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Anyone who’s ever managed a household or run a business understands the basic discipline of budgeting: Every new expense must be weighed against the money available and the priorities that cannot be ignored. 

The average American understands how this works, instinctively. Yet many state lawmakers, elected to manage those same Americans’ tax dollars, increasingly seem to have lost sight of it.  Fraud in the provision of taxpayer-funded services, especially as it relates to Medicaid, has become a story in nearly every state, and Georgia is no exception.  

The White House Task Force to Eliminate Fraud, led by Vice President J.D. Vance, has noticed and is beginning to turn its eyes south; not to protect abstract numbers on a balance sheet, but to ensure that children with autism receive the services taxpayers fund, without those dollars being lost to waste, fraud, and abuse.  

This is bound to be a contentious issue in Georgia. One area the task force will examine –  building on the work they’ve already done in Minnesota and California— is the rapid growth in Medicaid dollars going to autism-related services, particularly Applied Behavior Analysis (ABA),  

ABA is commonly provided by clinics and in-home technicians to help children develop social, communication, and behavior skills. Critics, however, have questioned the strength of the evidence supporting some ABA services and whether higher spending can be consistently linked to measurable clinical outcomes. In Georgia, the debate over reimbursementsrates, program oversight, and potential budget cuts for these programs have already begun. 

But some experts, and indeed the White House, believe these programs are especially vulnerable to fraud and abuse. Direct payments from state Medicaid programs grew from $660 million to $2.2 billion in just four years, prompting calls for states to implement stronger accounting and reporting standards. 

The demand for these autism-related services, and the accompanying fraud, is rising alongside the reported prevalence of Autism. In Georgia,1 in 31 children are diagnosed with autism, a rate that tracks with the national number. While everyone wants to know why (Overdiagnosis? Better clinical assessments? Something else?) desperate parents are often left navigating a complex treatment system and searching urgently for effective care.  

Fraudsters can smell the desperation of families seeking care and exploit it for financial gain. As costs rise and questionable providers siphon money from the system, the children who genuinely need autism services may face longer waits, fewer options, and care that is both more expensive and less effective. 

Earlier this spring, the Wall Street Journal shed light on several cases of autism therapy, such as  a boy in Florida whose “therapy” was being pushed on a swing for $10,000 a pop. 

Supporters of stronger oversight point to a growing body of alleged fraud cases. Tom Jones, president of the American Accountability Foundation, a nonprofit government oversight and research organization, spoke on the issue in a piece in the Washington Examiner.  

“One of the biggest fraud magnets in the entire Medicaid program is Applied Behavior Analysis, better known as autism ‘therapy,’” Jones writes. “The Department of Health and Human Services Office of the Inspector General has made ABA improper payments a standing item on its work plan, and whenever the auditors pull the thread in a state, they find this program rife with fraud. Every. Single. Time.” 

Part of the problem seems to be that Medicaid ABA is typically reimbursed by the hour, creating a situation in which providers are incentivized to maximize billable time. There are reported instances in which a single company controls all aspects of the billing cycle – diagnoses, recommended therapy hours, provision of therapy, and billing Medicaid. So longer treatment means more money for this single company with very little oversight. 

The U.S. Department of Justice has already charged 15 defendants. “Jones writes that “Georgia, despite the state identifying ABA as “high-risk” for fraud, is burdened by lawmakers who “have tried to block efforts by the state’s Medicaid plan partners to hold ABA providers accountable and protect taxpayers.” 

That resistance will have to change, however, if the Fraud Task Force is serious about bringing their clean-up crew to Georgia. State lawmakers will be required to be specific about how they’re going to adjust their contracts with Medicaid partners to make sure proper oversight is implemented and tax dollars are being used responsibly. The Centers for Medicare and Medicaid Services has rolled out a new state toolkit to help state leaders protect children with autism. 

The goal is to protect the most vulnerable Georgians by shielding them from criminals who would steal their most-needed services. Anything less would be irresponsible budgeting. 

Sarah Lee is a freelance writer and policy wonk based in Washington, DC and Atlanta, Ga. with bylines at The Washington Examiner, Townhall, The Daily Caller, The Hill, and others.