Maine made $45.6M in improper Medicaid payments for autism services, audit finds

AUGUSTA, Maine (WGME) — Maine made at least $45.6 million in improper fee-for-service Medicaid payments for services provided to children diagnosed with autism, according to an audit report.

The report from the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) claims Maine’s payments for rehabilitative and community support (RCS) services did not fully comply with federal and state requirements, and the $28.7 million federal share of the improper fee-for-service payments should be returned to the federal government.

The Maine House Republicans issued a statement about the audit, saying in part:

“This federal Inspector General’s audit confirms what Republicans have been warning for years: fraud, waste, and abuse within MaineCare is widespread and can no longer be dismissed or hidden. These failures harm taxpayers and, more importantly, jeopardize services for the vulnerable children and families who truly depend on MaineCare.”

RCS services help children with developmental disabilities, including autism, build skills in areas of daily living and behavioral management to support the child’s functioning in their home and community.

In the span of five years, HHS-OIG states that Medicaid payments for RCS services in Maine grew from $52.2 million in 2019 to $80.6 million in 2023.

Given the increase, HHS-OIG says it examined whether Maine’s fee-for-service Medicaid payments for RCS services complied with federal and state requirements.

HHS-OIG says the audit determined that Maine’s payments for RCS services did not fully comply with federal and state requirements. HHS-OIG found that some RCS services were provided to children who either did not receive the required comprehensive assessments, or the assessments did not include signatures of the staff who conducted the assessments or the signature of the parents or guardians.

HHS-OIG also identified issues with supporting documents for RCS sessions, including session notes that did not contain a full description of the services provided or the goals addressed, or data collected.

These issues, and those that led to improper and potentially improper payments, could have had a significant effect on the quality of care provided to children with autism, according to HHS-OIG.

HHS-OIG says they made four recommendations, including that Maine refund $28.7 million to the federal government, provide additional guidance to RCS providers for documenting RCS services, and periodically perform a statewide post-payment review of Medicaid payments for RCS services to educate providers on requirements.

According to HHS-OIG, Maine potentially concurred with the first recommendation and concurred with the remaining recommendations. Maine has detailed steps it plans to take to address the recommendations.