Maine Made at Least $45.6 Million in Improper Fee-for-Service Medicaid Payments for Rehabilitative and Community Support Services Provided to Children Diagnosed With Autism

Why OIG Did This Audit

• Early treatment for autism is important because proper care can reduce children’s difficulties while helping them build on their strengths and learn new skills. In Maine, rehabilitative and community support (RCS) services for children diagnosed with autism include applied behavior analysis and other treatments for autism.
• Maine’s fee-for-service (FFS) Medicaid payments for RCS services in 2019 were $52.2 million, and by 2023, these payments had increased to $80.6 million.
• This audit examined whether Maine’s FFS Medicaid payments for RCS services for 2023 complied with Federal and State Requirements.

What OIG Found

Maine’s payments for RCS services did not fully comply with Federal and State requirements. All 100 sampled enrollee-months included payments for one or more claim lines that were improper or potentially improper. On the basis of our sample results, we estimated the State agency made improper payments of at least $45.6 million ($28.7 million Federal share).

What OIG Recommends

We 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 postpayment review of Medicaid payments for RCS services to educate providers on requirements.

Maine potentially concurred with our first recommendation and concurred with our remaining recommendations. Maine detailed steps it plans to take to address our recommendations.

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