Industry Social Media and Updates

Medicaid Loopholes Fuel ABA Therapy Exploitation Crisis

Outstanding WSJ story on the explosion of ABA/autism therapy -fueled by lax Medicaid payment and often non-existent compliance policies, $20/hr RBTs credentialed after a 40-hour online course, and annual staff churn of 50–100%. Our “pay and chase” reimbursement system assumes everyone is acting in good faith, all the time. Most are. Some decidedly are not. That compact is broken. Some providers find a way to bill to the max allowable on every single case, assuming a “max” even exists across thousands of payor types and plan designs. Often it doesn’t. The whole framework needs to be rethought. It’s just a game of whack-a-mole now and the next one will pop up. In the last decade I remember: varicose vein clinics, pediatric Medicaid dental mills in poor communities, etc etc. all fueled by the same dynamic. Related: one of the great quotes about our healthcare system, from a legend I think about often and wish was alive today: “Every dollar of health spending is someone else’s income, including fraud, waste and abuse.” — Uwe Reinhardt