HHS-OIG Audit Finds Maine Made At Least $45.6 Million in Improper Medicaid Payments for Autism Services

Thursday, January 22, 2026
FOR IMMEDIATE RELEASE

Washington, D.C. - The U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) has released an audit report revealing that Maine made at least $45.6 million in improper fee-for-service Medicaid payments for rehabilitative and community support (RCS) services provided to children diagnosed with autism. Maine's payments for 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.

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. Early treatment for autism can reduce challenges and help children build on their strengths. In Maine, RCS services for children diagnosed with autism include applied behavior analysis (ABA) and other evidence-based treatments that are provided in a child's home, school, or in community settings.

In the span of five years, Medicaid payments for RCS services in Maine grew significantly, from $52.2 million in 2019 to $80.6 million in 2023. Given this increase, HHS-OIG examined whether Maine's fee-for-service Medicaid payments for RCS services complied with federal and state requirements.

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.

"The integrity of Medicaid programs is non-negotiable. Improper payments undermine public trust and divert resources from those who need them most," said Inspector General T. March Bell. "Maine has agreed to implement corrective actions, including conducting its own review and reimbursing the federal government as much as $28.7 million for the federal share of these improper payments. We expect full compliance with federal and state requirements to ensure taxpayer dollars are spent appropriately and vulnerable children receive the care they deserve."

This audit is part of a series looking into unallowable services and questionable billing patterns in Medicaid ABA services provided to children diagnosed with autism. To date, HHS-OIG has completed three state audits; Indiana, Wisconsin, and Maine.