When your child is diagnosed with autism, you’ll do whatever it takes to help them.

You’ll rearrange your work schedule. Spend hours on waiting lists. Drive across town for appointments. You put your faith in the professionals because every parent wants the same thing: the best possible future for their child.

Some autism providers honor that trust.

But others don’t.

And when bad actors exploit vulnerable families and taxpayer-funded Medicaid programs, everyone loses.

Autism diagnoses have risen dramatically over the past several decades. Today, approximately 1 in 31 American children has been identified with autism. As demand for treatment has grown, so has spending on Applied Behavior Analysis (ABA) therapy, one of the most common interventions available to families. Medicaid payments for ABA have surged in recent years as more children seek services. In fact, ABA therapy has become Medicaid’s fastest-growing area of spending, going from $660 million in 2019 to $2.2 billion in 2023.

Unfortunately, explosive growth has also created opportunities for abuse.

Reports from whistleblowers, investigative journalists, and government agencies describe providers allegedly billing for services never delivered, recommending excessive treatment hours driven by financial incentives, and placing profits ahead of patient care. Federal investigations have uncovered nearly $200 million fraudulent billing schemes, while recent criminal prosecutions have exposed clinics accused of submitting false claims and even enrolling children who did not qualify for services.

Here in Georgia, state leaders are taking notice.

The Georgia Department of Community Health recently announced that Applied Behavior Analysis is now considered a high-risk Medicaid service category and has proposed stronger prior authorization requirements, enhanced provider oversight, and additional program integrity measures aimed at reducing fraud, waste, and abuse.

That’s a good start.

But protecting children requires more than just administrative changes.

Georgia lawmakers must ensure Medicaid dollars reach children not fraudsters.

That means targeted rate reductions of areas that are ripe for abuse, requiring greater transparency in treatment recommendations, strengthening audits of high-risk providers, increasing penalties for fraudulent billing, removing repeat offenders from Medicaid networks, and empowering parents to report suspected abuse without fear of retaliation.

Not only is this about common sense, it’s about ensuring families receive the right care from the right providers.

Every fraudulent claim steals resources from the children who need them. Every dollar lost to waste means longer waitlists, fewer services, and diminished trust in a system families depend on during some of the most difficult moments of their lives.

At Moms for America Action, we believe government has a responsibility to be a responsible steward of taxpayer dollars but an even greater responsibility to protect children.

Georgia has an opportunity to become a national leader in restoring integrity to autism care.

Families deserve transparency.

Taxpayers deserve accountability.

Most importantly, children with autism deserve providers whose first priority is their well-being, not their billing department.

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Article by Raquel Mitchell
Deputy Director of Moms for America Action.

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