Federal Review Finds 90% Of Maine's Autism Support Services Lacks Justification

Authored by Debra Heine via American Greatness,

Centers for Medicare and Medicaid Services (CMS) Administrator Dr. Mehmet Oz revealed Tuesday that federal investigators have found widespread irregularities in Maine’s support services for adults with autism.

Speaking Tuesday during a Department of Justice anti-fraud press conference in Philadelphia, Oz said investigators have found that 90 percent of autism services provided by the blue state lacked justification.

“Yesterday I was in Maine,” Oz said. “We’re investigating home support services, just like you’re seeing here, for adults, in that case, who have autism.”

“We have massive increases that have grown to the kinds of numbers you could not imagine being able to show on a clipboard, with 90 percent of services billed and paid for—in Maine in particular—where there is no justifiable backup for it,” Oz said. “Nine out of ten services, you can’t justify they should have happened. It’s the opposite of what you’d normally expect.”

The Trump administration has been urging states to increase oversight of Medicaid autism services, and examine whether a massive surge of spending on a new therapy called “applied behavior analysis” is medically appropriate, Axios reported.

During the press conference Tuesday, state and federal prosecutors announced charges of 19 defendants in connection with a $4 million scheme to defraud government-run Medicare and Medicaid system in Pennsylvania.

Federal officials detailed several new anti-fraud initiatives, including “expanded Medicaid Strike Forces, new investigative toolkits for states and enhanced data analytics designed to identify suspicious billing patterns before taxpayer money is paid,” Maine Wire reported.

Oz did not identify the providers under review, specify the total amount of claims being examined or announce any criminal charges connected to Maine. He also did not allege that every unsupported claim constituted fraud. Instead, he said the findings demonstrate the need for significantly greater oversight of Medicaid-funded home support programs.

Nevertheless, his remarks represent a major escalation in the Trump administration’s examination of MaineCare spending.

Federal officials have spent months reviewing Maine’s administration of Medicaid-funded autism and developmental disability services. Earlier this year, federal auditors questioned tens of millions of dollars in payments involving rehabilitative and community support services while requesting additional records from the Mills administration concerning providers and billing practices.

Far-left Maine Democrat Senate candidate Troy Jackson’s health care platform is focused on passing a government run “Medicare for All” insurance system to replace the current system.

Oz said programs that were originally designed to help disabled Americans have increasingly become vehicles for fraud.

“We have no tolerance for anyone who invents hours, invents a disability, invents a workforce at the expense of people who depend on these programs,” Oz said. “And if you love these most vulnerable Americans, you should care as well.”

The CMS administrator told reporters that the COVID-19 pandemic was the catalyst for the explosion of fraudulent Medicaid schemes currently plaguing the country.

“What happened in 2020 that has catalyzed this?” Oz asked. “COVID appears to have unleashed massive fraud because criminals knew the federal government would not follow up on the money that was being sent out.”

The Trump administration, he said, has adopted an “all-of-government” strategy deploying the Department of Justice, the Department of Health and Human Services, the FBI, the Drug Enforcement Administration, the IRS Criminal Investigation Division and state attorneys general to identify and prosecute Medicaid fraud.

“They’re not just stealing money, they’re stealing our trust,” Oz said of the fraudsters. “And that’s a much more difficult thing to replace.”

At the close of the nearly two-hour long presser, Assistant Attorney General Colin McDonald delivered a stern warning to those defrauding government health care programs.

“The era of getting rich off the backs of our programs for our sick, elderly and disabled is over,” McDonald said. “Your time is up.”