It’s not just Minnesota where people have bilked Medicaid for millions.
Federal auditors found $198 million “improper payments” for Medicaid-funded autism services in four states, and another $410 million may have been incorrectly billed.
The Department of Health and Human Services (HHS) put Medicaid spending for autism care in Indiana, Wisconsin, Maine and Colorado under the microscope, examining 100 monthly bills in each state over a year.
They found potential payment errors in every single one.
According to the audits, Indiana made at least $56 million in improper payouts, Wisconsin $18.5 million, Maine $45.6 million and Colorado a whopping $77.8 million.
Payments should not have been made due to reasons like caregivers failed to properly document therapy sessions, lacked the appropriate credentials to provide treatment or patients had not been properly diagnosed with autism.
In addition, in each case the audits flagged separate “potentially improper payments” in each state, which was a much higher number: up to $77 million in Indiana, $22 million in Maine, $94 million in Wisconsin and $207 million in Colorado.
These payments were flagged as carers billing for potential non-therapy time and during recreational activities and not keeping proper notes of the care.
“There’s a big myth that needs to be busted, is the idea that states and the federal government equally share the goal of reducing improper spending,” Chris Medrano, an analyst at the free-market health care researchgroup Paragon Health, told The Post.
He also claimed “a lot” of states use “funding gimmicks” to redirect boatloads of Medicaid money into their general funds, suggesting they may be incentivized to keep the gravy train flowing and turn a blind eye to overbilling.
Although no companies have been prosecuted for fraud related to the HHS audits at this time, the federal government has requested the return of millions of dollars in improper payments from each of the states.
More children are being diagnosed with autism in the US, largely due to increased screening, greater public awareness and a widening of the definition on what counts as autism. Key revisions in 2013 merged previously separate diagnoses into a single Autism Spectrum Disorder (ASD) umbrella.
Diagnosis rates have gone from 1 in 150 children in 2000 to 1 in 31 children in 2022, according to the CDC.
Some autism researchers, however, have criticized the supposed “epidemic” in autism by suggesting that the new broad criteria has contributed to overdiagnosis.
In 2014, new federal rules required Medicaid to cover autism care. Since then, Medicaid spending on Applied Behavior Analysis (ABA) therapy — the primary treatment protocol for children with autism — has skyrocketed 298% nationwide from seven million hours of therapy administered to 25 million a year in 2024, according to a report from healthcare analytics company Trilliant Health.
As our graph charts, In Indiana, ABA spending rose from $21 million in 2017 to $611 million in 2023 and is projected to reach $825 million by 2029.
North Carolina ABA spending grew from $122 million in 2022 to $329 million by 2024. It is projected to reach an eye-popping $639 million this year.
ABA spending in Nebraska surged from $4.6 million in 2020 to over $83 million in 2024. One provider, Above and Beyond ABA, billed for $29 million alone, according to a state report (it is not suggested they were part of the overbilling).
Colorado ABA payments were $60 million in 2019 and, and $164 million by 2023.
However, none has been more eyepopping than Minnesota which received just over $1 million in Medicaid reimbursements for autism care in 2017, but by 2024 that number had skyrocketed to $343 million, according to the Minnesota Department of Human Resources.
As part of numerous federal prosecutions centered around the Somali community in Minneapolis, in September Asha Farhan Hassan and Abdinajib Hassan Yussuf both pleaded guilty to an autism fraud scheme in Minnesota. Hassan owned Smart Therapy Center and was found to have hired unqualified staff, paid kickbacks of $300–$1,500 per month to parents to recruit children — some not diagnosed with autism — billed for services not provided or inflated hours, and submitted false documentation between 2019 and 2024, according to the Department of Justice.
With all the money sloshing around, private equity has taken note of the seemingly recession-proof profitability potential of Medicaid-funded autism centers.
In the last decade, private equity firms have acquired over 500 autism centers in the US, according to a January 2026 Brown University study.
Among them, Michigan-based Centria Healthcare LLC, a business which has distributed over half a billion in Medicaid reimbursements. It was acquired by private equity firm Thomas H. Lee Partners in 2019.
Indiana-based Hopebridge LLC, backed by PE firm Arsenal Capital Partners, has also taken in at least $140 million, according to the data.
“The increases you’re seeing in some states are astronomical,” Daniel Arnold, a health policy researcher at Brown University, told The Post.
“When private equity comes in, usually the price [of care] increases, the intensity of services increase as well. In the ABA space this would mean more hours at a higher price.”
“It’s not obvious to me that, say, 40 hours a week of ABA is better than 20. It gets to a point where you are crowding out other services kids are doing —like speech therapy, occupational therapy or play activities,” he added.
For those who are proven to have inflated bills, there are consequences.
Two executives at South Carolina Early Autism Project, Angela Breitweiser Keith and Ann Davis Eldridge, were sentenced to a year in prison in 2019 and paid $8.8 million in a settlement for using autism services to defraud Medicaid.
The Department of Justice said the execs had instructed employees to bill for time waiting in driveways and sitting in restaurants; pressured employees to submit exaggerated session timesheets; forged patient signatures and incentivized fraud by establishing high billing goals with rewards like gift cards and company-paid vacations for those who met quotas.
During last week’s State of the Union address, President Trump announced he was appointing Vice President JD Vance to lead a “war on fraud” task force.
“The gold standard solution would be to have some sort of set funding because right now Medicaid is an open-ended reimbursement,” said Medrano. “Have the state internalize the cost of Medicaid so they’re incentivized to save money.”
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