MaineCare Medicaid Program Response to CMS Investigation

The Maine Department of Health and Human Services (DHHS) and Governor Janet Mills have addressed inquiries raised by the Centers for Medicare and Medicaid Services (CMS) concerning MaineCare, the state's Medicaid program. This response follows a CMS investigation that unearthed potentially improper payments totaling $45.6 million related to autism treatment services. Dr. Mehmet Oz, representing CMS, had submitted 33 questions about MaineCare payment management, prompting a robust response from DHHS Commissioner Sara Gagné-Holmes.

Commissioner Gagné-Holmes provided insights into the state's efforts to maintain program integrity and regulatory compliance, noting measures that surpass federal standards. She elaborated on how the state manages fraud, waste, and improper payments, highlighting the absence of set recovery goals to focus on prevention. The Maine Medicaid Fraud Control Unit plays a crucial role here, as 22 potential fraud cases were referred to it since 2021, leading to one guilty plea and several ongoing investigations.

Governor Mills, in a statement, emphasized the state’s commitment to maintaining high standards for MaineCare providers. She underscored the strong regulatory frameworks and partnerships with law enforcement that are in place to mitigate risks of fraud. The DHHS's detailed response to CMS provides a comprehensive look at Maine’s operational frameworks and strategies aimed at reducing fraudulent activities within Medicaid.