LEWISTON, Maine- Maine’s Medicaid system, known as MaineCare, is under serious scrutiny after a series of alleged Somali fraud schemes drained millions of taxpayer dollars from the program. Federal and state investigators have tracked several cases that show a clear pattern of abuse, many tied to people of Somali origin working in health care and interpreter services in the Lewiston-Auburn area.
These schemes redirected money meant for low-income and medically fragile residents, raised doubts about oversight, and sparked public concern about how MaineCare is managed and protected.
The Somali Kickback Scheme
One of the most serious recent cases ended in 2021 with the sentencing of two Lewiston men, Abdirashid Ahmed, 41, and Garat Osman, 35. Both were ordered to repay more than $2.4 million to MaineCare. Ahmed and Osman, who worked as Somali interpreters, pleaded guilty to health care fraud tied to a scheme involving a local counseling agency, Facing Change.
Court records show the fraud took place from late 2015 through 2018. Prosecutors said Ahmed asked Nancy Ludwig, the owner of Facing Change, for kickbacks in return for sending MaineCare patients to her clinic. Once clients arrived, Ahmed, Osman, and others joined with Ludwig to file false claims with MaineCare.
The group billed for services that were never provided or inflated the level of care given. In many cases, they claimed both counseling and interpreter services, which did not happen at all.
When MaineCare rules changed in 2016, the group allegedly found a way to keep the money flowing. According to the government, Ludwig and Ahmed agreed to change many patients’ diagnoses to schizophrenia so they would still qualify for high-paying services at Facing Change.
When the MaineCare Program Integrity Unit showed up to audit the agency in fall 2016, the people involved did not stop. Investigators say they created fake records to back up their false claims and mislead auditors. Osman, who joined the plot in late 2016, set up his own interpreter company and used it to keep the fraud going and move the illegal payments.
Acting U.S. Attorney Donald E. Clark praised investigators and made clear how serious the case was, saying that federal and state agencies will keep going after anyone who cheats public health programs. Phillip M. Coyne, Special Agent in Charge for HHS-OIG, said that health care fraud drains money that should help the most vulnerable patients.
Ahmed received a two-year prison sentence. Osman was sentenced to three years of probation, along with heavy restitution and financial penalties.
Early Home Care Fraud Case
The interpreter case did not come out of nowhere. Years earlier, in 2012, another Lewiston resident, Somali native Mohdi M. Ali, 56, pleaded guilty to several federal charges, including making false statements involving a health care benefit program.
Ali was the former head of Decent Home Care Inc., a company that provided nonmedical services to seniors and people with disabilities under MaineCare. According to prosecutors, Ali obtained a Social Security number and an alien registration card by lying about his background, including falsely claiming that he had lived in refugee camps in Kenya.
Decent Home Care Inc. took in more than $1 million from MaineCare in 2008 alone. Ali used his fraudulently obtained documents to sign up for MaineCare benefits in 2006, the same year he created his company.
A 2007 review found that Ali had lied to the Maine Department of Health and Human Services (DHHS). He hid about $29,000 in bank savings and $24,000 in wages he earned as the executive director of his own firm. By hiding that income and those assets, he got approved as a MaineCare provider for his company.
Ali faced a possible 15-year prison sentence and up to $500,000 in fines. As part of his plea deal, he also agreed that he would be removed to Canada after serving any prison time. His case showed how MaineCare can be exploited when someone is willing to lie about their status, income, and assets.
The Cost to Maine Residents
Taken together, these fraud cases reveal long-term weaknesses in how MaineCare is monitored. The numbers are large on their own, with more than $2.4 million tied to the interpreter scheme and more than $1 million linked to Decent Home Care. The broader impact is even larger, since every stolen dollar is money that does not go to people who need health care help.
The Maine Attorney General’s Healthcare Crimes Unit, which receives federal funding, leads many of these investigations. State officials are encouraging residents and health care workers to report suspicious billing, fake records, or unusual patterns of service use. Public tips often help stop fraud before it grows.
The fact that several high-profile cases involve members of the Somali community has caused tension in Lewiston-Auburn and beyond. Community leaders, providers, and state agencies are debating how to strengthen background checks and monitoring for health care and interpreter services, while also avoiding unfair treatment of honest providers.
Federal and state law enforcement agencies say they will keep working together to track and prosecute Medicaid fraud. Their message is direct: those who abuse MaineCare for personal gain can expect aggressive investigation and serious legal consequences.
For a broader look at similar issues in another state, the video Unmasking the Minnesota Somali Fraud Network discusses alleged fraud involving Somalis and government-funded programs, which mirrors some of the patterns seen in the MaineCare cases.
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