The Trump administration’s stepped-up fight against Medicaid fraud is drawing support from an unexpected corner: the autism services industry itself. In a new commentary published by The Daily Wire, Rebecca L. Thompson — a psychologist and board-certified behavior analyst with 25 years in the field — argues that cracking down on fraudulent providers is essential to protecting the families and children who rely on applied behavior analysis (ABA) therapy.
Thompson, who serves on the board of the National Coalition for Access to Autism Services, says she is ‘outraged’ that a small number of bad actors have abused or defrauded autism benefits under Medicaid in several states, draining resources meant for the families she serves. Her remarks come as the Centers for Medicare & Medicaid Services (CMS) released a toolkit last week aimed at helping states strengthen program integrity in Medicaid-funded ABA services.
Fraud As A ‘Dual Victim Crime’
Thompson explicitly endorses the administration’s focus on oversight, pointing to Vice President JD Vance’s recent comment that ‘fraud is really a dual victim crime.’ She agrees, noting that fraudulent providers harm not just taxpayers but also the children who lose access to necessary care — and the families whose trust in the system erodes.
‘The goal should be simple,’ Thompson writes. ‘Find the bad actors, protect taxpayers, and make sure children who need ABA continue to receive the care they need.’
What ABA Is And Why It Matters
Applied behavior analysis, or ABA, is an evidence-based treatment designed to help people with autism build skills in communication, learning, social interaction, and daily living. In a typical session, a child works with a behavior technician who coaches them through structured activities. For many families, Thompson says, access to ABA can be ‘life-changing.’
But that access is threatened when fraudulent providers siphon off Medicaid dollars. The newly released CMS toolkit marks an ‘important first step,’ according to Thompson, but she argues there’s more the administration can do in partnership with the autism-services community to root out waste and abuse without undermining legitimate care.
A Call For Individualized Supervision, Not Fixed Quotas
Thompson’s first recommendation: Medicaid should rely on sound clinical judgment rather than arbitrary supervision ratios that drive up costs without benefiting patients. She warns that a universal supervision requirement — for example, mandating a fixed percentage of supervision for every child based on paid claims — could actually lead providers to deliver and bill for services a child doesn’t medically need.
‘This puts taxpayers on the hook for unnecessary care,’ she writes. Quotas like these can also reduce the number of children a provider can serve, restricting access for families. Thompson emphasizes that ‘individualized decisions are the cornerstone of effective healthcare,’ and that autism treatment should be no different.
Networks, Reimbursement Rates, And Out-Of-Network Spending
Second, Thompson urges Medicaid to maintain strong provider networks and eliminate unnecessary out-of-network spending. Medicaid managed care organizations, she says, should build robust networks of qualified providers who agree to provide care at negotiated rates. The program shouldn’t be paying excessive bills for out-of-network providers who bypass enrollment and validation processes.
But building those networks requires competitive reimbursement rates. Without stable, fair-market pricing, Thompson argues, quality providers may leave the system — leading to longer travel times for appointments and longer waits for families in need.
The Case For ‘Medically Unlikely Edits’
Third, Thompson calls on state Medicaid programs to expand their use of CMS’s Medically Unlikely Edits (MUEs) — a claims-review tool that flags charges exceeding reasonable parameters and requires providers to justify them before the government pays. Although the tool is simple and effective, she notes that many state Medicaid programs lack this basic guardrail.
Drawing an analogy to personal finance, Thompson writes: ‘Each month, millions of Americans scrutinize their credit card statements before issuing payment to ensure they weren’t incorrectly or fraudulently charged. The same principle should apply in Medicaid.’ Expanding MUEs, she says, would help Medicaid identify improper payments while allowing legitimate claims to move forward and protecting access to autism services for those who rely on them.
Industry Alignment With The Administration
Thompson’s commentary signals a notable alignment between at least part of the autism-services industry and the Trump administration’s broader Medicaid reform agenda. By framing fraud as a threat to patient care rather than a bureaucratic concern, she makes the case that reform and access are not opposing goals — they’re mutually reinforcing.
‘No one suffers more from fraud in the autism services industry than the patients themselves,’ she writes. ‘The best reforms will protect the taxpayer, expose the bad actors, and make sure the patients most in need don’t pay the price for someone else’s fraud.’
The administration, for its part, has signaled that Medicaid oversight is a priority. The CMS toolkit released last week is designed to give states concrete tools to strengthen program integrity in ABA services, and Thompson suggests the autism community is ready to help build on that momentum.
Source: www.dailywire.com — https://www.dailywire.com/news/trump-is-right-to-crack-down-on-medicaid-fraud-autism-providers-should-help-him