$436 a minute: what the autism therapy billing cases allege, and who is paying now

A mother in New Jersey opened a bill for her autistic son's therapy. On one day alone, a single 70-minute session was billed at $30,500. That is about $436 a minute, for a therapy that, billed in network, costs closer to $1.50 a minute. Over nine months of care, the total bill came to $911,400, later revised up to around $916,000.

She is not a one-off. Right now, one of the largest autism therapy companies in the country is under federal criminal investigation, another is being sued by a grocery chain under the federal law usually used against organized crime, and a third had the U.S. House of Representatives open a probe into its billing this past July. In this post I walk through what each company is accused of, what is documented fact, why the business model made it easy, and who is paying for it right now.

Please read this first: Everything described here as alleged is an allegation. As of publication, no criminal charges have been confirmed as filed against ABA Centers of America or its founder, and the company denies wrongdoing. An investigation, a lawsuit, or a congressional letter is not a finding of guilt or liability.

If a provider's bill or explanation of benefits does not make sense to you, you are allowed to ask questions. A 45-minute family care mapping call is a calm place to lay out what your child is getting and what you are being charged for. Book a 45-minute family care mapping call

I am a BCBA, but I am not your BCBA. This is general education, not treatment, and not a treatment recommendation for your child or your state. Build the real plan with the people who actually treat your child.

Why parents said yes

Before I name a single company, I want to be very clear: these parents did not do anything wrong. If you have been on a real waitlist, the kind where you call every provider within 50 miles and hear "we're not accepting new clients," then you know what it feels like when a company calls you back the same day and says no waitlist, we'll handle it with your insurance. That is not a red flag to an exhausted parent. That is the first good news in months.

The soil: private equity in autism services

From 2017 to 2022, private equity firms made about 85% of all mergers and acquisitions in autism services. The standard playbook: buy a company that was running fine, often debt free and built by a clinician who cared about the work; load it with debt to finance the purchase; hold it about four years; then sell it, often to another private equity firm.

Clinical guidance puts the ratio of behavior analysts to clients at roughly 1 to 10, maybe 1 to 15. Under this ownership model, some companies reportedly stretched it to 1 to 40. There is no version of one supervisor for 40 children where every child gets individualized, well-supervised care.

One real example: the Center for Autism and Related Disorders (CARD) was bought by Blackstone in 2018 for a reported $600 to $700 million. Supervision ratios reportedly dropped. In June 2023 it filed for bankruptcy, and its founder bought back what was left for about $25 million. To be clear: private equity ownership is not a crime. It is the soil. Two specific companies grew out of that soil into something federal investigators, an insurer, a grocery chain, and Congress are now all looking at.

ABA Centers of America: the origin story

Christopher Barnett founded ABA Centers of America in 2020 in Fort Lauderdale, Florida, after searching for autism care for his own daughter and running into long waits. That is the reported origin, and it is the kind of story that is supposed to make you trust a founder. The company grew fast: it topped the Financial Times list of the Americas' fastest-growing companies in 2025, ranked high on the Inc. 5000, and in 2022 Barnett gave $1 million to Temple University, his alma mater, for an autism research and diagnostic hub.

From early on, the company operated almost entirely out of network, meaning it set its own prices instead of accepting an insurer's negotiated rate. On its own, that is not a red flag. Plenty of honest providers operate out of network for legitimate reasons. What matters is what got built on top of that choice.

The census tracker (alleged)

Everything in this section comes from one document: an affidavit connected to an ongoing federal criminal investigation, unsealed in July 2026. According to the affidavit, the company allegedly ran an internal "census tracker." In a clinic, a census usually tracks how many children you serve and how they are progressing. This one allegedly sorted patients by how well their insurance reimbursed, with a target that 40% of patients be what was internally labeled "super payers."

The affidavit also alleges that when a clinician recommended against taking on a particular case, Barnett's written response, once he learned the family had full coverage, was "get this client please." Allegation is not conviction. But an allegation this specific, with a named system, a named threshold, and a direct written quote, is not a vague rumor either. Both of those things are true at once.

