Federal probes target Medicaid billing for autism therapy

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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