In The Politics of Autism, I discuss the day-to-day challenges facing autistic people and their families. Scams plague the world of autism. Some involve shady or abusive providers.
Wall Street Journal editorial:
Federal investigators are uncovering new layers of fraud in government programs, with a Minnesota man pleading guilty last week to bilking Medicaid by setting up a sham autism center. Meantime, a federal audit last week revealed how Medicaid autism treatment has become an open vault for fraud and abuse.
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Minnesota is far from alone, judging by audits by the U.S. Health and Human Services Department’s Inspector General of Medicaid autism spending in other states. An IG audit released last week estimated that 99% of Colorado’s Medicaid payments in 2022 and 2023 for autism treatment were improper or likely improper, totalling $285.2 million.
Nearly all providers failed to submit the required documentation for at least some claims, and a quarter billed the state for treatment provided by staff without appropriate credentials. Many autism centers billed Medicaid at more than $50 an hour for autism “treatment” when children were playing games, napping or eating. Many provided little more than glorified day care.
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The IG notes that the state failed to do a “postpayment review of payments” to verify compliance with state and federal requirements. Recent IG audits of autism treatment providers in Maine, Wisconsin and Indiana have turned up similar problems. Providers frequently billed for more hours of treatment than they provided, charging Medicaid as much as $256 an hour in Indiana.
Autism treatment was often “provided by staff who did not have the appropriate credentials” and “to children who did not receive the required diagnostic evaluations or treatment referrals,” the IG reported in its Indiana review. In Wisconsin, records from 19 of 22 audited providers showed that Medicaid was billed for time spent in recreational activities.
Maine Medicaid pays for clinical specialists to work with autistic children in their homes. Yet the IG found that roughly half of children lacked documentation of an autism diagnosis or evaluation, and some 20% of providers didn’t substantiate their credentials to provide therapy. Questionable autism payments totaled $68 million in 2023 alone.
