Medicaid Fraud Crackdowns Curb Autism Care for 1 in 31 U.S. Children
Updated
Updated · POLITICO · Sep 11
Medicaid Fraud Crackdowns Curb Autism Care for 1 in 31 U.S. Children
2 articles · Updated · POLITICO · Sep 11
Summary
Nebraska providers say new Medicaid anti-fraud rules are already shrinking autism services: Heartland ABA said 40 children on its wait list cannot get therapy after July supervision changes.
State reimbursement cuts and tighter paperwork, credentialing and reapproval rules are hitting clinics that have not been accused of fraud, forcing wage cuts and staff losses that reduce treatment capacity.
CMS under Administrator Mehmet Oz has made autism billing a fraud priority after cases including a Minnesota scheme prosecutors valued at $90 billion and a federal audit flagging hundreds of millions in potentially improper payments.
Autism diagnoses have climbed to 1 in 31 children, while Medicaid spending on autism therapy rose from $660 million in 2019 to $2.2 billion in 2023, leaving oversight efforts colliding with surging demand.