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State regulators have accused a Maine-based counseling organization of fraudulently billing MaineCare for millions in mental health services, allegations the company vehemently denies as “false and without merit.”
Resilience Counseling Services, which operates facilities in Lewiston, Saco, and Portland, is under scrutiny after the Maine Department of Health and Human Services (DHHS) filed a notice of violation claiming the organization improperly billed the state’s Medicaid program for services that were either not provided or delivered by unqualified staff members.
According to the notice filed last week, state regulators allege that Resilience Counseling Services submitted approximately $3.8 million in fraudulent claims between 2020 and 2023. The state contends that the organization engaged in systematic practices that violated MaineCare billing regulations, including billing for therapy sessions conducted by unlicensed practitioners without proper supervision.
“We take allegations of MaineCare fraud very seriously as these programs are designed to serve our most vulnerable residents,” said a DHHS spokesperson in a statement. “Our investigation has uncovered concerning patterns that suggest intentional circumvention of billing requirements and quality standards.”
In response, Resilience Counseling Services issued a strongly worded statement defending its practices and denying all accusations. The organization’s attorney, Margaret Wilson, characterized the state’s claims as “baseless” and suggested they stemmed from administrative misunderstandings rather than intentional wrongdoing.
“Resilience Counseling Services has always operated with the highest ethical standards and in compliance with all MaineCare regulations,” Wilson stated. “We maintain meticulous records of all services provided and are confident that a fair review will demonstrate our full compliance with state requirements.”
The dispute highlights ongoing tensions within Maine’s mental health system, which has faced significant challenges in recent years. The COVID-19 pandemic exacerbated existing mental health needs across the state while simultaneously straining provider resources and complicating service delivery models.
Mental health advocates note that Maine’s rural nature creates additional barriers to care, with many counties facing severe shortages of licensed practitioners. This has led some organizations to rely more heavily on conditional licensees and trainees working under supervision—a practice that is permitted under MaineCare rules but requires strict adherence to supervision protocols.
“The regulations regarding who can provide services and how they must be supervised are complex and have evolved significantly since the pandemic,” explained Dr. James Harrington, president of the Maine Association of Mental Health Providers, who spoke in general terms about industry practices without commenting on this specific case. “Many organizations have had to adapt quickly to changing requirements while simultaneously handling unprecedented demand for services.”
According to state data, MaineCare spending on behavioral health services has increased by approximately 28% since 2019, reflecting both greater need and expanded coverage options. The program now serves over 400,000 Maine residents, making it a critical component of the state’s healthcare infrastructure.
For Resilience Counseling, the allegations could have far-reaching consequences. If the violations are upheld, the organization could face substantial financial penalties, repayment requirements, and potential exclusion from MaineCare programs—a devastating outcome for an organization that reportedly serves over 1,500 clients statewide.
The company has 30 days to contest the findings and has indicated it plans to vigorously defend itself. “We intend to cooperate fully with any review process while continuing to provide essential mental health services to our clients without interruption,” Wilson added.
State Senator Heather Sanborn, who chairs the Health and Human Services Committee, expressed concern about the potential impact on clients should services be disrupted. “While we must ensure proper oversight of MaineCare spending, we also need to consider continuity of care for patients who rely on these services,” she said. “Any resolution should prioritize patient needs while addressing compliance issues.”
The DHHS has stated that its primary goal is ensuring quality care for MaineCare recipients and proper stewardship of public funds. The department indicated it is exploring options to ensure service continuity for current clients should enforcement actions be necessary.
A hearing on the matter is expected to be scheduled within the next 60 days.
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20 Comments
Allegations of Medicaid fraud are always concerning, but the counseling organization’s strong denial of the claims is noteworthy. I hope a thorough investigation can uncover the truth and ensure accountability if wrongdoing is confirmed.
Well said. Transparency and due process will be essential in resolving this matter fairly for all involved.
The state’s claims of Medicaid fraud are certainly concerning, but the counseling organization’s firm denial of the accusations is notable. I look forward to seeing the results of a thorough investigation that can shed light on the facts and ensure appropriate accountability if wrongdoing is confirmed.
Agreed. Transparency and a balanced review of the evidence will be key to upholding the integrity of Medicaid programs.
While the state’s allegations of fraudulent Medicaid billing are concerning, the counseling organization’s strong denial of the claims is notable. I hope a comprehensive review can establish the truth and ensure appropriate accountability if wrongdoing is confirmed.
Exactly. Maintaining trust in Medicaid programs requires a balanced and thorough investigation process.
It’s good to see the counseling organization forcefully refuting the fraud accusations. However, the state’s claims of improper billing and unqualified staff also warrant serious attention. A balanced review of the evidence is needed to determine what actually occurred.
Agreed. This case highlights the importance of rigorous oversight and compliance within Medicaid programs to protect patients and public funds.
This is a complex case with competing claims. I appreciate the counseling organization’s denial of the fraud accusations, but the state’s allegations of improper Medicaid billing also warrant close scrutiny. A careful examination of the evidence will be crucial to determine what actually occurred.
Well said. Maintaining objectivity and following due process will be essential in resolving this matter fairly.
This is a serious allegation of fraud against a counseling organization. I’m curious to learn more about the details and evidence behind the state’s claims. Proper oversight and accountability of Medicaid billings is crucial to protect vulnerable patients and taxpayer funds.
You raise a good point. It will be important for the counseling organization to provide a clear and transparent response to address the state’s concerns.
While the state’s accusations are concerning, I appreciate the counseling organization denying the claims as false. More information is needed to understand both sides of this issue before drawing conclusions.
Agreed. It’s wise to withhold judgment until a full investigation can be conducted and all the facts are known.
Medicaid fraud is a serious issue, but the counseling organization’s denial of the state’s claims suggests there may be more to this story. I’m interested to see how the investigation unfolds and what additional details emerge.
You make a fair point. It’s prudent to avoid rushing to conclusions until all the facts have been thoroughly examined.
Proper billing practices and oversight of Medicaid programs are critical. However, the counseling organization’s denial of the fraud claims suggests there may be more to this story. I look forward to seeing how this situation unfolds with further details.
That’s a fair perspective. These types of cases can be complex, so it’s important to avoid rushing to judgment until all evidence is reviewed.
While the state’s allegations of fraudulent Medicaid billing are serious, the counseling organization’s vehement denial of the claims is worth considering. I hope a comprehensive investigation can uncover the truth and ensure fair treatment for all involved.
That’s a reasonable perspective. Maintaining impartiality and due process is crucial in resolving complex cases like this.