Medicaid autism therapy spending sparks fraud crackdown and policy clash

Applied Behavior Analysis therapy, a key service for children with autism, has driven Medicaid expenditures past $5 billion in recent years, according to HHS data. Federal prosecutors recently indicted two Minnesota clinic owners for billing $46.6 million in services that were allegedly unnecessary or never delivered, and another Minnesota resident pleaded guilty to a separate $14 million scheme. Investigations have highlighted inflated billing units and claims that amount to hundreds of dollars per minute.

Florida announced a statewide Medicaid Integrity Initiative, citing $72 million recovered and the exclusion of numerous behavior analysts for fraud. In contrast, Georgia legislators are focusing on a proposed 20% reduction in ABA reimbursement rates, arguing that therapy usage has risen over 300 percent. The situation underscores a tension between curbing fraud and maintaining access to a treatment many families consider essential.