Published: August 27, 2026
Publisher: The Maine Mirror
The Maine Mirror Accountability Series — Article 2 of 7

🪞 THE MIRROR BRIEF

Federal auditors recommended Maine refund $28,796,366 after estimating at least $45.6 million in improper Medicaid payments involving services for children diagnosed with autism. But records obtained by The Maine Mirror show Maine did not fully accept that determination. The state “PARTIALLY AGREE[D],” said it had not yet verified aspects of OIG’s calculation, and committed to refunding the federal share of improper payments confirmed through its own Program Integrity review. CMS, meanwhile, warned that an outstanding refund could ultimately be pursued through a federal disallowance process.

The number is difficult to miss:

$28,796,366.

That is the amount federal auditors recommended Maine return to the federal government following an audit of fee-for-service Medicaid payments for rehabilitative and community support services provided to children diagnosed with autism.

But there is an important question behind that number:

Does Maine actually owe the federal government exactly $28.8 million?

Primary-source records obtained by The Maine Mirror through Maine’s Freedom of Access Act show the answer is more complicated than the headline figure alone suggests.

The documents establish the $28.8 million federal refund recommendation.

They also show that the Centers for Medicare & Medicaid Services formally followed up with Maine, established requirements for addressing the audit and warned of a potential federal enforcement mechanism if an outstanding refund was not resolved.

Maine, however, did not simply accept the $28.8 million calculation.

Instead, the state partially agreed with the finding, questioned aspects of OIG’s overpayment determination and extrapolation methodology, and established a four-step process for determining what its own Program Integrity Unit could confirm.

That distinction is at the center of Article 2 of The Maine Mirror Accountability Series.

About These Records

The records examined in this report were obtained directly from the Maine Department of Health and Human Services through a Freedom of Access Act request submitted by The Maine Mirror.

They include CMS’s February 2, 2026, Request for Information concerning OIG Audit A-01-24-00006, the federal attachment detailing the $28.8 million recommendation, and Maine’s corrective-action plan.

Four images from those records are reproduced below in the same documentary sequence in which they appear in the underlying material.

CMS Formally Followed Up With Maine

On February 2, 2026, CMS sent Maine State Medicaid Director Michelle Probert a formal Request for Information concerning OIG Audit A-01-24-00006.

The subject line identifies the audit by its full title: Maine Made at Least $45.6 Million in Improper Fee-for-Service Medicaid Payments for Rehabilitative and Community Support Services Provided to Children Diagnosed with Autism.

CMS said it had reviewed the January 16 OIG audit report, Maine’s responses to the audit and the corrective-action plans mentioned in the report.

The agency described its objective plainly: CMS wanted identified instances of noncompliance closed as soon as possible to avoid adverse audit opinions in future audits and said it would work actively with Maine toward that goal.

The letter also provides important context about federal recovery rules.

CMS explained that recoveries based on eligibility errors can only be pursued when identified through specified federal processes and that this limits CMS’s ability to recover on most Social Security Act eligibility findings.

CMS said it would pursue internal-control deficiencies identified by OIG but would not pursue recoveries associated with certain questioned costs. The agency also identified circumstances outside that limitation, including federal financial participation claimed for services to deceased beneficiaries or situations involving inaccurate increased federal matching rates.

(The first page of CMS’s February 2, 2026, Request for Information to Maine State Medicaid Director Michelle Probert concerning OIG Audit A-01-24-00006. The letter establishes CMS’s formal post-audit review and explains federal rules and limitations concerning recovery of certain questioned Medicaid costs. Source: CMS record obtained by The Maine Mirror through a Freedom of Access Act request.)

That context is important because the amount identified during an audit and the amount ultimately recovered are not necessarily the same thing.

But CMS’s letter also makes clear that where money is ultimately determined to be refundable, the federal government has a mechanism for pursuing it.

CMS Warned That an Outstanding Refund Could Lead to Disallowance

The second page of the February 2 letter continues CMS’s instructions for handling audit overpayments.

CMS directed Maine to make the appropriate reporting adjustments for Medicaid and, where applicable, the Children’s Health Insurance Program, and to provide supporting documentation for the federal refund.

Then comes one of the most consequential statements in the correspondence.

CMS wrote:

“If an outstanding refund is not received within the time limits identified in 42 CFR 433.316 as referenced above, we may then initiate a disallowance to obtain the recommended refund amount.”

The letter also explains that Maine would have an opportunity under federal law to request reconsideration of a disallowance or appeal it to the Departmental Appeals Board.

