Indiana has barred a major autism therapy provider from billing its Medicaid program following the revelation that the company received some of the highest per-patient payments in the nation, marking an aggressive state action amid a broader federal crackdown on Medicaid fraud and waste.
The Indiana Family and Social Services Administration this week moved to terminate agreements with Piece by Piece Autism Centers, which will be prohibited from seeking reimbursement through Medicaid, according to state officials.
The decision follows a Wall Street Journal investigation that found the company averaged roughly $340,000 per Medicaid patient in 2023, in part by charging up to $640 per hour for services often delivered by lower-paid staff. Piece by Piece was paid $58 million by the state for autism therapy services from 2019 to 2023.
State officials said the move was necessary to protect taxpayer funds, even though audits had not concluded the company committed fraud. The provider has previously denied wrongdoing and blamed the situation on Indiana’s lack of “any oversight.”
Piece by Piece founder Meghann Mitchell reportedly purchased a $2.5 million home on Florida’s Sanibel Island and a $600,000 waterfront house on Indiana’s Tippecanoe River during the time in which the center’s Medicaid billing increased.
The immediate impact for patients remains unclear. Piece by Piece serves dozens of children, many of whom rely on Medicaid for applied behavior analysis, a widely used treatment that helps children with autism develop communication skills.
Families may now need to find new providers, raising concerns about disruptions in care in a system already facing shortages.
The circumstances with Piece by Piece highlight recent criticism of Medicaid billing for autism therapy services.
A recent investigation by the Department of Health and Human Services found that Indiana made $56 million in improper Medicaid payments. The HHS audit found issues in several other states as well, specifically related to autism therapy, with a total of $600 million in improper or possibly improper payments for autism services.
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Indiana has already begun tightening its system, replacing its previous reimbursement model, which allowed providers to effectively set their own rates, with lower standardized payments and possible caps on services.
Additionally, the state’s FSSA gave autism providers until April 3 to self-report any past Medicaid abuses or fraud. The agency said those who fail to report fraud risk federal investigation. It added that HHS and the Centers for Medicare & Medicaid Services would take over the investigations into autism therapy fraud.
