ABA therapy, when delivered well, changes lives. It also represents a meaningful slice of pediatric Medicaid and commercial-insurance spend, and where there's spend, there's a small minority of providers who bend the rules. Parents, often the only consistent witness across sessions, are uniquely positioned to spot it.
01 / Why it mattersWhy this matters to parents
Three reasons:
- Your child's care. Fraudulent billing usually means the time and intensity reported don't match what your child actually received
- Your insurance. Fraud-driven recoupments can land back on the family as denied benefits or surprise bills
- The field. Every public fraud case tightens auth requirements and audit pressure on the legitimate providers your child depends on
02 / Red flagsRed flags in billing
- EOBs showing service hours that don't match what your child actually received
- Sessions billed on days the clinician didn't show up
- RBT or BCBA names on EOBs you've never met
- "Group" services billed when only your child was present
- Pressure to consent to more hours than the BCBA's clinical recommendation
- No data shared, no progress reports, no treatment-plan reviews
- Billing for telehealth sessions that were actually phone check-ins
- Vague or generic session notes that read identically across days
If you receive an EOB and don't recognize the dates, hours, or services billed, and the practice is reluctant to walk you through it, that's the flag. Ethical practices welcome the question.
03 / What good looks likeWhat good ABA billing looks like
- Treatment plans are explained clearly, with goals you understand
- You receive periodic progress reports tied to those goals
- Your clinicians are introduced by name, credential, and role
- Session notes are available on request and reflect real activity
- Caregiver training is part of the plan
- Authorization changes are explained before they happen
- Your EOBs match the schedule you observed
Parents are the highest-quality fraud-detection signal in ABA. They notice when the schedule says one thing and the EOB says another. Listen to them.
04 / QuestionsQuestions to ask your provider
- Can you walk me through last month's billing on this EOB?
- Who is the BCBA supervising my child's case, and how often do they observe sessions?
- How are direct vs. indirect hours billed for my child's case?
- What's our authorization period and current utilization?
- How do I get a copy of session notes if I want to review them?
- What's your audit history with Medicaid / our commercial payer?
05 / ReportingHow to report concerns
If you suspect billing fraud:
- Document specific dates, services, and amounts that don't match your records
- Contact your insurance company's fraud line first, they investigate and can recover funds
- For Medicaid, contact your state's Medicaid Fraud Control Unit
- The BACB also accepts ethics complaints against credentialed BCBAs
The vast majority of ABA providers are doing right by your child. The few who aren't are visible in their billing trail. Your attention to it is part of how the field stays accountable.