CMS then directed Maine to provide the information requested in Attachment A within 30 days.

(The second page of CMS’s February 2, 2026, Request for Information. CMS instructs Maine on reporting federal refund adjustments and states that if an outstanding refund is not received within applicable federal time limits, CMS may initiate a disallowance to obtain the recommended refund amount. The page also identifies Maine’s reconsideration and appeal rights and directs the state to provide the requested information within 30 days. Source: CMS record obtained by The Maine Mirror through a Freedom of Access Act request.)

That warning is important to understanding the dispute that followed.

Maine could review the underlying claims and question aspects of OIG’s calculation.

But CMS had not surrendered federal authority over an outstanding refund.

The next page identifies exactly how much money was at issue.

Attachment A: $28,796,366

Attachment A identifies Recommendation Code 1: 26-A-01-033.01.

The finding states that Maine’s fee-for-service Medicaid payments for rehabilitative and community support services provided to children diagnosed with autism did not fully comply with federal and state requirements.

According to the document:

“All 100 sampled enrollee-months included payments for one or more claim lines that were improper or potentially improper.”

Based on those sample results, OIG estimated that Maine made at least $45.6 million in improper payments, including approximately $28.7 million representing the federal share.

Then comes the formal recommendation:

Maine DHHS should refund $28,796,366 to the federal government.

The document separately lists:

“Related Questioned Costs: $28,796,366.”

But the same page also records Maine’s response.

According to Attachment A, Maine said it would conduct reviews of the providers and claims identified by OIG and that, “to the extent those reviews identify overpayments,” the state would recover those overpayments from providers and refund the federal share.

CMS responded with an action item of its own: within 30 days, Maine was to provide supporting documentation concerning recovery of identified provider overpayments and repayment of the federal share.

(CMS Attachment A identifies Recommendation Code 26-A-01-033.01, OIG’s estimate of at least $45.6 million in improper payments, the $28,796,366 recommended federal refund and related questioned costs, Maine’s stated plan to review the identified providers and claims, and CMS’s request for supporting documentation concerning recovery and repayment. Source: CMS record obtained by The Maine Mirror through a Freedom of Access Act request.)

That single page captures the central tension behind the $28.8 million figure.

OIG recommended a specific refund: $28,796,366.

Maine committed to reviewing what the federal auditors identified and recovering the overpayments its reviews established.

Maine’s formal corrective-action plan provides considerably more detail about that distinction.

Maine’s Official Position: “PARTIALLY AGREE”

Maine’s corrective-action plan repeats the federal finding.

It again states that all 100 sampled enrollee-months included payments for one or more claim lines that were improper or potentially improper and repeats OIG’s estimate of at least $45.6 million in improper payments.

It also repeats the recommendation that Maine refund $28,796,366.

Then the document asks:

“Does the Auditee Agree/Disagree With the Audit Finding?”

The answer is unmistakable:

“PARTIALLY AGREE.”

Maine’s explanation is significant.

The Office of MaineCare Services said it agreed that OIG’s improper-payment findings warranted an OMS review of RCS providers’ claims and associated documentation.

But the state said that, at that time, it had not had sufficient time to assess the degree of its concurrence with the overpayments identified by OIG.

Maine also said it had not yet had sufficient time to determine whether the OIG-identified overpayments represented the correct sanction under state rules or to verify the statistical validity of OIG’s extrapolation methodology.

That does not establish that OIG’s methodology was wrong.

It establishes that Maine had not yet verified it and was not fully concurring with the federal determination.

Maine Created Its Own Four-Step Review and Repayment Process

The same corrective-action document explains what Maine intended to do next.

Step 1: MaineCare’s Program Integrity Unit would review OIG’s findings and associated provider medical records to confirm whether violations occurred.

Estimated completion: April 30, 2026.

Step 2: MaineCare’s Program Integrity Unit would issue Notices of Violation and Notices of Debt to providers it determined owed a recoupment for OIG findings confirmed by the unit.

Estimated completion: June 30, 2026.

Step 3: Maine DHHS would refund the federal share of all “PIU-confirmed improper payments” through its standard refund processes.

Estimated completion: September 30, 2026.

Step 4: Maine DHHS would provide CMS with a final report detailing the results of Program Integrity’s review and the dates of all repayments of the federal share of confirmed improper payments.

Estimated completion: October 30, 2026.

