Maine Medicaid Autism Services Improper Payments

The US Department of Health and Human Services Office of Inspector General (HHS OIG) has released a report (A-01-24-00006) detailing that Maine made at least $45.6 million in improper fee-for-service Medicaid payments for rehabilitative and community support services for children diagnosed with autism in 2023. The audit examined 100 sampled enrollee-months and found that all included improper or potentially improper claim lines, estimating the total improper payments at $45.6 million, with a Federal share of $28.7 million.

This finding necessitates that Maine's Department of Health and Human Services refund $28.7 million to the Federal Government and address potentially improper payments totaling an additional $14.1 million. The OIG also recommended that Maine provide enhanced guidance to providers on documenting services and conduct periodic postpayment reviews. Maine has concurred with these recommendations, with updates expected by July 15, 2026, indicating a need for immediate review of internal controls and provider documentation practices related to these services.