MaineCare Fraud Risk Map: Explore New Data on Medicaid Claims for Maine Providers

Thanks to the Trump Administration’s unprecedented release of Medicaid claims data, taxpayers may now get insight into how one of America’s most expensive welfare programs has been spending their money.

(Note: The map is based on federal data released by the Department of Health and Human Services. The data show monthly claims-level payments to Medicaid providers from 2018 to 2024. That data was layered with the National Provider Index to form a complete picture of the business connected to each set of billing records. The index used here is a measure of fraud risk based on indicators commonly used by fraud investigators.)

Maine’s Spending Trajectory (2018–2024)

Year	Total Spending	Claims	Providers (Based in Maine)	Avg Cost/Claim
2018	$1.077B	11.9M	1,570	$90.78
2019	$1.200B	12.9M	1,567	$92.85
2020	$1.186B	11.8M	1,616	$100.45
2021	$1.299B	13.8M	1,657	$94.45
2022	$1.388B	13.8M	1,601	$100.20
2023	$1.658B	14.4M	1,641	$115.33
2024	$1.679B	13.1M	1,605	$128.21

In the seven years from 2018 to 2024, Maine spent a total of $9.49 billion on Medicaid at providers located in Maine. The cost per claim increased 41 percent ($90.78 → $128.21) — far beyond the rate of inflation. Total claims volume grew only 10 percent. This means the cost increase is overwhelmingly driven by unit price inflation, not increased utilization. That’s a red flag — it suggests providers are billing higher per service, not that more people are getting care.

Maine vs. National: Cost Per Claim Outliers

This is where the data gets alarming. Maine is spending 5.4x as much per claim on substance abuse treatment drugs like Methadone and Suboxone. That means that the same treatment covered by the same program is more than five times cheaper in most other states. The same story goes for Maine’s residential care program, which provides group homes for disabled Mainers to live in. The average claim in Maine under that program is $1,671 versus $482.04 nationwide. Here are the numbers for Maine’s cost per claim compared to the national average (with Maine excluded from the benchmark):

Service Code	Description	Maine Cost/Claim	National (excl ME)	Ratio	Maine Spending
H0020	Methadone/Substance Abuse	$106.80	$19.68	5.4x	$129M
S5140	Adult Foster Care	$527.15	$149.01	3.5x	$421M
T2016	Residential Habilitation	$1,671.26	$482.04	3.5x	$2.31B
G0299	Home Health Skilled Nursing	$151.85	$53.33	2.8x	$143M
H2036	Psych Rehab – Intensive	$735.77	$256.97	2.9x	$33M
S5125	Attendant Care	$160.76	$78.54	2.0x	$149M
H0019	Behavioral Health Residential	$564.68	$277.07	2.0x	$670M
T1019	Personal Care Services	$223.01	$111.29	2.0x	$513M
H2012	Day Treatment – Behavioral	$232.06	$122.73	1.9x	$212M
H2021	Community Support	$294.49	$170.23	1.7x	$534M