If you’ve followed the news about autism therapy this spring, you have reason to be troubled. So am I. Over the past few months, the New York Times and the Wall Street Journal have published investigations into how some clinics bill Medicaid for applied behavior analysis (ABA) therapy, the evidence-based treatment for children with autism spectrum disorder. The reporting describes thin oversight and, in several states, criminal charges for outright fraud. As a physician who refers children for this care, I take these reports seriously. They point to real, systemic failures.
That situation compromises the trust of families and taxpayers, while unfairly overshadowing the thousands of honest clinicians who provide this care by the book. We cannot conflate a few bad actors with the reputation of an entire field.
I see what ABA achieves. A child who could not speak develops the language to ask for what they want. A child who struggled in the classroom learns social skills. A family that could not get through a meal together begins to enjoy that time each evening. That is therapy working.
ABA is recognized as the standard of care for autism in young children by the American Academy of Pediatrics and the American Academy of Child and Adolescent Psychiatry, with effectiveness documented across six decades of research. The question isn’t whether ABA works. It’s whether our system delivers it honestly and well.
Know your child’s BCBA, and grow that relationship
A Board Certified Behavior Analyst (BCBA) should be a constant presence: designing the treatment plan, adjusting it as a child progresses, and directly supervising the technicians who deliver most hands-on hours. When that relationship is real, families notice. They know their BCBA’s name, hear from them regularly, and understand why their child’s plan looks the way it does.
The clinics under investigation share the opposite profile: a BCBA’s name on files they rarely visit, too many children per supervisor, and hours billed by uncredentialed staff. Parents are often the first to sense when supervision is a formality rather than a practice. That’s precisely why HB 696 and the coming update to Clinical Coverage Policy 8F focus so heavily on real supervision standards and proper certification for the care team. Families deserve a clinician they can actually trust and engage with, not just a name on a billing form.
Parents are part of the treatment, not bystanders to it
The best ABA programs don’t stop at the clinic door. They coach parents, so skills a child builds in session generalize to the dinner table, the classroom, and the playground. That partnership is also one of the best safeguards against fraud: A parent who is coached knows what their child’s therapy should look like and notices quickly when it doesn’t. As Policy 8F is finalized, North Carolina has an opportunity to build parent involvement into how care is delivered and reviewed, not leave it to individual clinics’ discretion.
Quality and access rise together
My biggest concern is that alarming headlines push lawmakers toward across-the-board cuts to hours or rates. That punishes every clinic, honest or fraudulent, and the families with the fewest alternatives who lose access first. Fraud is the enemy here — not hours, not access.
A blunt cap on hours is not the fix for uneven care. Instead, we must lean into our families and parents as active partners, empowering them to work alongside clinicians to ensure strong, BCBA-led oversight.
While intensity and timing of care remain part of the equation, our focus must be on understanding how each child develops and responds to their care, ensuring every plan is truly individualized.
House Bill 696 is the right vehicle for that accountability
North Carolina is ahead of the curve. HB 696 directs the state to tighten the very weaknesses these investigations exposed, like proper certification, real supervision standards, and guardrails on telehealth, with an estimated $140 million a year in Medicaid savings coming from cutting out fraud, not cutting care.
I didn’t become a developmental pediatrician to defend an industry. I did it for the child in my exam room and the parents across from me. They deserve a BCBA they trust, a role in their child’s treatment, and a system willing to hold its own accountable. The families I serve are counting on us to finish that work.