Federal government auditing Maine’s Medicaid program
CMS Launches Medicaid Program‑Integrity Audit of MaineCare
WASHINGTON, D.C. – The U.S. Centers for Medicare & Medicaid Services (CMS) announced Friday that it will conduct a program‑integrity audit of the state’s Medicaid program, MaineCare. The audit will focus on the agency’s oversight operations and processes in high‑risk areas, including its safeguards against fraud, waste, and abuse.
CMS said the review will assess how MaineCare identifies risks, refers suspected fraud, and addresses improper payments. “The audit will examine MaineCare’s oversight operations and processes in high‑risk areas,” the agency’s statement read. “It will also assess the state’s safeguards against fraud, waste, and abuse, including how it identifies risks, refers suspected fraud, and addresses improper payments.” No further details, including which specific programs will be examined, will be released while the audit is underway.
The announcement comes after a federal Office of Inspector General (OIG) audit earlier this year uncovered that Maine made at least $45.6 million in improper payments for autism support services in 2023. The OIG report noted that the state failed to document services correctly and did not conduct “post‑payment reviews.” While the OIG audit flagged improper payments, officials said it did not allege fraud.
State officials said the new CMS audit is part of an ongoing effort to strengthen program integrity. “Protecting MaineCare from fraud and abuse is essential to ensuring that health care remains available for the people and families who rely on it and that taxpayer dollars are invested responsibly,” said Lindsay Hammes, spokesperson for the Maine Department of Health and Human Services (DHHS). The DHHS maintains its own program‑integrity unit to monitor MaineCare programs for fraud, and the agency will involve the Office of the Maine Attorney General to investigate potential crimes when necessary.
The audit follows a recent investigation involving a Portland‑based provider. In late 2025, the DHHS suspended payments to Gateway Community Services, a Medicaid provider that serves people with disabilities, after allegations of falsifying billing records emerged. Gateway has denied the claims and has not appealed the suspension. The investigation is ongoing.
Maine’s Medicaid program, operated under state jurisdiction with federal oversight, provides insurance and healthcare services to low‑income residents. The program receives a mix of federal and state funding. CMS’s oversight role includes ensuring that state Medicaid programs operate in accordance with federal requirements and that the program is free from fraud, waste and abuse.
The CMS audit is expected to review MaineCare’s processes for identifying and mitigating high‑risk activities, including claims that may be fraudulent or improperly paid. While the agency has not released specific targets, it has indicated that the audit will focus on areas that have shown elevated risk in past reviews.
“CMS will evaluate how MaineCare manages risks and how it responds when potential fraud is identified,” a CMS spokesperson said. “This audit will help confirm that the program’s safeguards are effective and that any improper payments are identified and corrected promptly.”
The state has previously faced scrutiny from federal regulators. In addition to the OIG audit, the OIG’s January 2026 report highlighted improper payments tied to autism services, prompting Maine to enhance its documentation and payment review procedures.
Maine residents and providers are watching the audit closely. The DHHS has stated that the agency remains committed to transparency and accountability. “We will share additional information as the audit progresses and as it becomes available,” Hammes said.
For now, the CMS audit will proceed quietly, with the expectation that its findings could lead to reforms aimed at tightening MaineCare’s oversight and reducing the risk of future improper payments.
