The fraud behind the waitlist: four states, one playbook

I am angry about the field I work in. Furious, actually. It used to show up as burnout, and I felt hopeless to change what my clients and their families were going through. I could not wave a magic wand and bring more diagnosticians to town or more speech, occupational or behavioral providers to the area. I cannot keep accepting things as they are.

Four cases, four states

A 10 year old girl named Kennedy could not communicate and was suspected to have autism. (I am naming a minor here because this is in public records.) Her mama enrolled her in autism therapy at a center outside of Detroit. That provider had never been licensed to treat anyone.

In Bridgeport, Connecticut, a Medicaid auditor found a clinic owner billing for a board certified behavior analyst who had not worked there in over a year. In Minnesota, a company was paying parents cash every month to keep their kids enrolled. In Miami, investigators had video of a woman cheating on her certification exam with someone coaching her through the answers.

These are not four unrelated stories. What I found is the same story repeated four times in four states using the same playbook.

The wait is the setup

Here is the simplified version of what happens to parents. You notice something. The doctor says that is what babies do. Months later you finally get a referral, and the average wait to see a diagnostician is about eight to nine months. You get the diagnosis, you read that early intervention matters most, and you get on every waiting list you can. Another six months. Meanwhile your child is getting bigger and stronger and the behaviors are getting worse.

Then the phone rings. They have an unexpected opening this Monday. You do not ask for the BCBA's certification number. You do not call the state to check a license. You say yes, because saying no means waiting longer, and you have already waited long enough.

That is not a failure of judgment on your part. This is the exact moment every fraud scheme in this film exploited on purpose.

Michigan, up close

A woman worked as director of services at a facility with locations outside Detroit treating children with autism. To families she was a board certified behavior analyst. She was not. She used a real BCBA's certification number to get hired at three separate companies over five years. One of the families on her caseload was Kennedy's. Her mother later told reporters she watched her daughter change during her time at that center in ways she could not explain at the time.

The unfinished sentence

Deinstitutionalization was the right call. Olmstead was decided correctly. But somewhere between closing Willowbrook and today, the country stopped at "let's get people out of institutions" and never finished the sentence by funding what replaces them. Families became the workforce. Nobody built the infrastructure to support the workforce they became.

Respite care, the one service designed to give a family a break, is underfunded and understaffed almost everywhere it exists, and few insurance plans cover it at all.

Five things you can check today, for free

1. Anyone who says they are a BCBA has a certification number. The Behavior Analyst Certification Board keeps a public verification tool. Look it up before the first session.
2. If a provider offers you money, a gift card, cash or anything of value to enroll or stay enrolled, that is not a loyalty bonus. It is a kickback, and it is illegal. Report it to your state Medicaid fraud hotline.
3. Track the hours yourself, separately from what gets billed. If you are billed for five days and someone shows up two or three, call your insurer.
4. If your child is in public school, request the district's seclusion and restraint data in writing. In most states it is public record.
5. Before a group home or residential placement, call the state licensing agency and ask for its inspection history and complaint record. Do not rely on a tour alone.

If you are serving this community and doing it right, you have nothing to worry about from me. I support you and I thank you. This is not a field you get into just to make money.

Ashleigh Dominguez, MS, BCBA, is licensed in North Carolina, Georgia, and Iowa. This article is general education based on the episode. It is not clinical, legal, or treatment advice for your child or your state. Corrections and sources are listed in the YouTube description.