Autism Therapy Clinics Overbill Medicaid, Harming Children as Colorado Spending Tops ER Care
Updated
Updated · The New York Times · May 23
Autism Therapy Clinics Overbill Medicaid, Harming Children as Colorado Spending Tops ER Care
2 articles · Updated · The New York Times · May 23
A New York Times investigation found autism therapy clinics across the U.S. often maximize billing in ways that can harm children, including overprescribing treatment hours and steering some families away from school enrollment.
Medicaid’s federal requirement to cover the therapy helped drive a decade-long boom in clinics, alongside rising autism diagnoses and fresh private-equity investment in the sector.
Colorado last year spent more on autism therapy for children through Medicaid than on emergency-room care for all patients, underscoring how quickly the treatment has become a major state budget pressure.
The industry can expand rapidly because frontline staff working directly with children often do not need specialized medical degrees and can be trained largely on the job.
State legislatures have struggled to rein in the fast-growing spending, leaving Medicaid programs exposed to mounting costs as oversight lags the industry’s expansion.
How can states curb soaring therapy costs without harming children who need care?
As private equity buys autism clinics, are children's needs being sacrificed for profit?
Unchecked Overbilling in Colorado’s Medicaid ABA Program: $164 Million in Costs, Systemic Oversight Failures, and the Fight for Autism Care Integrity
Overview
In 2022, federal investigators began reviewing Medicaid payments to ABA therapy providers after a STAT investigation exposed widespread overbilling and substandard care, fueled by a surge of private equity investment in the industry. In Colorado, state officials recognized that a subset of revenue-driven ABA providers were driving unacceptable cost increases through improper billing and poor treatment quality. In response, the Colorado Department of Health Care Policy and Financing committed to stronger oversight and fraud prevention, aiming to protect vulnerable children and ensure Medicaid funds are used responsibly. This situation highlights the urgent need for reform and accountability in Medicaid-funded ABA therapy.