State investigation finds Medicaid fraud among autism treatment providers

Agency imposes moratorium on new providers in Broward, Miami-Dade

By Tim Swift - Digital Editor
Associated Press

TALLAHASSEE, Fla. - Florida officials will stop accepting new behavioral analysis providers in Miami-Dade and Broward counties after an investigation found Medicaid fraud, including cases of massive overbilling.

Applied behavior analysis therapy is used to treat children with autism. The therapy can also be used treat a wide range of problems in children including substance abuse and other behavioral problems, but it's most commonly associated with autism treatment.

The investigation found that providers had billed Medicaid for more than 24 hours in a single day or more than 40 hours in a single week. Officials said some of providers may have falsified their qualifications.

More than a dozen large providers could face criminal charges, officials said.

The Agency for Health Care Administration (AHCA) said the six-month moratorium would begin this week, but existing providers would continue to be reimbursed for "legitimate services."

"Our No. 1 priority remains the children who rely on this service and making sure that they have access to high quality providers," said Justin Senior, secretary of the AHCA.  "We need anyone who knows of a child who is not receiving necessary services to contact our agency so that we can connect them with an honest and qualified provide."

The agency said the moratorium would allow officials to evaluate the existing providers and remove ones believed to have committed fraud from the Medicaid system.

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