Governor Mills: CMS Letter Is Pretense to Send Weaponized Federal Agents to Maine

Letter to Mills Administration mimics recent actions taken against other Democratic-led states, including California and Minnesota

Governor Janet Mills and Commissioner of the Maine Department of Health and Human Services Sara Gagne-Holmes issued the following statements in response to a letter and social media video released by Dr. Mehmet Oz, the Administrator of the U.S. Centers for Medicare and Medicaid Services, late last Friday:

“Let’s be clear about what this is: Maine is facing a political attack from a president who uses allegations of fraud as a pretense to send ICE and other weaponized federal agents into states led by Democrats with devastating consequences. This is part of President Trump’s malicious playbook of using his administration’s power to punish anyone who dares to stand up to him or who disagrees with him,” said Governor Janet Mills. “As District Attorney, Attorney General, and as Governor, I have always cracked down on criminals and held accountable anyone who engages in fraud or abuse. That is why as governor, my Administration has implemented new and unprecedented licensing requirements for Medicaid providers, prioritized audits, and worked directly with State and Federal authorities to hold accountable individuals who attempt to defraud our state. Maine will not be intimidated by an Administration whose clear goal is to weaponize its power against the American people and to punish anyone who stands up to them.” 

“The Maine Department of Health and Human Services takes seriously its duty to serve as a responsible steward of taxpayer money by effectively disbursing funding and closely monitoring and ensuring compliance with the programs under its purview,” Commissioner of the Maine Department of Health and Human Services Sara Gagne-Holmes said. “To that end, the Department regularly audits programs to ensure compliance with State and Federal policies and addresses any errors, omissions, or inconsistencies that may be identified with providers. If through its processes, the Department identifies any issues of concern, including suspicion of fraud, then it refers those matters to the Office of the Attorney General for investigation. The Department works diligently to hold providers to the highest standards and pursues accountability any time those standards are not met. The Administration has received the letter from CMS and intends to review and respond to it.”

The Maine Department of Health and Human Services has detailed how it identifies and investigates allegations of fraud, waste and abuse. Additionally, the following is the statement previously issued by the DHHS regarding the audit referenced in the letter:

Maine’s Department of Health and Human Services has received the report from the U.S. Office of the Inspector General (U.S. OIG). This report is based on a routine, programmatic audit as part of a broader ongoing Federal review that has included multiple states. The review was not triggered by any specific allegation involving Maine. It should be noted that the report does not include findings or allegations of fraud; the audit identified potential documentation and compliance issues, which the State is now reviewing. The report does not question the appropriateness or necessity of services, nor does it allege intentional wrongdoing by providers or the State.

As noted in the Department’s response to the draft findings, the Department flagged that MaineCare fee-for-service payments for Rehabilitative and Community Support (RCS) Services increased significantly from 2019 to 2023 due to a number of factors, including: increases in member population, Maine’s efforts to increase the availability of behavioral health services, reimbursement rate increases in MaineCare coverage for these services, and increased utilization of services. These increases, necessarily, resulted in increased costs, but also served the health care needs of Maine patients and their families.

Also of note: the U.S. OIG’s audit included non-ABA services, and its report deemed those inclusions as lacking proper documentation. This is important because, while clinical notes for ABA-services will almost always include the data that was collected during the session, other services audited by the OIG generally do not have the same systematic data collection, such as detailed session notes. Those differences in documentation for the different types of services are typical and not considered improper, though this distinction was not accounted for in U.S. OIG assessment.

Again, this audit and the resulting report reflect standard OIG oversight activity conducted across multiple states and should not be interpreted as a fraud investigation. The Department is now reviewing the findings of the audit. In cases where inappropriate overbilling for claims may have occurred and cannot be justified through required documentation and clarification, the Department’s Office of MaineCare Services’ Program Integrity Unit would seek to recover and recoup overbilled funds. If a credible allegation of fraud is made, it will be referred to the Office of the Attorney General.

The Maine Department of Health and Human Services (DHHS) provides essential health and social services to Maine residents while safeguarding the public resources entrusted to our care. The Department is committed to ensuring funds are used lawfully, effectively, and in direct support of the programs and people they are intended to serve.