The insurer counterclaim (alleged)

On a separate civil track, in November 2025 the insurer Point32Health (Harvard Pilgrim) filed a $19 million counterclaim against ABA Centers of America. This came after ABA Centers sued the same insurer for $80 million over claims it says were wrongfully delayed, so this is not a one-directional story.

The counterclaim alleges movie screenings, including A Bug's Life and Super Mario Bros., and trampoline park visits billed as therapy. It alleges a single billing code worth $1.9 million was used without the required on-site physician or documentation, an error the company allegedly acknowledged in July 2024 without repaying. It alleges a "diagnostic technician" title that is not a recognized credential, psychologists signing off on up to 80 assessments a week without meeting the children, charges far above standard in-network fees, and a $1 a month payment plan that functionally waived families' cost share while the insurer was allegedly told it had been collected. It also alleges that families were sorted into three tiers, "super payer," "mid-range payer," and "scholarship payer," and that the lowest tier was discharged once it stopped being profitable.

As someone who has built clinical triage systems, I can tell you that last allegation does not describe triage. It describes a spreadsheet that sorts children by what they are worth. And to be fair, the company's own $80 million claim against the same insurer is still part of the same lawsuit. Neither cancels out the other.

The Publix RICO suit (alleged)

Publix, the grocery chain, sued ABA Centers of America in August 2025 in the Southern District of Florida (case 0:25-cv-62146) under RICO, the federal racketeering law. The complaint alleges billing for services never provided or not covered, duplicate billing, and failing to collect the required 40% patient cost share while telling Publix's health plan that deductibles and out-of-pocket maximums had been met. It alleges a rate of $990 per 15 minutes, roughly $4,000 an hour, against a network average of about $21.90 for the same 15 minutes, about 180 times the going rate. Publix says it paid about $5.8 million over roughly two years ending in October 2024.

In September 2026, a federal judge denied ABA Centers' motion to dismiss the case. That does not mean fraud has been proven or anyone has been found liable. It means the case gets to keep going.

Not sure whether your child's provider is in network, or what you might owe? We can sort it out together. Book a 45-minute call

The federal criminal investigation

The timeline: the investigation opened in February 2025, search warrants were executed in December 2025, and supporting court filings were unsealed in July 2026. According to the unsealed affidavit, six federal offenses are being investigated, including health care fraud, wire fraud, conspiracy to commit health care fraud, and money laundering related offenses. The affidavit cites about $2.4 billion in total billing across the founder's ABA entities, with reimbursements above $480 million. It also alleges care delivered in Massachusetts was billed as if delivered in New Hampshire to get a higher rate.

Two things here are documented facts, not allegations. Barnett bought a private jet for $9.95 million in November 2024. And in September 2026, Temple University terminated his $55 million gift, the largest in the school's history, and removed his recognition. As of publication, no criminal charges have been confirmed as filed against him.

The Perfect Child

A different city, a different founder, the same shape. The Perfect Child LLC is based in Brooklyn and reportedly operates across 30 states through more than 100 separate LLCs. I do not have a confirmed answer for why one therapy company needs 100 legal entities, and I am not going to guess. What it does, functionally, is make the company harder to see all at once.

Since late 2024, the company has sued at least 19 families and employers over unpaid bills, at rates reported as high as $13,000 an hour against an average in-network rate of about $89. That includes the New Jersey mother from the top of this post. She says she was never properly told the provider was out of network, and when her insurer denied the claims, the company came after her directly. She has spoken to national reporters on the record because she wants other parents to see this coming.

In July 2026, the House Committee on Education and the Workforce opened a probe and requested six years of records: revenue from every employer-sponsored plan, the 25 highest-reimbursed claims, records for every patient billed for 20 or more hours a week, internal pricing documents, compliance audits, and any claims the company itself had flagged for possible fraud. The trigger was a Wall Street Journal investigation into billing abuse nationwide.

