The U.S. Centers for Medicare and Medicaid Services has launched a program integrity audit of Maine’s Medicaid program, federal officials confirmed.
The agency said in a statement Friday that the audit will examine MaineCare’s “oversight operations and processes in high-risk areas.”
“The audit will assess the state’s safeguards against fraud, waste, and abuse, including how it identifies risks, refers suspected fraud, and addresses improper payments,” according to the agency’s statement.
CMS oversees the Medicaid program, which is operated by the states with federal oversight. Medicaid programs, which include insurance and healthcare services for lower-income people, are funded with a blend of federal and state dollars.
The statement offered that no further details, including what specific programs the agency is auditing, will be available while the audit is ongoing.
Maine was in the crosshairs of federal regulators earlier this year, when a U.S. Department of Health and Human Services Office of Inspector General audit found the state had made at least $45.6 million in improper payments. The audit, which examined support services for autistic children in 2023, said Maine failed to document services correctly and did not complete “post-payment reviews.”
At the time, Maine officials responded by noting that the Office of Inspector General’s audit did not include accusations of fraud.
In response to CMS announcing that the agency is conducting an audit, Lindsay Hammes, a Maine Department of Health and Human Services spokesperson, said in a statement on Friday that “protecting MaineCare from fraud and abuse is essential to making sure that health care remains available for the people and families who rely on it and that taxpayer dollars are invested responsibly.”
Hammes said the state DHHS has its own program integrity unit to monitor MaineCare programs for fraud. When needed, the Office of the Maine Attorney General will investigate potential crimes, she said.
In late 2025, Maine DHHS suspended payments to Portland-based Gateway Community Services and continues to investigate the provider for accusations of falsifying billing records. Gateway provides Medicaid services for people with disabilities. Gateway officials have denied the allegations.