DAILY BS BULLETIN
- Medicaid payments for a widely used autism-therapy billing code surpassed $5.15 billion between 2018 and 2024.
- Prosecutors allege Minnesota providers billed $46.6 million through kickbacks, unnecessary diagnoses and services never delivered.
- A new CMS operation recently stopped $203 million in potentially improper Medicaid payments nationwide.
Federal officials are intensifying their Medicaid crackdown as billions of dollars pour into Applied Behavior Analysis, a legitimate and often life-changing therapy for children with autism that prosecutors say has also attracted brazen fraudsters.
The newest enforcement results arrived July 28, when the Centers for Medicare & Medicaid Services announced that its Medicaid Fraud War Room had stopped more than $203 million in potentially improper payments during its first 88 days. The initiative identified 50 high-risk providers through coordinated federal and state investigations.
CMS Administrator Dr. Mehmet Oz said:
Every dollar lost to Medicaid fraud is a dollar taken away from vulnerable Americans who rely on it.
The crackdown comes as Medicaid spending under one major ABA billing code exceeded $5.15 billion between 2018 and 2024. Three providers received approximately $685 million combined, according to federal payment data examined by Fox Business.
Those numbers do not establish fraud. ABA frequently involves intensive, one-on-one treatment delivered for many hours each week, and rising autism diagnoses have increased legitimate demand. But explosive growth, concentrated payments and weak state oversight have produced an irresistible target for criminals.
Between 2021 and 2025, Medicaid spending on Applied Behavior Analysis — ABA therapy — grew 6X faster than the number of children actually receiving services.
Nationally, spending on went quickly from 2 BILLION to over 10 BILLION, a 420% increase. pic.twitter.com/0aIwsCSMJ6
— Dr. Oz CMS (@DrOzCMS) August 4, 2026
Minnesota provides the most alarming example.
Federal prosecutors charged two autism-center operators in May over an alleged $46.6 million scheme involving the state’s Early Intensive Developmental and Behavioral Intervention program. The government alleges that approximately $21.2 million was paid.
According to the Justice Department, the defendants allegedly paid kickbacks to families, enrolled children for medically unnecessary treatment and submitted claims for services that were never provided.
CMS described the alleged conduct bluntly:
These schemes did more than steal taxpayer dollars — they robbed children with autism, adults with disabilities, and other at-risk citizens of the essential care they rely on.
Minnesota’s spending on the program rocketed from roughly $600,000 in 2018 to more than $400 million in 2025, according to the Justice Department.
A defendant in a separate Minnesota autism case pleaded guilty after prosecutors said her operation extracted approximately $14 million. Another provider allegedly collected more than $6 million through inflated claims, unauthorized billing and nonexistent treatment.
The money did not always remain in the examination room. Prosecutors allege proceeds were used to purchase real estate in Kenya, acquire a semi-truck and finance kickbacks to participating families. The accusations remain allegations unless proven in court.
Jonathan Ingram of Foundation for Government Accountability: “Prosecutors charged 15 defendants…in the largest Medicaid autism fraud case in American history…those cases made headlines because prosecutors could bring charges many Medicaid losses never get that far.” pic.twitter.com/WDlUIWKdiJ
— RNC Research (@RNCResearch) August 4, 2026
Federal audits have exposed additional weaknesses beyond Minnesota. HHS investigators reviewing autism-service payments in Indiana, Wisconsin, Maine and Colorado identified approximately $198 million in improper payments and flagged hundreds of millions more for possible errors. Problems included missing documentation, unqualified caregivers and billing recreational activities as therapy.
An improper payment can result from incomplete paperwork or administrative error and is not automatically criminal fraud. But when every sampled claim contains a problem, “clerical oversight” begins sounding like the world’s busiest clerk.
The Trump administration has responded by adding 15 federal prosecutors devoted to Medicaid fraud and expanding its Health Care Fraud Strike Force. Florida has separately reported recovering more than $72 million in improper Medicaid payments while increasing provider screening and data analysis.
The challenge is rooting out predators without punishing honest therapists or families already struggling to obtain care. Aggressive cuts based solely on rising spending could reduce access for autistic children. Ignoring obvious warning signs, however, leaves those same children functioning as billing numbers for criminals.
MY QUICK TAKE:
Nothing attracts a crook quite like a government program with billions of dollars, complicated billing codes and somebody in charge saying, “Surely nobody would lie about helping children.”
Government traditionally discovers fraud after the money has purchased three houses, a luxury car and something inexplicably described in court filings as “livestock.” This time, perhaps somebody could check whether the therapy happened before mailing the check.
Protect the children. Pay the honest providers. And introduce the thieves to an intensive behavioral intervention called federal prison.
DBS WIRE SOURCES:
- CMS — Medicaid Fraud War Room stops more than $203 million in improper payments
- Justice Department — Minnesota fraud takedown charges 15 defendants
- New York Post — Minnesota parents allegedly faked autism diagnoses in $46 million scheme
- Justice Department — Minnesota health-care fraud case summaries
