A federal audit has found that Maine made at least $45.6 million in improper Medicaid payments for support services provided to children with autism in 2023.

The U.S. Department of Health and Human Services Office of Inspector General, which conducted the audit, said the state didn’t properly document the services, and failed to conduct “post-payment reviews” that could have caught issues.

“The integrity of Medicaid programs is non-negotiable,” the inspector general, T. March Bell, said in a written statement. “Improper payments undermine public trust and divert resources from those who need them most.”

The audit findings come amid scrutiny of social services programs in Maine — particularly those associated with immigrant communities. The Trump administration has used claims of Medicaid fraud as a pretext for sweeping immigration enforcement missions in Maine and Minnesota in recent weeks.

A state official, meanwhile, downplayed the new report on Friday as part of a routine exercise the federal government is conducting in multiple states.

 “The report does not include findings or allegations of fraud; the audit identified potential documentation and compliance issues, which the state is now reviewing,” Lindsay Hammes, a spokesperson for the Maine Department of Health and Human Services, said in an email. “The report does not question the appropriateness or necessity of services, nor does it allege intentional wrongdoing by providers or the state.”

The inspector general’s office also noted on Friday that the Maine audit is part of an ongoing series of reviews across states to look into “unallowable services and questionable billing patterns” in autism care. Similar analyses have already been conducted in Indiana and Wisconsin, resulting in federal authorities finding at least $56 million in improper payments in Indiana, and at least $18.5 million in Wisconsin.

In Augusta on Friday, Maine Republicans highlighted the findings as evidence that fraud, waste and abuse are widespread in the MaineCare program, the state’s version of Medicaid. The findings further support the need for a state watchdog agency to investigate MaineCare, they said.

“We’re getting new information out everyday,” Sen. Jeff Timberlake, R-Turner, said during a meeting of the Government Oversight Committee. “We got new information today about another $46 million. … I think it’s very important for us to find out (what) is happening.”

AUDIT REVIEWED AUTISM SERVICES

The audit looked specifically at MaineCare spending on rehabilitative and community support services provided to children diagnosed with autism during the 2023 calendar year.

It reviewed a random sampling of records for individual MaineCare enrollees that comprised 100 months of care, finding that dozens of those samples did not comply with state and federal requirements.

A-01-24-00006 by Maine Trust For Local News

The audit found that services were provided to children who either did not receive required comprehensive assessments, or whose assessments did not include the requisite signatures from parents or staff. It also identified issues with supporting documents, including session notes that did not contain a full description of the care provided.

The audit does not mention fraud as a reason for the overpayments. But it said Maine did not sufficiently ensure that providers were documenting services. It also states that Maine has not done regular “post-payment reviews” that could have caught the issues sooner.

As a result of its findings, the office estimated that Maine paid at least $45.6 million for services that did not meet requirements, and identified another $22.4 million in “potentially improper” payments.

The state had a total MaineCare budget of around $4.3 billion in fiscal year 2023, according to federal data, meaning the improper payments account for about 1% of MaineCare spending.

Maine has agreed to reimburse the federal government nearly $29 million in improper spending if, after conducting its own review, it is also able to identify overpayments.

Any potential credible fraud allegations will be referred to the Office of the Maine Attorney General, Hammes said.

STATE RESPONDS TO FINDINGS

The inspector general’s office noted that Maine’s spending on services for children with developmental disabilities, including autism, rose significantly from $52.2 million in 2019 to $80.6 million in 2023.

That could be the result of various factors, including an increase in the eligible population; state efforts to increase the availability of behavioral health services; reimbursement rate increases and increased utilization of services, the state said in a letter to the federal government.

Michelle Probert, director of the Office of MaineCare Services, who wrote the letter, blamed many of the issues in the audit on inadequate documentation from service providers.

Probert also wrote that the state is in the process of updating its rules regarding the services in question, and that it would be sending new guidance to providers. And she said the state will conduct post-payment reviews for a sampling of providers for the next few years to catch and address record-keeping issues.

The state has also taken issue with some of the federal government’s methodology, saying on Friday that their review failed to account for differences in documentation requirements for different types of services.

LAWMAKERS LOOKING AT FRAUD ISSUE

The audit released by the federal government this week comes as Republican lawmakers on the Legislature’s Government Oversight Committee have asked a state watchdog agency to review Maine DHHS’ MaineCare spending. That request was made following allegations of fraud by Gateway Community Services, a Portland-based provider for people with disabilities.

A former employee has publicly accused Gateway of overbilling MaineCare, and the Maine DHHS said last month that it forwarded a “credible allegation of fraud” to the attorney general’s office for investigation. DHHS has also suspended MaineCare payments to Gateway, a step it takes when fraud is suspected.

Gateway has denied allegations of wrongdoing and said it is working with the state to address overpayments found in state audits.

The lawmakers’ request for a review of MaineCare spending was taken up during Friday’s meeting, in which some Republicans pointed to the new report.

“We have some information of additional concerns, specifically with the autism piece that dropped and $46 million,” said Sen. Brad Farrin, R-Norridgewock. “This is an ongoing concern.”

The committee, which has the power to authorize investigations of government programs by an independent office, did not take that step Friday, but decided it will ask state officials to present to them on the issue of MaineCare fraud at an upcoming meeting.

Democrats on the committee also pointed out that the state is already taking steps in response to the Gateway allegations.

“I need to hear what is actually happening in the state right now and where they’re at,” said Rep. Anne-Marie Mastraccio, D-Sanford, co-chair of the committee. “I’m not willing to vote to start another investigation until I know exactly what we’re looking for.”