people
They are just paying them for their vote. lol.
Posted on 2/14/26 at 3:13 pm to HailHailtoMichigan!
There’s an even simpler way to observe the aberrant billing. Chart a doctor’s Medicaid coding compared to his insured coding.
Dentists are the most egregious examples. A child on Medicaid is 4X as likely to have crowns and root canals performed compared to those that don’t.
Dentists are the most egregious examples. A child on Medicaid is 4X as likely to have crowns and root canals performed compared to those that don’t.
Posted on 2/14/26 at 3:31 pm to W2NOMO
quote:
quote:
California caught sending over $3 billion dollars to dead people
They are just paying them for their vote. lol.
More like paying themselves...pure fraud. Think of all those offshore accounts being confiscated to pay down the national debt.
Posted on 2/14/26 at 3:49 pm to HailHailtoMichigan!
Blame the states bowing to providers
This happens WAY more than people realize
This happens WAY more than people realize
Posted on 2/14/26 at 4:13 pm to HailHailtoMichigan!
quote:
NYC is seeing same thing
Here in Florida we elect it as governor, twice, and 2 terms in the us senate... and counting.
Posted on 2/14/26 at 4:47 pm to W2NOMO
quote:
paying them for their vote.
Every single thing a democrat does is based on supporting federal programs that can be exploited fraudulently - and of course what the illegals do is perfectly OK with the democrats just so DEMs get a cut of the fraud for election purposes and a little for their own retirement funds.
I am convinced there are not innocent democrats in any elected or appointed position to play a tennis match.
All you have to do is look at what they are always willing to 'go to the mattress' for:
illegal aliens
no ID for voting
massive federal programs to support 'immigrants'
absolute maniacal support for 'mass protests' regardless of harm done.
going apoplectic over every instance of trying to enforce immigration law.
Allowing upwards of 15 million illegal aliens in the country during biden tenure - and now under Trump demand that EVERY ONE of them must have 'their day in court' - a process that would take a century to accomplish with all the lawfare tactics they could use to gum up the works.
NOTHING is more absolutely disgraceful as a Democrat politician (above local lever - I am sure there are SOME honest mayor and sheriffs.)
Posted on 2/14/26 at 4:55 pm to HailHailtoMichigan!
quote:
This is infuriating. It’s blatant. It’s a massive risk with having Medicaid cover in-home personal care services.
Anyone that has run urgent care clinics over the last 15 years should be investigated.
Lots of people should be in prison - including doctors. And mobsters.
Posted on 2/14/26 at 5:35 pm to wryder1
My mother gave up her home healthcare business while Jindal was governor. She was tired of constantly being audited because the state knew she would pass. Meanwhile, the crooked ones never got audited.
Posted on 2/14/26 at 5:48 pm to HailHailtoMichigan!
Those blue states love em some fraud
Posted on 2/14/26 at 6:02 pm to lsuconnman
There's a direct correlation between lower socioeconomic groups (Medicaid) and poor diet and dental health
Posted on 2/14/26 at 6:04 pm to D500MAG
quote:
My mother gave up her home healthcare business while Jindal was governor. She was tired of constantly being audited because the state knew she would pass. Meanwhile, the crooked ones never got audited.
Probably because she wasn't giving them kickbacks.
Posted on 2/14/26 at 7:33 pm to HailHailtoMichigan!
Good find HHM.
-- Best quote in Tweet
quote:
Nail it (in Minnesota), then scale it (in Maine)?
-- Best quote in Tweet
Posted on 2/14/26 at 7:50 pm to HailHailtoMichigan!
Decent Health Care
One of the first Google results for him:
quote:
The authorized official of this NPI record is Mr. Faysal Kalayaf Manahe (Admin)
One of the first Google results for him:
quote:
According to the one-count felony indictment filed yesterday in the U.S. District Court for the District of Maine, four Portland residents: Faysal Kalayaf Manahe; Yaser Aali; Ammar Alkinani; and Quasim Saesah — all owners and/or managers of home health care agencies — conspired to eliminate competition for the services of Personal Support Specialist (PSS) workers by agreeing to fix the rates paid to these workers and by agreeing not to hire each other’s workers. This indictment is the first in this ongoing investigation into wage fixing and worker allocation schemes in the PSS industry.
quote:
Decent Health Care in Maine, also known as Health at Home, has an estimated annual revenue of approximately $45.7 million.
Posted on 2/14/26 at 8:18 pm to HailHailtoMichigan!
A LOT must be going on in Maine. The Chinese in Oklahoma that have been running the illegal weed grows are all starting to pack up and head to Maine. I've got family that run a LEGAL growery, and there's actual excitement in the Oklahoma industry because of the Chini departure.
We need to be looking at Maine at this point with probably even more scrutiny than Minnesota. Things are afud there, and it needs to come to light. Feel free to bookmark me, but I'm telling you there's going to be some really big news coming from ME in the future.
We need to be looking at Maine at this point with probably even more scrutiny than Minnesota. Things are afud there, and it needs to come to light. Feel free to bookmark me, but I'm telling you there's going to be some really big news coming from ME in the future.
Posted on 2/14/26 at 8:26 pm to TigerAxeOK
I wish they would just shut up about it until someone decides to do something about it.
Posted on 2/14/26 at 8:29 pm to HailHailtoMichigan!
DEMs need money = DEMs believe Medicaid is “GOOD”.
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