HHS OIG Audits of the Applied Behavior Analysis Medicaid Benefit

Information to help ABA Organizations prepare for an OIG Audit

Original Air Date: November 17, 2025

Short title:  HHS OIG Audits of the ABA Medicaid Benefit

CEU offered: 1.5 BACB Ethics CEU

Webinar Duration: 90 minutes

Instructors:

  • Mariel Fernendez, MS, BCBA, LBA
  • Rebecca Thompson, PhD, BCBA-D
  • Jenna Minton, CPT, Esq
  • Julie Kornack
  • Chanti Fritzsching Waters, EdD, BCBA-D


Abstract:

This webinar will examine the recent federal oversight of Medicaid-funded applied behavior analysis (ABA) services for children with autism through audits conducted by the U.S. Department of Health & Human Services Office of Inspector General (OIG). We will first review the key findings from the OIG’s audit of Indiana’s fee-for-service Medicaid ABA program, which found at least $56 million in improper payments and identified documentation, credentialing and oversight deficiencies. We then turn to the state of Wisconsin, whose audit identified at least $18.5 million in improper payments tied to Medicaid ABA claims.

Finally, we discuss the broader implications for states as Medicaid oversight intensifies, the compliance bar rises, and risks for providers and state agencies grow. The enforcement environment signals that states and providers must review their ABA documentation, billing, provider credentialing, and pre and post-claim submission processes.

Participants will learn:

  • Key trends and common deficiencies identified by the OIG in ABA-related Medicaid claims (e.g., missing or inadequate session notes, unqualified providers, ineligible beneficiaries).
  • How the audit findings in Indiana and Wisconsin may translate into compliance expectations, provider risk, and state agency responses.
  • Strategies for providers and state Medicaid program administrators to strengthen internal controls, documentation practices, and oversight to reduce improper payment risk.
  • Emerging state-level implications and the legislative/regulatory environment that may follow in the wake of such audits.

This session is designed for ABA providers, Medicaid program integrity professionals, state agency staff, compliance officers, and reimbursement specialists seeking to understand the evolving landscape of Medicaid ABA oversight and how to position their programs for greater resilience and compliance.

Learning Objectives

  1. Attendees will explain the importance of reviewing and complying with state Medicaid policy- including ABA-specific program and general billing/operating requirements.
  2. Attendees will identify the three key areas of concern identified through already completed HHS OIG audits.
  3. Attendees will review clinical documentation requirements, in particular requirements for 97153 and 97155
  4. Attendees will explain the importance of internal program integrity processes.


Instructor(s)

Mariel Fernandez, LBA, MS, BCBA

Mariel Fernandez is the Vice President of Government Affairs at the Council of Autism Service Providers (CASP) and a Board-Certified Behavior Analyst (BCBA) licensed in Texas. She earned her master’s degree in applied behavior analysis (ABA) from Auburn University in 2004.  A passionate advocate for improved access to care, Mariel actively supports advocacy, public policy, and legislative initiatives at both the state and federal levels. Since 2008, Mariel has served TRICARE beneficiaries, navigating multiple TRICARE contract and operation manual changes. She draws on these experiences and the relationships she has built through federal advocacy to assist ABA providers in managing T-5 transition challenges across the country. Mariel serves on the Texas Department of Licensing and Regulation (TDLR) Behavior Analyst Advisory Board and is the President of the Texas Association for Behavior Analysis Public Policy Group (TxABA PPG). In these roles, she played a crucial part in the successful passage of behavior analyst licensure and the inclusion of autism services, including ABA, as part of the Texas Medicaid benefit.

Rebecca Thompson, PhD, BCBA-D

Dr. Becky Thompson is the Senior Director for Advocacy at LEARN Behavioral, where she leads efforts across 17 states to improve access to ABA services for Medicaid recipients. She is a Clinical Psychologist and Board Certified Behavior Analyst, Doctoral level (BCBA-D) who has been working with individuals on the spectrum since 2000. Dr. Thompson has experience supervising behavioral treatment programs for young children with autism, conducting and supervising diagnostic services, developing trainings for clinicians at all levels, and mentoring students seeking a Master's Degree in Behavior Analysis. Dr. Thompson serves as an appointed member of the Wisconsin Governor's Autism Council, secretary for the Wisconsin Association for Behavior Analysis (WisABA), and President of the Wisconsin Autism Providers Association (WAPA).

Esq Jenna Minton

Jenna W. Minton, Esq. is the President of Proactive Strategies (formerly Minton Healthcare Strategies). Proactive Strategies specializes in guiding clients through Medicare and Medicaid regulatory processes. Specifically, Jenna focuses on the development of CPT Codes. Jenna also assists in valuing medical services through the AMA Relative Update Committee. From 2016 through the end of March 2019, Jenna guided and contributed substantially to the efforts of the ABA coding work group, including the development of the 2019 ABA CPT code set and generation of subsequent educational materials aimed at their implementation. Jenna also serves as the Director of Operations at Residential Options, Inc. (ROI). She oversees audit, contracting, and reimbursement issues for ROI which employs almost 350 people and services around 300 clients with ASD or a developmental disabilities. Jenna is licensed to practice law in Maryland and is a member of the Maryland State Bar Association.