State auditor finds issues in top ABA service providers

The state auditor’s office found several issues with autism service providers that were receiving the most Medicaid money, including duplicate invoices, lack of documentation and employees not having proper credentials, according to a report released Tuesday.

The audit report comes at a time when the Nebraska Department of Health and Human Services recently reduced Medicaid rates for applied behavior analysis therapy, which helps kids with autism.

Under Medicaid, the state paid about $85 million for ABA services to more than 1,500 families in 2024. That was a nearly 1,800% increase in funds since 2020, when the state paid about $4.6 million for 169 families.

State Auditor Mike Foley said DHHS officials had reached out to his office requesting the audit.

“HHS was concerned about the cost and how we can serve all these kids,” Foley said. “We looked at all that, and we found some deficiencies, and just kind of gave them a little bit of a road map on things that they should be looking at to better control their costs.”

In the auditor’s report, DHHS responded to the findings, saying the “collaborative effort provides the department with an objective review of the ABA program, which will be used to make program improvements.”

The department further said it would take actions on:

• Clarifying what information needs to be included in claims
• Preventing duplicate claims
• Keeping reasonable rates.
• Ensuring qualified providers are supplying services
• Improving documentation and oversight for supervision requirements for providers
• Upgrading definitions to create clear documentation requirements for ABA services.

Foley said his office was not part of DHHS’s decision to decrease Medicaid rates. He added that he believes the rates were a big reason behind why ABA costs were so high in Nebraska.

The state auditor’s office only looked at a couple of the providers receiving the most money, Foley said.

“If you expanded that and looked at all the providers, undoubtedly you would find many, many more instances of duplicate invoices and other incorrect invoices,” Foley said. “We didn't want to prove that we could ding every single provider, just point out, ‘Hey, if you look at the two big ones, you've already got problems.’”

Foley said he thinks DHHS should make firm guidelines and regulations for ABA providers to follow, especially with credentialing for board certified behavior analysts and registered behavior technicians.

“It's a great hardship for these families to have children with autism, and there's just so many, many more families that are facing this challenge,” Foley said. “Then to have the child sent off for services and the person providing services isn't even credentialed to do it, that's just a double burden on the family. That's not fair.”