Autistic children caught up in Medicaid fraud investigation

Probe has made obtaining services more difficult, advocates say

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POMPANO BEACH, Fla. – A state crackdown on Medicaid fraud could also mean kids with autism and other developmental disabilities are missing out on much-needed therapies.

Parent Carisma Jones' two boys are both on the autism spectrum. She says for her sons, 8-year-old Croix and 7-year-old Kruxe, therapy known as Applied Behavior Analysis or ABA has been a huge help socially and in school. But the boys have been going without those therapies since March when the business providing it suddenly shut down over a fraud investigation.

"We had no forewarning that this was happening," Jones told Local 10 investigative reporter Amy Viteri. "So it really just took our family by surprise."

In May, Florida's Agency for Health Care Administration, or AHCA, which manages Medicaid, put a six-month moratorium on approving new Medicaid-funded therapists in South Florida. The agency cited widespread fraud and abuse, such as overbilling for services. The state's investigation has led to several providers being suspended and others terminated. Meanwhile, many more are unable to work as the investigation is pending.

"I have probably 10 to 12 families, and some families have more than one child that is in need of services," said Lori Sugar, a certified behavioral analyst with Broward Children's Center, a nonprofit in Pompano Beach. She said the crackdown on therapists left many families scrambling to find new services. But the freeze on approving new therapists has meant turning families away and a long waitlist.

"We are ready to hire new people, we just can't get them Medicaid provider ID numbers so that their services are billable," Sugar explained. 

Jones' children go to summer camp at Broward Children's Center but do not get ABA therapy because of the lack of staffing to provide it. Their old therapist, like many others, is unable to work in the field due to the investigation into his old employer. 

"Going into five months, and we still have had no progress," Jones said, "Medicaid has said nothing about it to the parents, so we are completely in the dark."

She said it has been hard seeing both her boys take a big step backward. Grades plummeted at the end of the school year and both have struggled in social situations. 

"It's punishing the kids, the parents, the teachers, all of us. We have all received that impact from not getting the therapy anymore," she said. 

Carisma Jones says her boys have been without autism therapy since March.

According to a statement issued by AHCA: 

"There is absolutely zero loss of services for children that need BA therapy. Saying otherwise is untrue and misleading. To crack down on widespread fraud and abuse and to protect taxpayers, AHCA recently put a moratorium on new providers in Miami- Dade and Broward counties. Those seeking BA therapy, including those in Miami, still have access to services. In fact, between March 26, 2018 and June 23, 2018 more than 7,500 recipients were authorized to receive services in Florida," said Mallory McManus, communications director.

Parents and therapy providers insist there are many children currently going without services, including Jones' boys. 

"I think a lot of parents feel alone, like we're fighting this battle on our own. And we have no help," she said. 

Nikki Dickens is president of Florida's Association for Behavior Analysis, which represents providers across the state. Dickens issued a statement that read in part: 

"Our state government simply cannot sit back while these vulnerable children suffer as a result of an ineffective and inefficient bureaucratic system." 

Providers say the problem got worse when AHCA hired a new contractor to authorize Medicaid services and terminated all prior approvals, making providers reapply for authorizations for plans to treat children. A letter from AHCA to the previous contractor Beacon Health, blamed the switch in part on costs, writing: "(Beacon) has not denied or reduced a single claim since last May, and the state's expenditures for this service have subsequently exploded."

The new process, providers said, has led to long delays resulting in children having to wait weeks without services unless providers can cover the cost out of pocket.

"Right now we are providing services to seven clients that still have not been approved for services," Sugar said. 

For Jones and her family, the search for therapy has been a source of concern.

"It worries me, you know that this is the difference between whether or not they will be able to succeed in life," Jones said.

AHCA officials said they have asked agencies to put them in touch with families seeking services but many businesses have been reluctant or unwilling to hand over client information. They urge anyone looking for a therapist to contact them directly at 1-877-254-1055.

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