Lawmakers question Maine’s health department after federal audit 

Members of a legislative oversight committee on Friday pressed the Maine Department of Health and Human Services over how it scrutinizes MaineCare reimbursements, focusing on a federal audit that found about $45 million in potentially improper payments to dozens of providers.

With a separate Medicaid fraud investigation into Portland-based health provider Gateway Community Services underway, Republican lawmakers have questioned the inadequacy of the state health department’s scrutiny of MaineCare reimbursements and the corrective process to recover taxpayer money. 

While the federal audit was not triggered by any specific allegations of fraud and similar audits also found improper payments in other states, some lawmakers questioned how the department had not noticed the billing errors the U.S. Department of Health and Human Services’ Office of the Inspector General pointed out in the report.

“You’re not improperly billing, but you’re not providing any oversight either,” Republican Rep. Chad Perkins from Dover-Foxcroft said to Maine Department of Health and Human Services Commissioner Sara Gagne-Holmes.

The department has stressed that the federal audit did not contain any allegations of fraud and is different from the Gateway investigation. 

Democratic Rep. Adam Lee from Auburn emphasized that point, saying “I’ve read every single page of this report from OIG … there is no allegation being made by the federal government that any of these overpayments was fraud.”

In a letter responding to the office, the state health department agreed with most of the findings and is conducting its own review, after which it will reimburse the federal government its share of the improper payments — about $28.7 million.

“We are not saying that this report does not cause us concern,” Gagne-Holmes said. “If we find that there are mistakes, we are going to collect that money, and we’re going to repay the federal government.”

Mills decries federal intervention

Earlier this month, the audit was cited by Dr. Mehmet Oz, who heads the U.S. Centers for Medicare and Medicaid Services in his letter to Gov. Janet Mills and Gagne-Holmes. Oz requested detailed information regarding eligibility and oversight of MaineCare, the state’s Medicaid program. 

“These findings … underscore the need for immediate corrective action and enhanced transparency,” he wrote.

The agency will work with Maine “to put their house in order,” Oz said, adding that if the federal government is not satisfied, “we reserve the right to cut off payments entirely.” 

In a video, he also compared Maine to Minnesota, which has faced significant national scrutiny for how it has handled fraud in the state’s public programs. 

Mills said in a statement that the threats of federal intervention are “part of President Trump’s malicious playbook of using his administration’s power to punish anyone who dares to stand up to him or who disagrees with him.” 

Improper payments investigation 

According to the Office of the Inspector General’s report released last month, Maine’s Medicaid payments for rehabilitative and community support services for children diagnosed with autism increased substantially in 2023. 

Contributing factors include Maine’s efforts to boost behavioral health services, the reimbursement rate increases in MaineCare coverage, and greater reliance on them, the department said in its response to the federal government. 

“These increases resulted in increased costs, but also served the health care needs of Maine patients and their families,” said department spokesperson Lindsay Hammes in an emailed response to Maine Morning Star.

But the department “did not provide effective oversight” of Medicaid payments for autism treatment services, the report said. 

Since the program began in 2010, the state agency has not performed a post-payment review to verify that providers complied with federal and state documentation requirements, nor did it provide sufficient guidance.

Michelle Probert, director Office of MaineCare Services responded saying that the office’s program integrity unit “has previously identified the need to review” rehabilitative and community support services.