The Trump administration has made rooting out fraud a top priority. The White House Task Force to Eliminate Fraud is waging, in their words, “an unrelenting, full-scale assault on the fraudsters, scammers, and corrupt operators who have looted billions from American taxpayers.” They’re halting hundreds of millions in Medicaid payments to Minnesota, blocking $1.3 billion in California, and auditing Medicaid Fraud Control Units in all 50 states.
One of the biggest fraud magnets in the entire Medicaid program is Applied Behavior Analysis, better known as autism “therapy.” The Department of Health and Human Services Office of the Inspector General has made ABA improper payments a standing item on its work plan, and whenever the auditors pull the thread in a state, they find this program rife with fraud. Every. Single. Time.
Auditors have found tens of millions of dollars in improper payments for ABA provided to children with autism in Colorado, Indiana, Maine, and Wisconsin. That’s nearly $200 million in improper payments in just four states, and the OIG says “at least” every time.
Even the mainstream media can’t ignore this scam. A recent Wall Street Journal investigation shows how real families with real needs are being used as tools to loot the system.
A New Jersey mother was “promised immediate treatment — and no out-of-pocket costs” for her 3-year-old autistic son. What she got was “a behavior technician spent a total of 70 minutes with Ezekiel, working on a puzzle and playing with educational toys.” The provider billed $30,500 for the day, or $436 a minute of puzzle time.
Instead of real treatment, one Florida boy got “therapy” that “included activities such as pushing him on a swing in the backyard.” This was billed at $10,000 for many single dates of service. His father commented, “If I wanted a babysitter for $10,000 a pop, I would have found me one.”
Real care might be priceless to these families, but the behavior technicians, who frequently need little more than a high school degree, are not providing it. Yet taxpayers nationwide are paying for it.
Almost anyone can open an autism therapy clinic with much less oversight than a daycare center faces. Meanwhile, the founder of the outfit that scammed that New Jersey mother just closed on a $3.1 million Brooklyn home.
The Department of Justice knows autism care has become a gold mine for swindlers. Federal prosecutors just charged 15 defendants in a healthcare fraud takedown involving more than $90 million, including the largest Medicaid autism fraud case DOJ has ever charged, an approximately $46.6 million scheme where providers paid kickbacks to parents, diagnosed children with autism regardless of medical necessity, and billed for services never provided.
HHS Secretary Robert F. Kennedy, Jr. called it “the largest autism fraud bust in American history.” He continued, “These criminals exploited vulnerable children, stole taxpayer dollars, and diverted critical autism care and resources away from families who truly need support, and we will continue rooting out fraud to protect children and restore integrity to America’s public health programs.”
The White House is doing its part. OIG is doing its part. DOJ is doing its part. But some states want to turn a blind eye to this gusher of graft. For example, Georgia.
Even though the state has identified ABA as “high-risk” for fraud and requiring additional oversight policies, Georgia lawmakers have tried to block efforts by the state’s Medicaid plan partners to hold ABA providers accountable and protect taxpayers.
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Policymakers must either shut down the fraud and abuse in the state’s Medicaid program or explain why the taxpayers were taken for a ride while those charged with protecting the treasury stood idly by.
And this has to happen in all 50 states. Every. Single. One. The guardians of our taxpayer dollars need to stop blowing smoke about “waste, fraud, and abuse” and start doing something about it.
Tom Jones is the president of the American Accountability Foundation, a nonprofit government oversight and research organization that seeks to protect the interests of the American people.
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[ H/T Washington Examiner ]
