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The federal Department of Health and Human Services (HHS) conducted an audit in several states and found that spending on autism treatment through Medicaid is soaring, making it ripe for Medicaid fraud.
“Taxpayers are unwittingly sponsoring a multi-million dollar Medicaid reimbursement fraud perpetrated by bad actors against autism programs.”
This was taken from a new report by Open The Books (OTB).
The audit found that Medicaid reimbursement claims were fraudulently inflated, billed without the provider’s knowledge, and billed for services that were not actually provided.
Improper payments for uncertified autism services.
HHS’s internal oversight agency, known as the Office of Inspector General (OIG), conducted an audit of Medicaid ABA (applied behavior analysis) services and found hundreds of millions of dollars in improper payments.
An improper payment is an overpayment, underpayment, or payment for which insufficient information was provided under the terms of the program.
Several red flags were detected by OIG auditors.
No treatment was actually provided. Providers charged children for naps, meals, playing on tablets, and watching movies.
Health care providers repeatedly failed to produce records to prove that treatment was performed. OIG reported that the payment was flagged because the behavioral technician was not certified. Open the Books also said that providers found ways to charge up to $800 an hour for work that “even a high school graduate could do” and that providers were moving faster than regulators could catch up, with some charging up to 10 workers evaluating one patient a day.
The Wall Street Journal reports that autism is the fastest-growing area of Medicaid spending, and that autism treatment is lucrative because Medicaid pays relatively high rates ($61 an hour) for routine therapy for those with a high school diploma or certification, compared to $75 an hour for psychotherapy with an advanced degree. Because they are easy to authenticate and the profits are relatively high, ABA claims are easy targets for fraud.
The Florida Department of Health Care Administration announced this year that it recovered just over $72 million of last year’s fraudulent Medicaid payments. The state said it is monitoring Medicaid fraud primarily targeting health care providers who serve young people with special needs.
