Have Financial Backers Damaged Autism’s Gold Standard of Treatment?

September 05, 2022

Some Claim the Pressure of Billing Hours is Degrading the Quality of ABA Services

The role of private equity companies is to invest money for wealthy individuals, university endowments, and pension funds. These firms intend to make more money for their clients through private investments than what could be made by investing in the stock market. In 2015, private investments in behavioral health totaled $120 million. According to industry analysis, five years later, that amount had grown to $1.2 billion. 

Applied Behavioral Analysis (ABA) has long been considered the gold standard for autism treatment. The therapy is considered such a staple that every state mandates its coverage. In the past decade, there has been a rapid increase in private equity firms investing in ABA providers. With 1 in 44 children on the spectrum and the promise of state-mandated insurance reimbursement, ABA therapy has become a lucrative market for these investors.   

However, many question whether this infusion of private equity funds is good for ABA. Since big business has become involved with ABA, families and clinicians are starting to be disillusioned with the therapy and the industry supporting it. Both parties point to financial investors’ fixation on profit and say it has degraded the quality of services that many children receive. Parents complain that ABA, which should be tailored to each child, has become “cookie cutter.” This one-size-fits-all approach allows bigger providers to save money on time-intensive assessments by using treatment plans that were simply copied from other clients. But that reuse goes against the highly individualized treatment plans that ABA is supposed to deliver. One clinician said that time-saving practices made her feel like a “billing machine, trying to make as much money for private equity as possible.” A former ABA provider employee shed more light on this practice and said that private-equity-owned companies would set billing quotas, reward top billers with bonuses, and question any holes in their schedules. 

Allegations of overbilling for ABA by these companies are now surfacing across the country. These claims involve both providers with private equity backing and those without. For instance, in Nevada, 1000 individual clinicians sent bills to the Medicaid program suggesting they delivered 24 hours of therapy in a single day. In one outrageous case, one clinician billed 65 hours in just one day. Florida ABA providers have also been singled out for billing Medicaid for more than 40 hours of therapy in a week. The situation has gotten so out of hand that the federal government is stepping in. The Health and Human Services Department’s Office of Inspector General is working on a sweeping audit of Medicaid claims for ABA. The report should be released later this year. 

In the meantime, ABA providers are also unhappy. They complain of staff shortages, employee turnover, high inflation, and receiving reimbursement payments from health insurers. 

Subsequently, parents who are trying to juggle physical therapy, occupational therapy, speech therapy, and special education day classes are now questioning if ABA is worth their child’s time. Many decide it is not. Some parents are viewing ABA as useless and even harmful. They see it as a practice that masks the traits that make their child unique and view ABA as an attempt to force their child into having behaviors that fit neurotypical norms. 

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