State of Maine Medicaid Program

HHS-OIG recommended that Maine refund $45.6 million to the federal government and implement corrective actions to strengthen its Medicaid program integrity. The state must improve its provider enrollment and screening processes, enhance claims review systems, and establish better monitoring of autism service billing practices.

The HHS Office of Inspector General audit found that Maine made at least $45.6 million in improper Medicaid payments for autism services. The audit covered services provided from July 2018 through June 2022 and identified systemic issues in the state's Medicaid billing and oversight processes for autism-related treatments.

The improper payments resulted from several factors including services that were not medically necessary, lacked proper documentation, were provided by unqualified providers, or did not comply with state Medicaid requirements. The audit identified weaknesses in Maine's oversight of autism service providers and its claims processing system.