WHO REALLY CAUGHT MAINE’S $45 MILLION MEDICAID PROBLEM?
Sen. Susan Collins’s Convenient Version of the MaineCare Audit
Sen. Susan Collins recently offered what sounds like an encouraging story about government accountability in Maine.
“An independent Inspector General audit initiated during the Biden Administration found more than $45 million in improper payments for autism-related services in the MaineCare program,” Collins said, before calling for stronger provider screening, more frequent surveys and unannounced site visits.
The sentence is technically defensible.
It is also potentially misleading without the rest of the timeline.
The audit was indeed initiated while Joe Biden was president. But that should not leave readers with the impression that Maine or the Biden administration had already uncovered a $45.6 million fraud scheme, aggressively pursued it, and handed the results to the next administration.
That isn't what happened.
What the audit actually found
The federal Department of Health and Human Services Office of Inspector General examined MaineCare's fee-for-service payments for rehabilitative and community-support services provided to children diagnosed with autism during calendar year 2023.
Spending in the program had climbed dramatically—from approximately $52.2 million in 2019 to $80.6 million in 2023. That increase helped prompt federal scrutiny.
Auditors eventually estimated that Maine had made at least $45.6 million in improper payments, with another $22.4 million considered potentially improper. The federal share subject to repayment was approximately $28.7 million.
Those are extraordinary numbers.
But another finding is arguably more important.
The OIG found that Maine had not been conducting regular post-payment reviews that could have identified these problems earlier.
That is difficult to square with any suggestion that Maine's existing oversight machinery had successfully caught the problem.
“Improper” does not automatically mean “fraud”
There is another distinction politicians from either party should respect.
The Inspector General did not determine that $45.6 million had been stolen.
“Improper payments” can include insufficient documentation, missing required assessments or signatures, billing unsupported by records, services that failed program requirements and other payment errors. Some improper payments can eventually lead to evidence of fraud; others do not.
The audit itself did not characterize the $45.6 million as fraud. Maine officials have specifically stressed that distinction.
So Collins is right to discuss fraud prevention in response to the findings.
But $45.6 million in improper payments should not casually become $45.6 million in proven fraud.
That distinction matters particularly when discussing providers caring for autistic children.
The timeline matters
The report is numbered A-01-24-00006, reflecting an audit initiated during the Biden period. But the final report was issued in January 2026, during the Trump administration. Maine's formal response to the draft report is dated November 24, 2025.
In other words, this was a lengthy federal audit spanning administrations.
That makes Collins's wording politically convenient: she can truthfully say the investigation was “initiated during the Biden Administration.”
But initiation isn't the same thing as completion, enforcement or recovery.
Nor does it tell us whether Maine's state government independently discovered the magnitude of the problem.
In its response, MaineCare said its Program Integrity operation had previously reviewed providers delivering these services and believed the OIG had not fully accounted for some of those reviews. That deserves acknowledgment.
Nevertheless, the $45.6 million estimate came from the federal OIG audit—not from Maine announcing that its own controls had discovered $45.6 million in improper payments.
Where was the preventive oversight?
That may be the most important question.
MaineCare has had these services for years. Spending accelerated substantially. Yet federal auditors found weaknesses serious enough to extrapolate tens of millions of dollars in improper payments from their sample.
Maine itself now says that improper payments identified through federal Payment Error Rate Measurement audits must be reimbursed to the federal government, while the state can seek recoupment from providers when provider error caused them.
That's what happens after the money has gone out.
The better system prevents questionable payments before they occur or identifies them rapidly afterward.
That is why Collins's proposed reforms—stronger provider screening, more frequent surveys and unannounced site visits—are sensible.
But they also invite an obvious question:
If these safeguards are necessary now, why weren't adequate safeguards already operating while spending was climbing?
This was not Maine standing alone against fraud
There is also a broader national context.
Medicaid payment integrity isn't something Maine invented. Federal authorities routinely audit states through OIG investigations and the Payment Error Rate Measurement program. Maine's own provider guidance describes the recurring federal PERM process and the state's responsibility to reimburse the federal government for identified improper payments.
So the story shouldn't be reduced to:
Maine discovered fraud under Biden.
A more accurate description is:
Federal oversight initiated an audit during the Biden administration of a rapidly growing Maine Medicaid service category. That audit continued across administrations and ultimately identified an estimated $45.6 million in improper payments, while also finding weaknesses in Maine's post-payment oversight.
That's less politically satisfying.
It is considerably more informative.
And what happened after the audit?
The answer matters because identifying questionable payments is only the first step.
Maine agreed that it would reimburse the federal government approximately $28.7 million if its own review confirms the overpayments. State officials also said credible fraud allegations would be referred to the Maine Attorney General.
That is not the same thing as announcing $45.6 million in criminal fraud, recovering $45.6 million from fraudulent providers, or convicting the people responsible.
Those distinctions are important because government press releases often blur the line between:
problem identified → improper payment established → fraud proven → money recovered → offender punished.
Those are five different events.
Collins actually knows this distinction well
There is a certain irony here.
Collins has been discussing Medicare improper payments and fraud for many years. In 2014, she correctly noted that Medicare's reported improper-payment figures included “waste, fraud, abuse, and mismanagement.”
In 2010, she similarly wrote about improper federal payments as encompassing broader government payment errors rather than treating every improper dollar as criminal theft.
That makes precision particularly important now.
Collins is right that taxpayer money diverted to fraudulent providers is taxpayer theft.
But first establish which payments were fraudulent.
The lesson isn't partisan
There is no reason to excuse the Biden administration if federal investigators moved too slowly. There is equally little reason to credit the Trump administration for an audit largely conducted before it took office.
And Maine shouldn't receive credit merely because federal auditors eventually found the problem.
The proper questions are institutional:
Who first detected the suspicious pattern?
Why did spending grow so dramatically before the problem was quantified?
Why weren't post-payment controls adequate?
How much of the $45.6 million represents recoverable overpayments?
How much has actually been recovered from providers?
How much was simple noncompliance, and how much involved evidence of intentional fraud?
Has anyone been excluded, prosecuted or convicted as a result?
Those answers will tell Maine taxpayers far more than which presidential administration happened to occupy the White House when an audit file was opened.
Collins's statement contains an important truth: the audit began during the Biden administration.
But that's the beginning of the story—not the accomplishment.
The real measure of government accountability is not who started the audit.
It is who noticed the money disappearing, how quickly they acted, whether they stopped it, how much they recovered, and what happened to anyone who deliberately took it.
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