Legal
DOJ and State MFCU Enforcement Rises in Applied Behavior Analysis Billing
Epstein Becker & Green reports that Department of Justice and state Medicaid Fraud Control Unit enforcement activity targeting applied behavior analysis (ABA) providers has increased. The firm advises ABA providers to strengthen compliance programs by monitoring state Medicaid billing rules, scope-of-practice requirements, CMS guidance, and recent OIG audit findings. No specific enforcement actions or effective dates are identified. The guidance addresses compliance risk management for ABA providers billing Medicaid, particularly for behavioral health services.
Why it mattersRising DOJ and MFCU enforcement in ABA billing signals heightened scrutiny of behavioral health provider compliance with Medicaid billing and scope-of-practice rules, requiring immediate compliance program review.