The post focuses heavily on autism-related behavioral therapy, a high-revenue area where providers can bill $50–$70 per hour for up to 30 hours per week per child, resulting in annual costs of $50,000–$100,000 (or roughly $2,000 per week) per patient. Therapists often need only a high school diploma and brief training (1–2 weeks), and the programs lack copays or deductibles, making them highly attractive for fraud. Berenson questions the treatments' efficacy, citing a 2015 study noting that children are often unmotivated and disruptive during sessions, with limited evidence of long-term benefits.
Key evidence from state-level examples illustrates the scale:
Indiana: Spending on autism behavioral therapy surged from $21 million in 2017 to over $600 million in 2023—a 30-fold increase—equating to about $75,000 per child annually.
Nebraska: Spending rose from $4.6 million to $82.8 million in four years. One provider, Above and Beyond ABA, saw revenue explode 90-fold from $300,000 to $28 million.
Florida: The state spent $2.6 billion on autism therapy in the latest reported year (up from $1.5 billion two years earlier), with roughly half concentrated in Miami-Dade County (which has only 13% of the state's population). A 2024 Florida report found that of 162 site visits to providers, 117 (72%) were non-operational or fake. Despite a 2018–2022 moratorium on new providers in South Florida, fraud persisted and worsened.
Berenson highlights specific fraud schemes, including kickbacks to parents for enrolling children, fake providers, and enrollment manipulation. In Minnesota, prosecutors charged a 28-year-old migrant in a $14 million scheme from 2019–2024, involving $1,500 monthly kickbacks to families (often in tight-knit Somali communities). He extrapolates nationally: If Florida (with about 1/15th of the U.S. population) spends ~$2.5–$2.6 billion on these programs, conservative estimates suggest $25 billion+ nationwide by 2026, potentially higher in states with looser regulations.
The author attributes the explosion to policies since the Obama-era Affordable Care Act, which mandated behavioral health coverage, combined with lobbying and entrepreneurial exploitation. States struggle to detect and prosecute due to the program's massive scale, lengthy legal processes, and providers operating near legal edges. Even multimillion-dollar cases may not prioritize prosecutors, as recovery is difficult.
Berenson warns that this unchecked abuse—enabling criminals to pocket huge revenues with low risk—erodes public trust in Medicaid's $1 trillion scale (roughly $3,000 per American). He questions the wisdom of spending an average annual U.S. salary per child on potentially ineffective programs, calling for tighter rules and aggressive enforcement to curb the "unthinkable" levels of waste and fraud.
