The Medicaid Autism Racket

Behavioral therapy payments are an easy target for fraud.

WSJ editorial. Excerpts:

There was "a Minnesota man pleading guilty last week to bilking Medicaid by setting up a sham autism center."

"Medicaid autism treatment has become an open vault for fraud and abuse."

"Behavioral therapy is an especially ripe target for people looking to game Medicaid. Diagnostic standards can be elastic, and states provide little oversight of providers and pay claims without requiring verification of treatment or benefits. While insurers that administer Medicaid benefits have an incentive to police fraud, autism treatment has become a fee-for-service free-for-all."

"Abdinajib Hassan Yussuf set up a fly-by-night autism center [in Minnesota] claiming to provide one-on-one therapy for autistic children . . . and paid kickbacks to parents to enroll them in his center."

"99% of Colorado’s Medicaid payments in 2022 and 2023 for autism treatment were improper or likely improper, totalling $285.2 million."

"Many autism centers billed Medicaid at more than $50 an hour for autism “treatment” when children were playing games, napping or eating."

"the state failed to do a “postpayment review of payments” to verify compliance with state and federal requirements."

"treatment was often “provided by staff who did not have the appropriate credentials”"

"states have little incentive to police waste and fraud because they get paid more for enrolling more of their citizens in Medicaid."