Maine State Auditor Matt Dunlap’s office identified a significant gap in Medicaid oversight during its fiscal 2025 audit, revealing the Program Integrity Unit failed to document how it selected projects and conducted payment reviews for Medicaid services. The auditor’s report classified this issue as a “significant deficiency” requiring documented procedures and retained evidence supporting review scope.
The Department of Health and Human Services disputed the finding, arguing the audit conflated one unit’s annual plan with the entire agency’s oversight program and cited other reviews and controls outside that unit. Auditors maintained those additional safeguards were not properly documented for providers or services identified in their assessment.
A separate federal review uncovered at least $45.6 million in improper payments—approximately $28.7 million in federal funds—for children diagnosed with autism receiving rehabilitative and community support services under Maine’s 2023 fee-for-service program. Federal auditors sampled 100 enrollee-months, finding each included at least one line item requiring further scrutiny.
The Office of Inspector General recommended repayment of the federal share, additional review of potentially improper claims, improved provider guidance, and periodic statewide oversight. Maine conditionally agreed to repay federal funds but has yet to implement the other three recommendations as of August 31. Federal tracking shows all four actions remain open and unimplemented, with updates scheduled for November 19.
The dispute underscores a federal requirement that state Medicaid agencies must maintain comprehensive monitoring against unnecessary services and excess payments—not treat oversight as optional. This obligation covers both payment accuracy and service quality, ensuring public funds are protected while safeguarding beneficiaries’ care.
