Florida Flags Autism Therapy Providers Who Billed Medicaid for More Than 24 Hours of Care in One Day

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The finding came from expanded claims monitoring under the state’s Medicaid Integrity Initiative, according to an Oct. 6 announcement from Gov. Ron DeSantis’s office.

The state also found providers billing for consecutive days, including weekends and holidays. Officials now project Florida’s Medicaid spending on the therapy, known as ABA, will be about $2.88 billion in fiscal year 2026-27. That is nearly $1 billion below an earlier projection of $3.86 billion.

These are state findings, not court rulings. The state did not say how many providers billed impossible hours, and most ABA providers have not been accused of wrongdoing. For families, the concern runs both ways. Fraud drains money meant for children’s care, but enforcement can also disrupt therapy for children whose providers are cut off.

ABA was one of three areas the state singled out in its site visits, along with durable medical equipment and adult day care. The Agency for Health Care Administration, which runs Florida Medicaid, has made more than 400 provider site visits since January, the governor’s office said.

Across all of Medicaid, not ABA alone, the state reported terminating more than 220 providers for fraud, waste or abuse. Those terminated providers billed more than $230 million in 2025. More than 260 providers were placed on payment restrictions or suspensions, and more than 150 cases were referred to the attorney general’s office over the past year.

“Protecting Medicaid means protecting the people it was created to serve,” said AHCA Secretary Shevaun Harris.

The scale of spending helps explain the scrutiny. Florida Medicaid spent about $6.57 billion on ABA from 2023 to 2025, nearly four times more than any other state’s Medicaid program, Harris said, according to WPTV’s report on the announcement. At one point, WPTV reported, spending was projected to grow 30% a year.

ABA is an intensive therapy that teaches communication, daily living, and behavior skills. Children may receive many hours a week, often in sessions led by trained technicians and overseen by board-certified analysts. Because providers bill by the hour, the total number of hours claimed is a key way regulators spot problems.

Medicaid covers this kind of care largely because of federal rules for children. Under Medicaid’s child health benefit, states must cover medically necessary services that correct or improve a child’s physical or behavioral condition, including for children with autism, according to a 2014 federal Medicaid guidance bulletin on autism services. That benefit applies to children and young adults under 21.

Florida has changed how it pays for ABA. The state moved the therapy into Medicaid managed care in 2025 and added utilization management, which reviews whether services are needed before they are paid. Officials say that slowed annual growth to under 10%. The governor’s office credits fraud enforcement, managed care and utilization management together for the lower spending forecast, without separating how much each one saved.

The state is also screening providers more closely. It launched an identity-verification pilot with SentiLink to catch stolen or fake identities and hidden ownership. It also imposed enrollment moratoriums on some high-risk provider types and required all active Medicaid providers to revalidate their credentials.

Parents have felt the effects. Families in Palm Beach County told WPTV in July that their children’s ABA access was abruptly cut off. They described therapy that helped their children communicate, learn in school, use the bathroom and manage tantrums.

DeSantis said that when a provider offers some legitimate services but bills much of its work fraudulently, “that’s that provider’s fault.” Harris said managed care plans are helping affected families find new providers and that parents having trouble can contact AHCA.

Switching providers can mean a new assessment and a gap in care. The state’s announcement did not include data on how many children lost services or how long it took them to resume.

There are other limits to what the state has disclosed. The announcement did not say how many ABA providers were terminated, how many billed more than 24 hours a day, or how many of the 150-plus referrals involved ABA. It did not describe how the state separated fraud from billing errors, and independent audits have not been released.

Parents whose child receives ABA through Medicaid can check the explanation of benefits or service records their managed care plan provides. Compare the hours billed with the hours your child actually received. A claim for sessions on a holiday when your family was away, or for more hours than your child attended, is worth reporting.

If your child’s provider is suspended or terminated, contact your Medicaid managed care plan right away and ask for help finding a new in-network provider. Ask whether your child’s existing treatment plan and authorization can transfer, so therapy does not restart from scratch. Keep copies of assessments, treatment plans, and progress notes.

Suspected billing fraud can be reported to AHCA’s Office of Medicaid Program Integrity at 1-888-419-3456 or through its online fraud complaint form. Reports can be made anonymously. Suspected fraud by health care providers can also be reported to the Florida Attorney General’s Office at 1-866-966-7226.

Families with legitimate providers have no reason to stop therapy, because the state’s findings target specific billing patterns, not ABA itself. The attorney general’s office will decide which referrals lead to charges, and the state’s spending forecast will be tested against actual 2026-27 claims. MedicalDaily will report on any criminal cases and on data about children’s access to care.

What did Florida find about autism therapy billing? State regulators found some ABA providers billed Medicaid for more than 24 hours of services in one day and billed for consecutive days through weekends and holidays. The state did not say how many providers did this.

How much has ABA spending changed? Florida now projects about $2.88 billion in ABA spending for fiscal year 2026-27, down from an earlier projection of $3.86 billion. The state credits fraud enforcement, managed care, and utilization management together.

Are all ABA providers suspected of fraud? No. The state says its efforts target specific bad actors. Most providers have not been accused of wrongdoing.

What should parents do if their child’s provider is cut off? Contact your Medicaid managed care plan for help finding a new provider, and ask whether your child’s treatment plan and authorization can transfer.

How can I report suspected Medicaid fraud in Florida? Call AHCA’s Office of Medicaid Program Integrity at 1-888-419-3456 or use its online complaint form. Reports can be anonymous.

Why does Medicaid cover ABA therapy? Federal rules require state Medicaid programs to cover medically necessary services for children under 21, including care for children with autism.