Applied Behavior Analysis (ABA) therapy is utilized by many American families to assist children with autism in developing essential skills. Medicaid spending on ABA therapy has significantly increased, leading to concerns about potential fraud within the program. Republican-led states, such as Florida, have implemented stricter fraud enforcement measures, while other states, like Georgia, are focusing on reimbursement rates and maintaining access to care. The Trump administration has prioritized addressing fraud in federal programs, including Medicaid.
Data from the Department of Health and Human Services indicates that Medicaid disbursed over $5.15 billion for ABA therapy from 2018 to 2024. Some providers received substantial reimbursements, with three providers alone accounting for approximately $685 million during this timeframe.
Federal prosecutors in Minnesota have charged two autism clinic operators with allegedly billing Medicaid for $46.6 million in unnecessary services, while another individual pleaded guilty to a separate $14 million fraud scheme. Investigative reports have highlighted instances of providers billing for services not rendered and inflating therapy hours.
The Centers for Medicare & Medicaid Services (CMS) has noted a significant increase in Medicaid spending on ABA therapy, emphasizing the need for clinically appropriate services delivered by qualified providers. Florida has reported recovering over $72 million in improper payments and has initiated a Medicaid Integrity Initiative to enhance oversight. In contrast, Georgia lawmakers are addressing reimbursement rate reductions despite a reported 300% increase in the use of autism therapy services.