The Wall Street Journal follows my scoop on autism therapy providers taking billions from Medicaid

You read it here first. But the WSJ found a stunning case - an Indiana woman who billed the state thousands of dollars DAILY for EACH child (and bought a $2.5 million Florida house with the money).

This is the kind of plagiarism I like.

Two months ago, I wrote a piece called “Medicaid fraud and abuse are hitting unthinkable levels.” It focused on soaring spending on behavioral therapy for autistic kids — and led with Indiana, where spending rose 20-fold in four years. By 2023, Indiana Medicaid was shelling out $600 million for therapy for 8,000 children, about $75,000 per kid per year.

Today, the Wall Street Journal ran its own investigation, called “The Boom in Autism Therapy Is Medicaid’s Fastest-Growing Jackpot” and centering on (wait for it) Indiana.

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(Leading the way for the legacy media — by months. Support independent journalism!)

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To its credit, the Journal did not just rewrite my piece but it advanced it.

The paper’s reporters found what may be the most egregious example of (apparently) legal Medicaid abuse ever — a single company which in 2023 billed the state $29 million to treat 84 children.

Yes, you read that right.

“Piece by Piece Autism Centers,” run by Meghann Mitchell, charged $340,000 per child that year. The company took advantage of a loophole in Indiana’s Medicaid program that through 2023 set no upper limit on per-hourly reimbursements for autism therapy.

Instead, the state simply processed all bills at 40 percent of whatever rate a provider charged. As companies found and exploited the loophole, Indiana’s spending on autism behavioral therapy rose from $21 million in 2019 to over $600 million in 2023.

Mitchell and Piece by Piece were particularly aggressive. By late 2023, Piece by Piece billed Indiana at $1,600 per hour per child.

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(She can afford to smile…)

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Even after the state’s automatic 60 percent discount, the company received $640 per hour per child, for treatment provided by “registered behavioral therapists” who generally are paid about $25 per hour.

In these “behavioral analysis” programs, therapists — usually working one-on-one — try to help autistic children speak, answer questions, and recognize objects, offering them rewards if they succeed. In most states, the therapists providing the therapy need only a high school diploma and a week or two of training.

Many children receive 30 hours a week of therapy, a level that would translate into almost $20,000 per week per child.

Piece by Piece’s $1,600 per-hour billed rate lasted only a couple of months before Indiana moved to the fixed-reimbursement system most other states use. Still, Mitchell was able to buy a $2.5 million house in Florida and pay off the mortgage shortly afterward, the Journal found.

The state now offers $68 per hour per child, still enough for Piece by Piece to profit.

To be clear, the piece offers no hint that Mitchell did anything illegal or faces any civil or criminal investigations. Indiana set the reimbursement rules, and as long as Piece by Piece actually was providing real services to real kids, the state cannot claim it was defrauded.

As for how Mitchell sleeps at night?

Apparently quite well. She appears to have cooperated with the piece, which features this line:

Asked what specific costs supported such high payments for services with labor costs as low as $20 an hour, Mitchell said, “I really don’t have an exact reason for that.”

Here’s one: the cost of Florida real estate.

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(Honesty pays. I hope.)

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January’s piece, if you missed it.

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