Indiana officials have revoked Medicaid billing privileges for Lebanon, Ind.-based Piece by Piece Autism Centers, citing concerns over the provider’s payment practices, state officials said in a March 25 report from The Wall Street Journal.
The state revoked the provider agreements for all seven of the company’s centers, a move effective in 60 days and subject to appeal, according to letters viewed by the Journal. Marcus Barlow, deputy chief of staff at the Indiana Family and Social Services Administration, said the state terminated the provider over its billing practices.
Piece by Piece received the highest per-patient Medicaid payments in the U.S. in 2023 — about $340,000 on average — according to the report. The company set list prices that allowed it to collect up to $640 an hour for some services in 2024. From 2019 to 2023, Indiana paid the provider $58 million for autism therapy.
The company treated 84 children with autism in 2023, according to the latest year of available data. Piece by Piece founder Meghann Mitchell said in a previous interview with the Journal that the company followed state rules and that audits found no evidence of fraud or intentional wrongdoing.
Indiana for years has reimbursed providers at 40% of their self-set list prices, a structure that allowed companies to increase rates and drive higher payments. The state replaced that model in 2024 with a flat rate of $68 an hour for certain services and is planning additional limits as part of broader Medicaid changes.
Mitch Roob, secretary of Indiana’s Family and Social Services Administration and the state’s acting Medicaid director, posed an ultimatum to autism-therapy providers in the state to self-report past abuses or fraud. If providers do not self-report, they should expect scrutiny from federal health agencies, he said.
The number of Medicaid patients affected by the termination has not been determined, according to the report.
Becker’s reached out to Piece by Piece for comment and will update this story if more information is received.
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