(Maine’s corrective-action plan combines OIG’s $28,796,366 refund recommendation with the state’s official “PARTIALLY AGREE” response. Maine said it had not yet fully assessed the identified overpayments, determined whether they represented the correct sanctions under state rules, or verified OIG’s extrapolation methodology. The same page establishes four corrective-action steps: provider-record review, Notices of Violation and Notices of Debt, repayment of the federal share of PIU-confirmed improper payments, and a final report to CMS, with estimated completion dates running from April 30 through October 30, 2026. Source: Maine DHHS record obtained by The Maine Mirror through a Freedom of Access Act request.)

The wording of Step 3 is particularly important.

Maine did not state in this plan that it would automatically refund $28,796,366 by September 30.

It committed to refunding the federal share of “PIU-confirmed improper payments.”

That leaves a consequential question unanswered by the records produced to The Maine Mirror:

How much did Maine’s Program Integrity Unit ultimately confirm?

Two of Maine’s Own Deadlines Have Already Passed

The timeline contained in Maine’s corrective-action plan creates concrete accountability benchmarks.

As of this article’s August 27 publication date, two of those dates have already passed.

The Program Integrity review was estimated for completion by April 30.

Notices of Violation and Notices of Debt were estimated for completion by June 30.

The September 30 deadline for refunding the federal share of PIU-confirmed improper payments has not yet arrived.

Neither has the October 30 deadline for Maine’s final report to CMS.

The records examined for this article do not establish how many violations Maine ultimately confirmed, whether Notices of Violation or Notices of Debt were issued, which providers may have received them, how much Maine determined should be recouped, or whether the April and June steps were completed on schedule.

That does not establish that those actions did not occur.

It means the records currently in The Maine Mirror’s possession do not answer those questions.

Those unanswered questions now provide specific targets for additional public-records requests and continued reporting.

So, Does Maine Owe $28.8 Million?

Based strictly on the primary-source records examined by The Maine Mirror, the most precise answer is:

OIG recommended that Maine refund $28,796,366. These records do not establish that $28,796,366 became Maine’s final, undisputed repayment obligation.

That distinction matters.

Maine did not reject the underlying concerns.

The state agreed that OIG’s improper-payment findings warranted review.

But Maine only partially agreed with the finding and said it had not yet verified aspects of the overpayment determination or OIG’s statistical extrapolation.

Maine instead committed to determining what its Program Integrity Unit confirmed and refunding the federal share of those confirmed improper payments.

At the same time, CMS did not leave the final matter entirely in Maine’s hands.

The federal agency expressly warned that if an outstanding refund was not received within applicable federal time limits, it could initiate a disallowance to obtain the recommended refund amount.

Maine, in turn, would have reconsideration and appeal rights.

So the records do not support reducing the story to either extreme.

They do not establish that Maine unquestionably owes exactly $28,796,366 as a final, undisputed debt.

They also do not establish that Maine does not owe that amount.

What they document is a federal refund recommendation, Maine’s partial agreement, a state review and recovery process, and a federal mechanism for pursuing an outstanding refund.

And they leave one central question:

What did Maine’s Program Integrity review actually find?

How many violations were confirmed?

Were Notices of Violation and Notices of Debt issued?

How much did Maine determine providers owed?

How much will ultimately be recovered?

How much will Maine return to the federal government?

And will CMS accept Maine’s determination?

Maine’s own corrective-action plan created the milestones against which those questions can now be measured.

The Money Is Only Part of the Story

The first two articles in this series have followed what happened after the audit and examined the enormous dollar figure attached to its first recommendation.

But the records contain another finding that shifts the focus.

Beyond the $45.6 million estimate, federal auditors separately identified $22.4 million in potentially improper payments associated with documentation concerns.

That raises a different set of questions about the records supporting services billed for children diagnosed with autism—and precisely what those documentation problems do and do not establish.

That is where this series goes next.

Next in The Maine Mirror Accountability Series — Article 3 of 7

The Other $22.4 Million: What Federal Auditors Found in Maine Autism-Service Records

Article 3 will examine the separate $22.4 million finding, what federal auditors identified in the underlying documentation, what those records say about services billed through MaineCare, and the limits of what the findings actually prove.

Article 3 of 7 continues tomorrow.

Transparency Note

The Maine Mirror uses artificial intelligence as an editorial-assistance tool in researching, organizing and drafting coverage. Reporting decisions, source review, verification and publication decisions remain the responsibility of The Maine Mirror.

The primary-source documents reproduced in this article were obtained directly from the Maine Department of Health and Human Services through a Freedom of Access Act request. AI-generated material is not used as primary-source evidence.

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