Overview
- The HHS Office of Inspector General identified $77.8 million in improper and $207.4 million in potentially improper Medicaid payments for applied behavior analysis services in 2022–2023, totaling $285.2 million.
- Auditors said every reviewed case contained at least one improper claim, frequently linked to missing documentation and use of uncredentialed behavioral technicians.
- The report recommends periodic statewide reviews of ABA payments and recovery of improper funds from providers receiving Medicaid dollars.
- Colorado’s Medicaid spending on ABA therapy rose from $60.1 million in 2019 to $163.5 million in 2023, a surge the watchdog flagged as warranting closer scrutiny.
- The state health department disputes the audit’s calculations, has launched pre- and post-payment checks, and is contending with budget pressures that heighten concerns about service access.