WASHINGTON (Diya TV) — A new investigation by The Wall Street Journal using recently released Medicaid billing data has uncovered major spending irregularities in autism therapy programs, raising fresh questions about oversight and the rapid growth of a multibillion-dollar industry funded largely by taxpayers.
The analysis found that some autism therapy providers have billed state Medicaid programs at unusually high rates, in some cases charging hundreds of dollars per hour for services often delivered by technicians with minimal formal training. In one striking example highlighted in the investigation, an Indiana provider, Piece by Piece Autism Centers, received $29 million in Medicaid payments in 2023 to treat just 84 patients, averaging about $340,000 per child for the year.
Billing records show the company received reimbursements as high as $640 per hour for routine therapy sessions, far above the national average of about $61 per hour for similar services.
Autism therapy has become one of the fastest-growing categories of Medicaid spending in the United States. Payments from state Medicaid programs for behavioral therapy services surged from about $660 million in 2019 to roughly $2.2 billion in 2023, according to the Journal’s analysis of national billing data.
Much of the growth is tied to the expansion of Applied Behavior Analysis (ABA) therapy, a widely used treatment designed to help children with autism develop communication and behavioral skills. The therapy is often delivered by registered behavior technicians who may have limited formal education and earn wages under $20 an hour while working under the supervision of licensed specialists.
The investigation suggests that certain state reimbursement systems made it easier for providers to increase their billings. In Indiana, for example, the Medicaid program previously reimbursed providers at 40 percent of whatever rate they billed, rather than setting a fixed price. Critics say that approach effectively created an incentive for providers to raise their listed rates, resulting in large reimbursements from the state.
State officials have since acknowledged that oversight of the program was limited during the period when spending surged. Indiana Family and Social Services Administration Secretary Mitch Roob said the system allowed billing practices that he described as “the epitome of abuse,” noting that regulators did not closely monitor how providers were charging the program.
The scrutiny comes amid broader federal concerns about potential misuse of Medicaid funds in autism treatment programs. A recent audit by the Department of Health and Human Services identified nearly $600 million in improper or potentially improper Medicaid payments for autism services across four states, citing issues such as undocumented therapy sessions, unqualified caregivers, and billing for activities that did not qualify as medical treatment.
The owner of Piece by Piece Autism Centers, Meghann Mitchell, told the Journal that her company complied with Indiana’s rules and that state regulators never objected to the rates she charged. She said the company increased fees over time due to rising labor and operating costs and maintained that audits of the business had not found evidence of fraud.
Nonetheless, the scale of payments has drawn attention to the broader economics of autism therapy programs. In some cases, the annual cost of treating a single child exceeded what Medicaid typically spends to treat serious medical conditions such as cancer or to provide a year of nursing home care, according to the Journal’s analysis.
In response to the growing costs, Indiana has already changed its reimbursement model, replacing the percentage-based system with a flat payment rate of about $68 per hour for therapy services. State officials have also introduced limits on the total number of therapy hours Medicaid will cover for each patient.
The findings highlight the challenges facing regulators as demand for autism services continues to increase nationwide. Autism diagnoses have risen significantly over the past two decades, with the Centers for Disease Control and Prevention reporting that about one in 31 children in the United States is now diagnosed with autism spectrum disorder.
For policymakers, the investigation underscores the difficulty of balancing two competing priorities: expanding access to therapy for children who need it while preventing fraud, overbilling, and waste in one of the country’s largest public health programs.
