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DHHS promises validation and recovery plans after federal OIG flags potential Medicaid overpayments for ABA services
Summary
At an oversight hearing, DHHS Commissioner Sarah Gagne Holmes outlined the department's program‑integrity units and said staff are validating an OIG ABA audit that used sampling to flag potential improper payments; DHHS said it will issue provider notices where findings are substantiated and pursue recoupment and referrals to the Attorney General when evidence meets legal thresholds.
The Department of Health and Human Services briefed the Joint Legislative Committee on Government Oversight about how Maine identifies, investigates and responds to possible improper Medicaid payments following a recent federal Office of Inspector General (OIG) review of applied behavior analysis (ABA) services.
Commissioner Sarah Gagne Holmes described the department’s layered program‑integrity framework: the Division of Audit conducts cost‑settlement and financial reviews for cost‑settled providers; the Fraud Investigation and Recovery Unit focuses on recipient fraud and intentional program violations; and the Program Integrity Unit (Office of MaineCare Services) runs surveillance, data analytics, post‑payment reviews and referrals to the Health Care Crimes Unit at the Attorney General’s Office when a…
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