CMS Chief Says 90% of Maine Autism Home-Care Claims Lack Justification, Skips Meeting With State Officials

Dr. Mehmet Oz, the administrator of the Centers for Medicare and Medicaid Services, says federal investigators have found that 90 percent of billed autism home-support services in Maine lack any justification for payment.

Oz made the claim Tuesday during a Department of Justice anti-fraud press conference in Philadelphia, where state and federal prosecutors also announced charges against 19 defendants in a separate $4 million Medicare and Medicaid fraud scheme in Pennsylvania, according to American Greatness.

"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, according to American Greatness. "Nine out of ten services, you can't justify they should have happened. It's the opposite of what you'd normally expect."

According to Ground News aggregation of Central Maine outlets, Oz has said MaineCare billing for autism home support rose sixfold in recent years and cited $45.6 million in overpayments tied to the program.

Oz did not name the providers under review, specify the total dollar amount of claims being examined, or announce any criminal charges connected to Maine specifically, American Greatness reported. He also stopped short of calling every unsupported claim fraud, framing the findings instead as evidence that Medicaid-funded home care programs need far more oversight.

Oz Skipped State Officials, Met Conservative Media Instead

Two days before the Philadelphia press conference, Oz traveled to Maine. He didn't meet with any officials from Gov. Janet Mills' administration. Instead, according to the Portland Press Herald, he met with former Republican Gov. Paul LePage, now a candidate for Maine's 2nd Congressional District, and with Jon Fetherston of The Maine Wire, a conservative outlet.

Mills spokesman Ben Goodman didn't hold back. "That Administrator Oz filmed videos with conservative media and a Republican candidate for Congress but made no effort to meet with any administration officials who are actually doing the work of fighting fraud suggests that the administrator is more interested in politics than in combatting fraud," Goodman said in a written statement to the Press Herald. CMS did not respond to the paper's request for comment.

If the goal is fixing a broken system, the federal government's point man would be expected to sit down with the people who run the program day to day, not just the political opposition and a friendly camera. Oz gave the state administration ammunition to frame this as a campaign stop, not a policy visit, especially with LePage running for Congress in the room.

Maine Announced Its Own Crackdown Within Days

The Mills administration didn't wait around. On Wednesday, according to the Press Herald, Maine officials released an overview of enforcement actions: payments suspended to five MaineCare providers over credible fraud allegations, one provider referred to law enforcement, two additional terminations over health and safety complaints, and 28 caregivers unenrolled for failing to submit a claim within a year.

State officials said the fraud suspensions actually happened back in June 2026, before Oz's visit, and that they're distinguishing their own enforcement work from what they characterized as a federal effort more focused on messaging than results.

Maine Senate Republican Leader Trey Stewart saw it differently. "Republicans have repeatedly attempted to address fraud in MaineCare and concerns about the program's sustainability through the legislative process," Stewart said, according to the Press Herald. "Regrettably, the administration and legislative Democrats have continued to bury their heads in the sand. I'm glad the federal government is stepping up to force the administration to do what it should have done years ago."

The Underlying Numbers Are Real, Even If the Politics Are Messy

Federal officials issued Maine's Medicaid Fraud Control Unit a conditional recertification last month, criticizing the state's anti-fraud staffing levels and giving Maine 30 days to submit a staffing plan and 60 days to report progress, according to the Press Herald. In March, the state had already terminated its contract with Paradise Residential Services over autism home-care health and safety concerns following a year of warnings.

A sixfold increase in billing for a single therapy category, applied behavior analysis, combined with a 90 percent unjustified-claims rate as described by Oz, would signal an alarming pattern in any state, run by any party. Whether that 90 percent figure holds up to independent audit, and whether it reflects actual fraud versus sloppy documentation, remains unconfirmed. Oz has not released the underlying data, and no state or federal indictment has been filed connecting a Maine provider to a specific fraud charge as of this writing.

The open question isn't whether MaineCare has a documentation problem. Even Maine's own June suspensions suggest it does. The open question is whether the Trump administration's approach, heavy on cable-friendly claims and light on transparent data, will produce prosecutable cases or just another partisan standoff between Augusta and Washington.