Not just two companies

Aetna reported a 300% increase in internal fraud investigations tied to autism therapy billing between 2024 and 2025. Across 40 large employers, annual autism therapy spending roughly doubled to $108 million between 2021 and 2025. Aetna, Highmark, UnitedHealth Group, and Blue Cross Blue Shield of Arizona are all reported to be investigating.

Fraud does get caught and resolved. Settlements in Indiana, South Carolina, California, and Massachusetts show what accountability looks like when it finishes. Neither of the two big cases in this post is anywhere close to that yet.

Physical harm

Fraud is a paperwork harm. This next part is not. In August 2024, the parents of a seven-year-old nonverbal autistic boy sued ABA Interactive, a center in North Richland Hills, Texas. The lawsuit alleges an employee slammed him into a wall with a hand around his neck, and that the parents were first told he had hurt himself. The owner was later arrested for failing to report abuse complaints, and the employee was charged with felony injury to a child. Charged is not convicted.

In Queen Creek, Arizona, a behavior technician at Action Behavior Centers, a different major chain, was charged this year with two counts of aggravated assault involving children in her care. Two states, two companies. The same conditions, high caseloads, thin supervision, and growth that outpaced oversight, can produce both kinds of harm.

Who is paying now

While these cases are unresolved, the companies under investigation are not the ones paying. Families are, through slower prior authorizations because insurers got burned and tightened the process for everyone. North Carolina, where I am licensed, moved this year to rein in Medicaid autism therapy costs over fraud concerns. Federal audits found Colorado made at least $77.8 million and Maine at least $45.6 million in improper Medicaid payments for autism services. Massachusetts is trying to claw back $19 million from providers over a supervision ratio rule, including from providers nobody has accused of anything.

There is a fair worry inside my field that coverage like this makes ABA itself sound like the scandal. The subject here is two companies and one business model, not the therapy. Honest small practices are absorbing a reputational cost they did not earn. Both things are true at the same time.

Recap and the one question

$2.4 billion in total billing cited in an affidavit. A $55 million gift terminated. A $911,400 bill for nine months of care. A House committee demanding six years of records. A grocery chain's RICO suit. None of it is settled, and all of it is real. Two companies allegedly let a child's reimbursement rate decide whether that child got care.

I still work in this field, and I still believe in the science. This is why I am building Roundtable Care the way I am: a BCBA, a speech-language pathologist, and an occupational therapist at the same table, agreeing on one plan with you in the room. I am not asking you to trust me instead of them. I am asking you to ask every provider, mine included, one question: who else is checking this bill besides you? If the honest answer is no one, you already know what to do next.

Tell me in the comments: has an ABA provider ever billed you for something you did not recognize, or made you feel like asking questions was not allowed? You do not need to name them. Tell me what it felt like.

Sources

• WSJ, The Autism-Therapy Business Is Booming, and So Is the Billing Abuse
• House Education and Workforce Committee letter to The Perfect Child (July 6, 2026)
• Follow-up letter (Aug. 21, 2026)
• Publix Super Markets v. ABA Centers of America, 0:25-cv-62146 (S.D. Fla.), order on motion to dismiss
• Behavioral Health Business on the Publix ruling
• Point32Health counterclaim coverage (Acuity)
• Philadelphia Inquirer on the unsealed affidavit and the Temple gift
• Temple University statement
• CEPR, Pocketing Money Meant for Kids: Private Equity in Autism Services
• PESP, Private Equity in ABA (2026)
• HHS-OIG, Colorado ABA audit
• HHS-OIG, Maine audit
• KERA on ABA Interactive (Texas)
• NBC 5 DFW on the arrests
• Queen Creek Independent on the Action Behavior Centers case

Ashleigh Dominguez, MS, BCBA, is a Board Certified Behavior Analyst licensed in North Carolina, Georgia, and Iowa. This article is general education based on the episode. It is not clinical advice, not treatment, not legal advice, and not a treatment recommendation for your child or your state. Ashleigh is not your BCBA and has not met your family. Please build your real plan with the providers who know your child.