The federal Department of Health and Human Services (HHS) conducted audits in several states and found that spending on autism therapy through Medicaid was soaring and ripe for Medicaid fraud.
“Taxpayers are unknowingly sponsoring bad actors’ multi-million-dollar Medicaid reimbursement scams for autism programs.”
That was a quote from a new report at Open The Books (OTB).
The audit said the Medicaid reimbursement claims were fraudulently inflated, billed without providers’ knowledge, and for services that were not actually provided.
IMPROPER PAYMENTS IN UNCERTIFIED AUTISM SERVICES.
HHS internal watchdog, known as The Office of the Inspector General (OIG), performed an audit of Medicaid ABA (Applied Behavior Analysis) services and discovered hundreds of millions in improper payments.
Improper payments are overpayments, underpayments, or payments where insufficient information was provided, under program rules.
Some of the red flags were detected by the auditors at OIG:
Therapy wasn’t actually provided. Providers billed for children napping, eating, playing on tablets, and watching movies.
Providers repeatedly could not produce records proving therapy occurred. OIG reported flagged payments because behavior technicians weren’t certified. Open the Books also said providers found ways to charge up to $800/hr for work that could be done “by high-school graduates,” and that providers shifted faster than regulators could keep up, with some billing for up to 10 workers evaluating a single patient in a single day.
The Wall Street Journal reported that autism was Medicaid’s fastest-growing area of spending and autism therapy is lucrative because Medicaid pays relatively high rates ($61/hr) for routine therapy for someone with a high school degree and certification vs. $75/hr for psychotherapy by someone with advanced degrees. The ease of certification and relatively high returns would make ABA billings a ripe target for fraud.
This year, the Florida Agency for Health Care Administration said it has retrieved just over $72 million in fraudulent Medicaid payments over the last year. The state says they have been monitoring Medicaid fraud primarily with providers helping out young people with special needs.
