A new federal audit has identified significant improper payments within Colorado’s Medicaid-funded autism therapy system, adding to a growing pattern of oversight failures in public healthcare spending.
The findings, released by the Office of Inspector General, focus on Applied Behavior Analysis (ABA), one of the most widely used therapies for individuals diagnosed with autism spectrum disorder.
ABA therapy is designed to improve communication, social interaction, and behavioral functioning, and it has become a central component of autism treatment nationwide.
As demand has increased, so has government spending. In Colorado, fee-for-service Medicaid payments for ABA rose sharply from $60.1 million in 2019 to $163.5 million in 2023. That rapid expansion, however, has not been matched by adequate oversight.
The audit examined Medicaid payments made in 2022 and 2023 and found systemic noncompliance with federal and state requirements.
Every single one of the 100 sampled enrollee-months reviewed included at least one claim that was either improper or likely improper. That finding alone signals a structural issue rather than isolated billing errors.
Improper payments in this context do not necessarily mean intentional fraud in every instance, but they do indicate that providers billed for services that were not properly documented, not eligible under program rules, or not supported by sufficient clinical justification.
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