Rising Medicaid spending on Applied Behavior Analysis (ABA) therapy for children with autism in the United States has triggered scrutiny over the use of taxpayer money and the possibility of fraudulent billing. Available data shows that Medicaid paid approximately $5.15 billion, or around ₹45,320 crore, under an ABA billing code between 2018 and 2024. During the same period, three providers received approximately $685 million, equivalent to around ₹6,028 crore, in Medicaid reimbursements.
The dollar figures have been converted at an approximate exchange rate of ₹88 to the US dollar. However, high reimbursement amounts by themselves do not establish fraud. Billing experts have noted that unusually large payments can result from several legitimate factors, including growth in the number of patients, treatment duration and increased demand for services.
ABA therapy is among the commonly used interventions for children with autism. It involves structured, often one-on-one sessions designed to support communication, social behaviour and daily living skills. Many families consider such services important for their children’s development, although views on the effectiveness and use of ABA can vary among families and medical professionals.
Officials at the US Centers for Medicare & Medicaid Services (CMS) said the agency has observed significant growth in Medicaid spending on ABA therapy in recent years. CMS has stressed that access to medically necessary services remains a priority, while the rapid expansion of the programme also increases the need to ensure that services are clinically appropriate, delivered by qualified providers and supported by strong programme-integrity safeguards.
As spending has increased, federal prosecutors have pursued several multimillion-dollar fraud cases involving ABA providers. In May, two operators of autism clinics in Minnesota were charged with allegedly billing Medicaid approximately $46.6 million, or nearly ₹410 crore, for services prosecutors said were either unnecessary or never provided.
In a separate case, a Minnesota woman pleaded guilty in connection with an alleged $14 million, or approximately ₹123 crore, Medicaid autism fraud scheme. Investigators in such cases have alleged that some providers billed Medicaid for therapy sessions that were not actually delivered, while other allegations involved inflating the number of hours of therapy provided.
Investigations by major US media organisations have also raised questions about alleged irregularities in the ABA sector. Reports have highlighted allegations that some providers expanded rapidly as Medicaid spending increased and, in certain cases, billed for more therapy hours than were actually delivered.
The scrutiny comes as the US administration has placed greater emphasis on reducing fraud, waste and abuse across federal programmes. Medicaid, one of the country’s major government-funded healthcare programmes for eligible low-income Americans, has emerged as an important area of oversight.
States have adopted different approaches to address potential improper payments. Florida officials said the state recovered more than $72 million, or approximately ₹634 crore, in improper Medicaid payments over the past year. The state has also introduced a Medicaid Integrity Initiative aimed at strengthening provider screening, improving fraud detection and increasing oversight.
In Georgia, meanwhile, lawmakers have focused on Medicaid reimbursement rates. Industry representatives have told lawmakers that the use of autism therapy services in the state has increased by more than 300 percent in recent years, highlighting the growing demand for such treatment.
The issue reflects a difficult balance for policymakers. Authorities want to prevent fraud and improper use of taxpayer funds, but excessive restrictions could also affect access to treatment for children and families who rely on autism-related services.
For Medicaid administrators and investigators, the challenge is therefore to strengthen programme integrity without disrupting legitimate care. The ongoing scrutiny of ABA billing is expected to focus on whether providers are delivering medically appropriate services, whether billing accurately reflects the treatment provided and whether public funds are being used for legitimate healthcare purposes.
The allegations against individual providers remain subject to legal proceedings, and high Medicaid reimbursements alone do not establish wrongdoing. Federal and state authorities are continuing to examine billing practices, provider payments and programme controls as spending on autism-related services continues to grow.
