For months now, loads of attention has been concentrated on the problem of "autism fraud" in Tim Walz's Minnesota.
But a new report makes clear that this problem is not just rearing its ugly head in liberal enclaves up North. Nope: Along with summer's heat and humidity, autism fraud has now come to America's South.
Medicaid spent more than $5.15 billion on Applied Behavior Analysis therapy between 2018 and 2024, and three providers alone collected roughly $685 million of it, according to HHS data reported by Fox News.
A ton of that has occurred in the South. Gov. Ron DeSantis announced a statewide Medicaid Integrity Initiative last month after the state recovered more than $72 million in improper Medicaid payments and barred hundreds of behavior analysts from the program over documented fraud. DeSantis has, of course, taken a pounding over this. But the numbers are staggering and demonstrate just how fiscally untenable dishing out these funds without rigorous oversight is.
And in North Carolina, a crackdown is also playing out. The Tar Heel state's auditor clocked a 47,000% increase in autism therapy billings in the state over five years, from $1.4 million to more than $660 million annually. Even the state's Democratic attorney general, Jeff Jackson, told lawmakers this year that the growth in ABA billing "deserves to be flagged as a potential source of fraud," and confirmed his office has open investigations into phantom billing schemes.
Where are the fraudsters perpetrating all this in Florida and North Carolina coming from? Unfortunately, the answer also appears to be... the South.
A state-by-state breakdown of North Carolina's biggest ABA billers shows how fast newcomers to the field have grown. One of them, Autism Behavioral Institute, based in Savannah, Georgia, only had its National Provider Identifier assigned in 2019, yet billed North Carolina's Medicaid program more than $10.8 million for ABA therapy in 2025 alone. That is a seven-year-old company pulling eight figures a year from a single neighboring state's Medicaid program. Nobody serious disputes that autism diagnoses have risen. Nobody serious believes diagnoses rose 47,000%.
Also in Georgia, concern has exploded from insurers paying claims that professionals lacking full psychiatric qualifications have been billing payers as if they were credentialed to the hilt, raising costs sharply. Records obtained by State Affairs show that CareSource reclassified licensed psychologists as "mid-level and/or non-physician providers" in October 2025, cutting their reimbursement rate from 100% down to 85%. Psychologists are less qualified than psychiatrists and arguably do not meet Georgia state law requirements for some autism-related work. Georgia requires a doctoral degree and a license to conduct the psychological testing used to diagnose autism and other conditions in children.
A "mid-level provider" is, by definition, someone with only a master's degree who is not authorized to perform that testing at all. If CareSource's classification is accurate, psychologists billing at the physician rate were never entitled to it in the first place, since a real academic and licensing gap separates a doctorate-holding psychologist from a master's-level provider. Nonetheless, a bevy of psychologists– not just psychiatrists– had been billing the full rate. Clinics are now pushing back hard on CareSource's efforts to recoup the money.
Despite all this, Georgia's state government response has not followed the example of either Florida or North Carolina, leaving insurers to battle over exploding costs and risk being tagged for "denying care to autistic kids."
But the reality is that autism fraud is emerging as a huge issue, and a buster of state and private employer benefits and budgets. Florida and North Carolina are leading the charge on fixing the problem, leaving Georgia looking behind the curve.
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