Federal probes target Medicaid billing for autism therapy
Federal prosecutors and state auditors are scrutinizing a sharp rise in Medicaid spending on applied behavior analysis (ABA) therapy after HHS data show more than $5.15 billion paid under a key ABA billing code from 2018 to 2024. Prosecutors charged clinic operators with allegedly billing $46.6 million for unnecessary or unprovided services, and a separate case involved a $14 million guilty plea. CMS flagged significant growth and urged program integrity safeguards. States vary in response: Florida has recovered over $72 million and launched a Medicaid integrity initiative, while Georgia debates rate cuts amid rising service use.
Federal charges allege millions billed for autism therapy not provided
Context
Medicaid payments for ABA therapy have grown rapidly in recent years. Federal charges and state audits followed that growth. States may tighten provider checks or change reimbursement rules next.
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