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2d ago

Federal Audit Finds $77.8 Million in Improper Colorado Medicaid Autism Payments, Orders $42.6 Million Refund

Auditors cite lax oversight of a fast-growing autism therapy market that relied on uncredentialed technicians.

In this photo provided by the Department of Health and Human Services Office of the Inspector General, federal agents from the HHS Office of Inspector General prepare for operations targeting individuals allegedly involved in genetic testing fraud in the Atlanta region, Friday morning, Sept. 27, 2019. Federal law enforcement officials say they’ve taken down a Medicare fraud scheme that enticed seniors to get their cheeks swabbed for unneeded DNA tests. Friday’s “Operation Double Helix” targeted telemarketing companies, doctors and labs, in a joint effort by the FBI, U.S. attorneys’ offices and the Health and Human Services inspector general. Officials say Medicare enrollees should refuse genetic tests unless ordered by their doctor. (Department of Health and Human Services Office of the Inspector General (HHS-OIG) via AP)

Overview

  • Colorado must repay $42.6 million in federal funds after OIG found widespread improper Medicaid payments for applied behavior analysis in 2022–2023.
  • In a sample of 100 beneficiaries, auditors found at least one improper claim for every person reviewed, indicating systemic billing problems.
  • The review flagged services delivered by uncredentialed behavioral technicians as a key source of noncompliance with program rules.
  • Colorado’s Medicaid spending on ABA rose to $163.5 million in 2023 from $60.1 million in 2019 as the number of providers expanded.
  • The Colorado findings contribute to HHS OIG’s broader tally of $285.2 million in improper or potentially improper ABA payments, with the state ordered to conduct periodic statewide payment reviews as it contests aspects of the repayment calculation.