Legislative oversight committee directs OPEGA to assess MaineCare program-integrity operations

The Legislative Government Oversight Committee voted to direct the Office of Program Evaluation and Government Accountability (OPEGA) to add a risk assessment of the MaineCare program-integrity unit to its work plan.

Committee members cited past findings and federal inspections that raised questions about the program-integrity unitstaffing, analytics, automated edits, and referral rates. OPEGA described relevant prior reports from 2009 and a 2015 federal on-site inspection and proposed a scaled risk assessment to evaluate whether the unit is "fit for purpose" to monitor MaineCare, a program OPEGA characterized as roughly a $5 billion expenditure across federal and state funding.

The motion to direct OPEGA was moved by a committee member and seconded on the floor; the clerk recorded the vote as unanimous of members present, with absent members given until the following Tuesday at noon to cast absentee votes. The committee discussed timing and competing priorities: two other OPEGA projects (seed-potato program review and Juniper Ridge) are in active work, and chairs noted procedures exist to reorder the work plan by majority vote if the committee later decides to prioritize the MaineCare work.

OPEGA said the risk assessment would focus on infrastructure elements such as staffing levels, analytics and data capability, automated system edits, referral rate history, and whether adequate processes exist to detect anomalies and refer cases for further investigation.

Committee chairs and members emphasized the assessment would be diagnostic and not a forensic audit of all MaineCare claims, but said it would identify areas that are "blinking red" and inform whether a larger review is warranted. OPEGA indicated it could provide a scaled report card on the unit's capacity and recommend follow-up tests or narrower audits based on findings.

The committee did not announce specific deadlines for OPEGA's work at the hearing; OPEGA staff said they would scope the review and report timelines back to the committee.