UMVA has learned that the Department of Health and Human Services has sounded an unprecedented alarm, putting every state on notice to clean up a massive wave of Medicaid fraud targeting autism services.
In a damning audit, investigators uncovered that Colorado alone overpaid $77.8 million in fee‑for‑service Applied Behavior Analysis therapy for children with autism during 2022‑2023, with every sampled enrollee‑month containing at least one suspect claim.
Further digging revealed an additional $207 million in potentially improper payments in Colorado, while Wisconsin, Indiana and Maine faced similar scandals, together accounting for roughly $198 million—about 31 % of the spending examined in those states.
Authorities have now turned their sights nationwide. The Department of Homeland Security’s investigative arm arrested two women in Minnesota for siphoning more than $21 million from the state’s autism program, a scheme that appears to be just the tip of an iceberg.
In response, the Centers for Medicare & Medicaid Services issued an urgent directive: every state must reevaluate high‑risk ABA providers, purge illegitimate operators, and submit a remediation plan within ten business days, with a full strategy due in thirty.
Backing this crackdown, the new AERO initiative—Audit Enforcement and Risk Oversight—is deploying artificial intelligence and aggressive follow‑up to finally hold states accountable for years of ignored audit failures and chronic non‑compliance across HHS programs.
Spending patterns are staggering. North Carolina’s Medicaid ABA budget exploded from roughly $1.9 million five years ago to over $505 million in 2025, with projections poised to break the $1 billion mark.
Across eight states with available data, total Medicaid autism therapy expenditures surged from $347 million to more than $2.2 billion—a 561 % jump in just a few years.
Minnesota’s figures are equally alarming, rocketing from under $700,000 in 2018 to $342 million by 2024 within its Early Intervention program.
These eye‑popping numbers have ignited a firestorm of scrutiny, signaling that the era of unchecked autism‑related Medicaid fraud may finally be coming to an end.
