Wiki ABA THERAPY BILLING

[castilloh]

ABA Therapy Billing Concerns
Hi everyone, I’m looking for some input from those working with ABA therapy billing. Has anyone run into issues with excessive billing, possible misuse, or concerns about how the guidelines are being applied? Specifically, I’m curious about:

• Use of the HO modifier
• Telehealth billing challenges for therapy sessions

Would love to hear if others are noticing similar patterns or if you’ve had to navigate problems in this area.

 

[amyjph]

https://oig.hhs.gov/reports/all/2024/indiana-made-at-least-56-million-in-improper-fee-for-service-medicaid-payments-for-applied-behavior-analysis-provided-to-children-diagnosed-with-autism/

https://oig.hhs.gov/reports-and-publications/workplan/summary/wp-summary-0000601.asp?ref=asd.media

https://www.acfe.com/acfe-insights-blog/blog-detail?s=ethics-risk-addressing-fraudulent-behavior-aba-therapy

https://www.michigan.gov/ag/news/press-releases/2024/08/08/director-of-autism-center-pleads-guilty-to-the-unauthorized-practice-of-a-health-profession

https://resources.cotiviti.com/fraud-waste-and-abuse/fwa-insights-catching-inappropriate-billing-within-asd-services

https://www.justice.gov/usao-sdin/pr/us-attorneys-office-recovers-2-million-autism-therapy-provider-alleged-false

https://www.mass.gov/news/inspector-general-estimates-masshealth-overpaid-up-to-173-million-to-service-providers-for-children-with-autism