Armed with audit evidence of widespread fraud, waste, and abuse (FWA), federal and state regulators have launched a wave of criminal and administrative enforcement actions against applied behavior analysis (ABA) providers.
The enforcement activity now underway spans Department of Justice (DOJ)-led criminal indictments, state Medicaid Fraud Control Unit (MFCU) prosecutions, and state administrative terminations and rate-reform litigation. These data-driven investigations are feature coordination across multiple departments and agencies.
Federal Enforcement Follows on OIG Audit Findings
Beginning with FBI raids in December 2024 and culminating in a May 2026 grand jury indictment, federal prosecutors, working jointly with IRS Criminal Investigation, HHS-OIG, and the Minnesota Attorney General (AG)’s MFCU, dismantled a network of sham ABA clinics that billed Minnesota Medicaid for therapy sessions that never occurred, paid kickbacks to parents to keep children enrolled, and concealed beneficial ownership by individuals previously excluded from federal health care programs. The Minnesota cases allege a $46.6 million scheme, the largest autism-related Medicaid fraud scheme ever charged by the DOJ.
The May 2026 indictments incorporate the same deficiency categories that the OIG identified in its multistate audit campaign referenced in our prior blog — uncredentialed staff, services not rendered, and fabricated documentation. After the indictments, the DOJ announced an expansion of the Midwest Health Care Fraud Strike Force in Minnesota, signaling that the federal criminal infrastructure targeting ABA fraud is being institutionalized, not wound down.
The Pending False Claims Act Horizon
To date, no False Claims Act (FCA) investigation or enforcement action against an ABA provider has been publicly announced. The Minnesota cases, for example, involve money laundering, health care fraud, and conspiracy charges — not FCA violations. However, qui tam complaints under the FCA are filed under seal, meaning private enforcement actions could exist without public announcement. The billing patterns identified in the OIG audits and charged in the Minnesota cases align with FCA liability theories. In other high-fraud Medicaid categories (home health, durable medical equipment, compounding pharmacies), civil FCA litigation has consistently followed criminal enforcement. There is no structural reason ABA will be different.
State Enforcement: Massachusetts Sets the Pace
The Massachusetts Attorney General’s Medicaid Fraud Division has been among the most active state enforcement bodies targeting ABA fraud. In June 2025, a grand jury indicted Patrice Lamour and two related ABA clinics on charges of submitting false claims and larceny for fraudulently billing MassHealth, the state Medicaid program, more than $1 million for ABA services that were never provided. According to the Attorney General’s office, staff were directed to bill based on historical data rather than actual services rendered, and to falsify documentation to mask the fraud.
The Lamour case followed a pattern of cracking down on ABA-related fraud: in February 2025, the Massachusetts AG’s office obtained conviction stemming from $33,000 in ABA billing fraud, and in October 2023, the AG’s office reached civil settlements totaling $2.5 million with two ABA providers for billing for services delivered by uncredentialed staff. In July 2026, the AG’s office announced a $770,000 settlement with Flexible Fundamentals, Inc. for services not provided and inadequate staff supervision.
Massachusetts is not unique; it is the demonstrative frontrunner at this time. As the federal government continues to pressure states to investigate and enforce Medicaid fraud, ABA providers across the country can expect increased scrutiny from their respective state Medicaid fraud control units.
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The Commercial Litigation Update blog is currently edited by Jennifer O'Connor and Adam Paine.
