Maine State Auditor Matt Dunlap’s office has identified a significant gap in Medicaid oversight that the Department of Health and Human Services disputes. The findings, part of the state’s fiscal 2025 audit released in March, indicate that the Program Integrity Unit failed to document how it selected projects and conducted payment reviews for Medicaid services.

The report classified this issue as a “significant deficiency” with no questioned costs, calling for documented procedures and retained evidence supporting review scope. However, the Department of Health and Human Services countered that the audit conflated one unit’s annual plan with the entire agency’s oversight program, citing other internal reviews and controls.

A separate federal review conducted in January found at least $45.6 million in improper payments for autism services under Maine’s Medicaid program during 2023. This assessment, based on a sample of 100 enrollee-months, estimated approximately $28.7 million in federal funds were improperly paid.

The federal audit recommended repayment of the federal share and additional steps to improve oversight. While Maine conditionally agreed with these recommendations, as of August 31, all four federal actions remain open and unimplemented.