$5,150,000,000
In Medicaid Spending
Corporate clinics are cashing in on autism Medicaid programs while taxpayers foot the bill and vulnerable, autistic children lose access to legitimate care.
The Autism Therapy Scam
- ABA therapy has become Medicaid’s fastest-growing area of spending, going from $660 million in 2019 to $2.2 billion in 2023.
- Routine ABA therapy is often provided by registered behavior technicians (RBTs), who typically receive limited training and comparatively modest wages, while Medicaid reimbursements in some cases reach several hundred dollars per hour.
- The Department of Justice has pursued criminal charges against ABA providers accused of fraud.
- In May 2026, federal prosecutors charged two Minnesota autism clinic operators with fraudulently billing the government $46.6 million for services never delivered or given to children with fake diagnoses.
- In September 2025, the Department of Justice charged a Minnesota woman with wire fraud for her role in a $14 million autism fraud scheme.
- In April 2026, the Trump administration announced a 50-state audit of Medicaid oversight programs.
- In late May 2026, the Florida Agency for Health Care Administration cracked down on Medicaid fraud, especially among providers serving children with special needs.
- Nebraska has implemented rate cuts for ABA services ranging from 28% to 79% and implemented a 30-hour-per-week cap on services.
In The News
- "The Autism-Therapy Business Is Booming—and So Is the Billing Abuse,” Wall Street Journal, 6/1/26
- "Short Naps, Long Hours: How Autism Squeeze Medicaid Dollars out of PreSchoolers" New York Times, 05/23/26
- "North Carolina autism therapy billing through Medicaid jumps 11,000% in 4 years, prompting audit" Fox 8, 05/16/26
- "Some autism providers and treatment facilities in Colorado overbilling, completely unregulated, according to report" CBS News, 04/15/26
Fast Facts:
ABA Therapy Billing and Medicaid Fraud Concerns
- Industry Growth: Applied Behavior Analysis (ABA) therapy is one of the fastest-growing sectors in pediatric healthcare, driven by rising autism diagnoses and expanded insurance mandates.
- The Core Billing Code: CPT code 97153 is the main code used for face-to-face ABA therapy. It is billed in 15-minute increments for services delivered by technicians under professional supervision.
- Who Delivers the Care: These services are usually provided by Registered Behavior Technicians (RBTs). RBTs are paraprofessionals who carry out treatment plans but do not design them. Becoming an RBT requires a high school diploma, 40 hours of training, and passing a competency exam.
- Massive Spending: Between 2018 and 2024, Medicaid paid out roughly $5.15 billion under CPT code 97153 across 2,200+ providers. Strikingly, just three providers accounted for approximately $685 million of that total.
- Fraud Red Flags: Rapid industry growth and heavy reliance on lower-paid, minimally trained personnel have led to widespread billing integrity issues. Common fraudulent practices include:
- Submitting claims for services never actually provided.
- Inflating the number of service hours.
- Billing for expert services that were actually performed by undertrained staff.
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