Overview
- Federal audits of Indiana, Wisconsin, Colorado and Maine documented about $198.4 million in improper autism-related Medicaid payments and prosecutors in Minnesota charged what the Justice Department called the largest Medicaid autism fraud case, allegations that together spurred new oversight.
- The Centers for Medicare and Medicaid Services issued an ABA oversight toolkit urging states to review billing and utilization, and several states including Louisiana have begun accelerated revalidation of high-risk providers.
- Louisiana officials say they are adding on-site visits, more frequent revalidation, background checks and fingerprinting for ABA providers while reviewing rules on treatment hours and medical necessity to make sure therapy is appropriate and time-limited.
- Oversight officials cite the therapy’s common 15-minute billing units and a rapid rise in Medicaid use and payments as factors that enabled questionable claims and drew private equity firms into the market.
- Lawmakers are weighing caps on hours, clinic and therapist standards, and rules about private ABA technicians in schools, a set of changes that could reduce waste but also change access to services for children who rely on the therapy.