Policy & Advocacy / Disability Rights / March 18, 2026
A Wall Street Journal investigation and a cascade of federal audits reveal how ABA therapy providers extracted hundreds of millions in Medicaid dollars while autistic children and their families had no idea it was happening.
Isha Snow Founder & Executive Director, NeuroHomes Communities
This week, a Wall Street Journal investigation (paywall) put numbers to something many in the disability advocacy community have known for years: the Applied Behavior Analysis industry has a structural exploitation problem, and Medicaid has been paying for it. The reporting, amplified by coverage in the International Business Times, is not a story about a few bad actors. It is a story about what happens when weak oversight, predatory billing practices, and a vulnerable population intersect inside a rapidly expanding market.
At the center of the Journal’s investigation is an Indiana provider, Piece by Piece Autism Centers, which billed Medicaid at rates reaching $1,600 per hour for sessions delivered by Registered Behavior Technicians. The minimum requirement to become an RBT, per the Behavior Analyst Certification Board, is a high school diploma, a clean background check, and a 40-hour training course. The full certification costs under $100. The workers earning those credentials typically made less than $20 per hour. The provider billed up to $1,600.
$29M – Medicaid billing by one Indiana provider for just 84 children in a single year
$2.2B – Total US Medicaid spending on ABA therapy in 2023, up from $660M in 2019
100% – Of sampled claim months in Indiana, Colorado, Wisconsin, and Maine audits contained improper payments
500+ – Autism therapy centers acquired by private equity over the past decade
The state of Indiana, at the time, reimbursed providers at 40% of whatever they chose to bill, with no cap. That billing model lasted just long enough for Piece by Piece to collect approximately $29 million to treat 84 children in one year, averaging $340,000 per child. The provider’s owner subsequently purchased a $2.5 million home in Florida and paid off the mortgage shortly afterward. Indiana has since moved to a flat rate of $68 per hour.
Asked what justified her billing rates given labor costs as low as $20 per hour, the provider told the Journal: “I really don’t have an exact reason for that.”
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Federal Auditors Found Errors in Every Single Claim They Sampled
What makes this more than a single-provider scandal is the federal audit trail. The HHS Office of Inspector General audit of Indiana, published in December 2024, examined 100 sampled enrollee-months and found that every single one included at least one improper or potentially improper payment. The OIG recommended that Indiana return $39.4 million to the federal government. A March 2026 audit of Colorado produced identical findings: all 100 sampled months, all improper. The OIG estimated $77.8 million in confirmed improper payments there, with an additional $207.4 million in potentially improper payments. Audits of Wisconsin and Maine told the same story.
The Wisconsin audit added a particularly stark detail: the state’s Medicaid program had never conducted a single post-payment review of ABA claims since the program began in 2016. Nearly a decade of billing, zero scrutiny.
“Fraud, waste, and abuse occur in ABA — and it has to stop.”
– Council of Autism Service Providers, formal statement responding to the Wall Street Journal investigation
Common errors across all four states included lack of documentation, sessions billed for non-therapy time, caregivers lacking required credentials, and claims billed for patients who had no confirmed autism diagnosis on file. These are not technical billing edge cases. These are foundational compliance failures at scale.
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Private Equity Entered the Picture, and the Problems Accelerated
The ABA industry’s rapid expansion over the past decade attracted significant private equity interest. According to Becker’s Behavioral Health, private equity firms acquired more than 500 autism therapy centers across the US over the past decade, with nearly 80% of those acquisitions occurring between 2018 and 2022. The Journal found that a private equity-backed national provider was flagged in the Colorado OIG audit for billing some of the highest hours per patient of any provider in the state.
Meanwhile, a Minnesota fraud prosecution concluded in March 2026 with a guilty plea from a woman who extracted $14 million from Medicaid through an autism care scheme. Minnesota had 85 open investigations into autism providers as of last summer, following FBI raids on two providers in 2024.
As one ABA industry CEO put it in a recent interview: “As an industry, we’ve dug ourselves into this hole.”
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What This Means for Autistic Adults and Their Families
It would be a mistake to read this as an isolated children’s services problem. The dynamics exposed here, profit extraction from public disability dollars, unqualified or under-supervised service delivery, and zero state oversight, appear wherever public funding meets disability support services without strong accountability structures. Autistic adults navigating housing, supported living, and community integration face versions of this same market every day.
States are now moving to cut reimbursement rates dramatically. Nebraska cut Medicaid ABA payments by up to 80%. UnitedHealth Group has begun limiting ABA coverage in several states. These corrections may be financially necessary, but they carry real risk: when regulators overcorrect by slashing funding without improving accountability, the families who had nothing to do with the fraud end up losing access to services they genuinely need.
The autistic community did not create this mess. Providers seeking to maximize Medicaid extraction, private equity firms optimizing for return, and state agencies that failed for years to audit a single claim, those are the actors responsible. The response to this crisis must protect access for autistic people while holding exploitative providers accountable, not the other way around.
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Why NeuroHomes Is Built Differently
At NeuroHomes, we are building housing and supportive services infrastructure that is neurodivergent-led, nonprofit, and structurally accountable. The exploitation documented in these investigations is made possible by a service system that treats autistic people as billing units rather than as full community members with rights and long-term housing needs. Our model integrates affordable housing with on-site services precisely because we believe stable housing is the foundation that makes everything else possible, and because we have no shareholders to satisfy, only the people we serve.
This reporting matters to us. It clarifies exactly why we are building an alternative.
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