HHS audit finds $56.5M in 'improper' payments to ABA providers: 5 things to know

An audit by HHS' Office of Inspector General found Indiana made at least $56 million in improper payments for autism treatment. 

Published Dec. 16, the audit examined payments Indiana's Medicaid program made to applied behavioral analysis treatment in 2019 and 2020. The state had the second-highest level of Medicaid spending on ABA treatment in the U.S., according to OIG. 

The audit found instances of non-qualified professionals billing the state's Medicaid program for ABA services, and children without a qualified diagnosis of autism receiving ABA treatment. 

Here are five things to know: 

  1. Indiana spent $101.8 million on applied behavioral analysis treatment for children with autism in 2020, up from $14.4 million in 2017. 
  2. In 2019 and 2020, the state paid ABA providers at least $56.5 million in improper payments, according to the OIG, and $76.7 million in possibly improper payments. 

  3. The OIG found potential improper or potentially improper payments in all 100 enrollee-months it sampled in its audits. 

  4. In 95 of 100 sampled months, the session notes from providers did not meet documentation requirements for the claims Indiana Medicaid paid. In 97 of 100 months, ABA services were provided by staff who did not have appropriate credentials. 

  5. The OIG recommended Indiana refund $39.4 million to the federal government. The watchdog also recommended Indiana provide additional guidance to ABA facilities on proper documentation. The state did not concur or or non-concur with the recommendations, but has taken steps in response to the recommendations, according to the OIG. 

Federal and state agencies have identified questionable billing patterns from some ABA providers, according to the OIG. In December, the FBI raided two Minnesota autism treatment centers as part of an investigation into alleged fraud. 


Read the full report here.

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