(The Center Square) — Maine Republicans are calling for an independent investigation after a federal watchdog faulted state officials for making nearly $46 million in “improper” Medicaid payments for services to autistic children.
A new report from the U.S. Department of Health and Human Services Office of Inspector General, released Thursday, found nearly 100 Medicaid payments for autistic rehabilitative and community support services did not fully comply with federal and state requirements. The federal watchdog directed the state to repay at least $28.7 million for the federal share of the payments.
“The integrity of Medicaid programs is non-negotiable. Improper payments undermine public trust and divert resources from those who need them most,” Inspector General T. March Bell said in a statement. “We expect full compliance with federal and state requirements to ensure taxpayer dollars are spent appropriately and vulnerable children receive the care they deserve.”
The agency said the investigation was prompted, in part, by data showing Medicaid payments for RCS services in Maine have increased significantly, from $52.2 million in 2019 to $80.6 million in 2023.
Medicaid is jointly funded by states and the federal government. In Maine, the federal government picks up most of MaineCare’s $5.4 billion in annual spending, with the state contributing about $1.5 billion, according to federal data.
Auditors said they found RCS services were provided to children who either did not receive required comprehensive assessments, or the assessments didn’t include signatures of the staff who conducted the assessments or parents or guardians, among other issues. The state hadn’t conducted a post-payment review of RCS payments since the program launched in 2010, auditors found.
“These issues, and those that led to improper and potentially improper payments, could have had a significant effect on the quality of care provided to children with autism,” the report stated.
Maine Republican House leaders said the IG’s audit confirms what they have been warning for years: that “fraud, waste, and abuse within MaineCare is widespread and can no longer be dismissed or hidden.” They’re calling for an independent investigation and changes to state law to prevent fraud and abuse in the programs.
“These failures harm taxpayers and, more importantly, jeopardize services for the vulnerable children and families who truly depend on MaineCare,” House Republicans said in a statement. “Rather than address rampant waste, fraud and abuse identified by their own Auditor, Democrats raised taxes primarily on Maine’s working poor.”
In a statement, the Maine Department of Health and Human Services noted that the audit was routine and “not triggered by any specific allegation” against the state. The agency said the IG’s report “does not include findings or allegations of fraud” but identified “potential documentation and compliance issues, which the state is now reviewing.”
“In cases where inappropriate overbilling for claims may have occurred and cannot be justified through required documentation and clarification, the Department’s Office of MaineCare Services’ Program Integrity Unit would seek to recover and recoup overbilled funds,” the agency said. “If a credible allegation of fraud is made, it will be referred to the Office of the Attorney General.”
But the IG’s report comes amid increased scrutiny of Maine’s Medicaid spending following recent claims by a whistleblower that the Lewiston-based Gateway Community Services, whose CEO is from Somalia — overbilled MaineCare — and submitted false claims for behavioral health services it didn’t provide. Republican lawmakers have also called for an investigation into those claims.
