Maine Lets Fraudsters Feast on Autism Funds [WATCH]

Centers for Medicare and Medicaid Services (CMS) Administrator Dr. Mehmet Oz has expanded a federal fraud crackdown to Maine, citing significant concerns identified by Health and Human Services investigators in the state’s autism services program.

Oz disclosed the findings in a video posted to X, outlining the results of a recent review conducted by the U.S. Department of Health and Human Services.

The announcement follows similar investigations into fraud patterns identified in Minnesota, California, and Nevada involving Medicaid-funded programs, including hospice care and autism treatment services.

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In the video, Oz said Maine’s program showed warning signs similar to those previously identified elsewhere.

“We might have another ‘Minnesota’ on our hands,” Oz said.

Oz referenced the earlier Minnesota case involving autism services.

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“Remember that state’s program for children with autism, the one where Somali fraudsters set up fake treatment centers and stole millions of taxpayer dollars?” he said.

“Well the same thing appears to be happening: in Maine.”

According to Oz, federal investigators released a report two weeks prior examining Maine’s autism program.

“Two weeks ago, Health and Human Services investigators released a report on Maine’s autism program in which they identified at least 45 million dollars in improper payments,” Oz said.

Oz said the findings extended beyond improper payments.

“But that’s not all,” he said.

He stated that investigators found a rapid increase in program expenditures.

“They learned that the program’s payouts increased more than 50 percent in just four years.”

Oz also said the review identified geographic concentration patterns similar to those previously seen in Minnesota.

“They found that treatment centers are clustered in small, geographic areas: just like they did in Minnesota,” he said.

According to Oz, documentation issues were widespread. “They reviewed paperwork that was missing crucial information,” he said, including whether children receiving services had received proper diagnoses.

“Like whether the kids receiving these services had been properly diagnosed with autism in the first place.”

Oz said the investigators found systemic issues across the claims reviewed.

“One hundred percent of the claims they examined had problems,” he said.

He also cited a lack of oversight at the state level. “And most troubling of all, they discovered that Maine had never conducted a statewide review of its autism program,” Oz said.

Oz said CMS has taken formal action in response to the findings.

“Rest assured, we’re going to get to the bottom of this,” he said.

“Today, we sent a letter to Governor Janet Mills and Maine’s health commissioner, demanding more information about how they’re preventing, identifying, and remediating fraud in the autism program, and other programs that have raised red flags.”

Oz identified the recipients of the letter as Maine Gov. Janet Mills and Health Commissioner Sara Gagné-Holmes.

He said CMS is seeking detailed explanations of oversight practices and corrective measures currently in place.

Oz also outlined potential consequences if CMS determines that corrective steps are insufficient.

“If we don’t like what we see, CMS will work with Maine to put their house in order,” he said.

“And if we’re not satisfied with their progress, we reserve the right to cut off payments entirely.”

The warning follows recent federal action in California, where Oz and Small Business Administration Administrator Kelly Loeffler halted certain federal payments after identifying fraud concerns in state-administered programs, according to CMS statements.

Oz said the enforcement actions reflect CMS’s broader approach to protecting federal healthcare funds.

“That’s what it means to fight fraud, preserve program integrity, and to protect your taxpayer dollars,” Oz said.

“And that’s we’ll keep doing, every single day, here at CMS.”

CMS attached the letter sent to Gov. Mills and Commissioner Gagné-Holmes to Oz’s post on X.

The investigation marks the latest step in a multi-state review of Medicaid-funded programs as CMS continues efforts to identify improper payments and compliance failures across state-administered healthcare systems.