Maine made tens of millions of dollars in improper Medicaid payments for services provided to children with autism, according to a January 2026 audit from the HHS Office of Inspector General. The report reviewed the state’s 2023 fee-for-service Medicaid claims for rehabilitative and community support services, or RCS, and found widespread noncompliance with documentation and billing rules.
Here are five things to know:
- Auditors estimated that Maine made at least $45.6 million in improper RCS payments in 2023, including $28.7 million in federal funds. The services were intended for children diagnosed with autism but were billed without adequate documentation or authorization.
- All 100 sampled enrollee-months included one or more claim lines that were improper or potentially improper. Ninety-two of those had confirmed improper payments due to documentation deficiencies.
- Common issues included:
- Missing comprehensive assessments or those lacking required signatures (81 enrollee-months)
- Session notes that did not meet documentation requirements (64)
- Treatment plans without parent or guardian signatures (30)
- Missing provider credentials (20)
- In addition to confirmed overpayments, auditors estimated $22.4 million in potentially improper payments due to incomplete or unreliable documentation, including vague session notes, billing for nontherapy time, and references to unallowable recreational or academic activities.
- The audit found Maine has not conducted a statewide postpayment review of RCS payments since the program launched in 2010. It also cited a lack of provider guidance on documentation requirements, signature rules, and what qualifies as billable RCS service time.
Read the full report here.
