Indiana Family and Social Services Administration chief Mitch Roob put autism therapy providers on notice in a tense meeting with key stakeholders last week — requiring self-reporting of “abusive” billing practices used before a recent revamp of the program.
Providers must “self-report” to the state any practices that could constitute fraud, waste or abuse by April 3, according to multiple people familiar with the meeting.
The urgency follows a March 10 Wall Street Journal article that highlighted an Indiana provider as an example of out-of-control costs billed to the Medicaid program for applied behavior analysis therapy.
In 2023, Indiana paid Piece by Piece Autism Centers $29 million to provide ABA therapy to just 84 patients — about $340,000 a child — according to the Wall Street Journal analysis. Some providers were charging $600 per hour.
Since then, a working group has recommended dozens of changes to Indiana’s program.
“We take fraud and abuse very seriously, and there’s no doubt that abuse happened,” FSSA spokesman Marcus Barlow said.
Barlow also said changes that were already in the works, including a moratorium on new providers and new required accreditation, will be accelerated — though a specific timeline hasn’t yet been set.
It is unclear whether federal agencies have opened a formal probe into Indiana’s ABA program and spending. The Centers for Medicare and Medicaid Services did not provide responses to the Capital Chronicle’s questions before publication.
How we got here
ABA therapy is often used to improve the communication and learning skills of children and young adults with autism or other developmental disorders.
Its popularity has surged in recent years. More than 8,000 Hoosiers rely on Medicaid to pay for ABA therapy, with most of them between three and eight years of age.
Indiana’s Medicaid program began covering ABA services in 2016, spending about $21 million over the following year.
Expenditures peaked at $611 million in 2023, and dropped to $445 million in 2024, after former Gov. Eric Holcomb’s administration set lower reimbursement rates. Before that, providers were allowed reimbursement up to 40% of whatever they billed.
Medicaid, which provides health insurance to low-income people, is paid jointly by the state and federal government.
When Gov. Mike Braun took office in January 2025, he appointed a working group to review the ABA program. That group in November forwarded a slate of major changes. That includes a “lifetime” allocation of 4,000 hours of service for a child and cuts to reimbursement rates.
Kim Dodson, CEO of the Arc of Indiana, called the tone of last week’s meeting with Roob serious.
“He was very disappointed in ABA providers because of that Wall Street Journal article,” she told the Indiana Capital Chronicle.
Dodson, whose organization advocates for people with intellectual and developmental disabilities, applauded the administration’s work to rein in the prior practices.
“In Indiana and across the country, certain bad actors have taken advantage of weak oversight and flawed reimbursement structures to generate extraordinary payments through excessive or inappropriate billing practices,” she said in a March 12 statement. “This type of conduct is completely unacceptable and contributes directly to the fiscal strain now facing Medicaid programs.”
Dodson is concerned that the crackdown on ABA and attendant care for medically frail children could hurt services for those who really need it.
“Unfortunately, the consequences of abuse within the Medicaid system are being felt by families and people with disabilities. Indiana now has a waiting list of nearly 20,000 people for home and community-based services, while policymakers are trying to address unsustainable growth in some program costs,” she said. “The vast majority of providers serve people with disabilities with dedication and integrity. Efforts to address Medicaid spending must focus on stopping fraud and abuse, not creating unintended harm for individuals, families, and responsible providers.”
National spotlight on Indiana
The Wall Street Journal article, published earlier this month, examined explosive growth in Medicaid spending on ABA therapy and identified Indiana as “the nation’s hotbed of the booming autism therapy industry.”
Many of the billing practices were allowed under Indiana’s reimbursement structure in the early 2020s, and the Wall Street Journal’s reporting raised questions about whether the state’s system lacked sufficient guardrails.
Nationwide, reporting showed Indiana was home to nine of the top 10 providers by per-patient spending in 2023.
The report found that some providers dramatically increased the rates they billed to Medicaid after Indiana shifted away from a fixed fee schedule to the 40% reimbursement system.
That structure, the Wall Street Journal reported, created an incentive for companies to raise prices — in some cases to extraordinarily high levels — because higher charges translated into higher reimbursements.
The investigation also described how the model made the state an attractive market for out-of-state providers.
Rep. Victoria Garcia Wilburn, D-Fishers, said it was a failure by Republicans to properly oversee and regulate Indiana’s Medicaid program and providers in recent years.
“For nearly two decades the office has underfunded and mismanaged Medicaid. By failing to properly audit and provide oversight for our autism care programs, leadership has allowed bad actors to take advantage of programs that are sorely needed by many Hoosier children,” she said in a statement.
“To be explicit, these instances of fraud have not come from program enrollees, but instead from rogue providers who clearly do not care about the people they purport to serve. It is critically important that any investigation does not result in a gap in services for the families who rely on them.”
Policy changes on the way
FSSA is implementing recommendations from an ABA working group Braun created by executive order in 2025 to address rapidly rising Medicaid costs while maintaining access to care.
That group recommended a range of reforms, including tighter utilization controls, clearer standards for medical necessity and stronger provider oversight in November.
In its report, the working group pointed to “unsustainable” growth in ABA spending and warned that gaps in oversight and inconsistencies in billing practices were contributing to rising costs.
A Feb. 26 bulletin on ABA changes indicated a phasedown of reimbursement rates and a new lifetime usage cap of 4,000 hours, beginning April 1. Those who exhaust the hours could access an additional 15 hours of therapy weekly if medically necessary.
Longtime advocates maintain that concerns over ABA spending and oversight have been building for years, however.
Susan Crowell, founder and executive director of My Autism Ally — a northern Indiana nonprofit that supports individuals with autism and their families — said Indiana’s previous reimbursement structure allowed some providers to legally bill at unusually high rates.
“There was a loophole that Indiana Medicaid created when they removed the standardized rates and decided that they would pay 40% of the bill ABA Therapy providers submitted,” Crowell wrote.
She argued in a recent blog post that the issue was not just provider behavior but also a lack of state oversight.
“Indiana Medicaid knows who billed in excess. They paid them. It was legal,” she wrote, adding that existing auditing and billing rules were not enforced.
“They had rules already in place regarding auditing and billing, yet they ignored them and made the decision to pay these excessive claims,” Crowell continued. “This isn’t news to anyone who is more deeply involved and understands billing practices in the ABA therapy community.”
She emphasized that the fallout has already prompted services to be cut for children and families, in addition to rate reductions for providers.
“As much as I’d like to see accountability for those who abused the system, I doubt that it can happen. I’m sure we’ll hear plenty from legislators and administration officials in the coming weeks that say otherwise. But ask yourself this. If the Wall Street Journal hadn’t published this article, would we even be talking about this? Personally, I think we wouldn’t,” Crowell wrote. “We’re only hearing from (Indiana officials) now because this article has caused our elected officials’ national embarrassment, as it should.”
Indiana Capital Chronicle is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Indiana Capital Chronicle maintains editorial independence. Contact Editor Niki Kelly for questions: info@indianacapitalchronicle.com.
