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Government watchdogs and prosecutors have intensified scrutiny of Applied Behavior Analysis (ABA), one of the primary therapies for autistic children, youth and adults. ABA seeks to help people build new skills and manage behavioral challenges commonly seen in autism spectrum disorders (ASD) by enacting changes based on the psychological principles of behaviorism. Sessions are often individualized and designed to meet the unique needs of each person. State Medicaid programs and similar public benefits often provide funding for ABA therapy, aiming to ensure all autistic individuals can access these essential services.
Despite the positive intent behind ABA therapy, recent years have seen a surge in government scrutiny and enforcement actions targeting fraud and abuse within publicly funded autism treatment programs.
In an HHS OIG audit of Indiana's fee for service Medicaid ABA payments, every sampled enrollee-month contained improper or potentially improper claim lines, with issues including missing documentation, lack of appropriate credentials, and inadequate session notes, leading to an estimated $56.5 million in improper payments and $76.7 million in potentially improper payments; the OIG recommended refunding $39.4 million in federal share and tightening documentation and review practices statewide.
Criminal enforcement is also rising. In Minnesota, federal prosecutors charged a provider in a scheme that used unqualified “behavioral technicians”—often young adult relatives without autism related training—to deliver purported one on one ABA, while inflating claims, forging signatures, and submitting bills for services not rendered, yielding more than $14 million from state Medicaid and a private health plan. DOJ emphasized this was not an isolated scheme, linking it to wider networks of public benefit fraud and noting the scale of taxpayer harm.
FCA exposure when special needs services fail to provide proper care
When providers bill Medicaid or other government programs for ABA but use unqualified staff, falsify supervision, or misrepresent credentials, they risk False Claims Act (FCA) liability. The OIG's audit specifically found “No Appropriate Credentials” among improper claims, underscoring that credentialing and supervision are core conditions of payment. In the Minnesota case, prosecutors alleged unqualified staff, forged approvals, and billing for services not provided—elements that align with classic FCA priorities.
Beyond Medicaid: DOJ signals broader harm to patients and private insurance
The Minnesota charging document shows proceeds came not only from Medicaid but also from a private insurer, indicating that improper ABA practices can trigger parallel risk across public and private payors. Federal statements highlight the harm to vulnerable patients when public health programs are abused, and the protection of the neurodivergent community and taxpayers alike through enforcement. This aligns with DOJ's broader focus on safeguarding patient care and deterring schemes that endanger treatment integrity—even outside traditional Medicaid contexts.
Why Does Fraud in ABA Therapy Matter?
When federal and state dollars meant to support autistic individuals are stolen or misused, both families and honest providers suffer. Fraud diverts critical funding away from those who truly need resources and undermines trust in vital autism services. Recent enforcement actions reflect increased vigilance by authorities at every level, with new requirements and closer oversight expected going forward.
Whistleblowers play a crucial role in exposing fraud. If you suspect fraud in ABA therapy, now is the time to come forward. If you have questions regarding your potential whistleblower claims and qui tam actions, please fill out our online intake form to contact a whistleblower attorney at Sanford Heisler Sharp McKnight today.
What Families and Providers Need to Know
How can families spot signs of potential fraud in ABA therapy?
Warning signs include being asked to sign blank session notes, noticing billing for services that your family member did not actually receive, or being offered incentives or kickbacks to enroll your family member in a program. Lack of transparency or frequent changes in provider staff can also be red flags.
What can providers do to avoid legal risk?
Ensure all staff meet credential and training requirements, keep detailed documentation for every service provided, and review session notes regularly. Providers must avoid billing for services not actually rendered and never offer incentives to families for enrollment.
Are families ever at risk for unknowingly participating in fraud?
Yes. Accepting kickbacks or signing off on false attendance or session notes—even without direct involvement—may expose families to investigation or legal repercussions.
Where can I get advice if I suspect abuse or fraud?
Contact your state Medicaid fraud control unit, the Office of Inspector General, or seek legal counsel with experience in healthcare fraud.
The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.
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