INDIANAPOLIS: Indiana is barring one of the nation’s most expensive autism-therapy providers from billing the state’s Medicaid program two weeks after the company’s practices were detailed in a Wall Street Journal article, state officials said.
The autism-therapy provider, Piece by Piece Autism Centers, received the highest per-patient payments in the country in 2023—about $340,000 on average—according to a Journal analysis of Medicaid billing records.
Piece by Piece did so in part by raising its list prices to levels that allowed it to collect as much as $640 an hour from the state for services that could be performed by a high-school graduate. From 2019 to 2023, Indiana directly paid Piece by Piece $58 million for autism-therapy services, the billing records show.
Piece by Piece founder Meghann Mitchell didn’t respond to requests for comment this week. In an interview last month, she defended her company’s billing practices, saying, “I don’t think Indiana really had any oversight, or not much.”
As the company’s Medicaid billings soared, property records show Mitchell bought a $2.5 million home on Florida’s Sanibel Island and a $600,000 waterfront house on Indiana’s Tippecanoe River.
Mitchell said audits by government health programs, private insurers and a third-party auditor had found no evidence of fraud or intentional wrongdoing at Piece by Piece.
“They obviously abused Indiana taxpayers and then went and bragged about it, so we terminated them,” said Marcus Barlow, deputy chief of staff at the Indiana Family and Social Services Administration, which oversees the state’s Medicaid program.
In letters sent to Piece by Piece this week, the state said it was revoking the company’s provider agreements for all seven of its centers. The move, effective in 60 days, would bar the centers from billing Medicaid. The letters, viewed by the Journal, say the termination is subject to appeal.
In a message to employees earlier this week, Mitchell said the Indiana agency had singled it out, citing “recent negative publicity we have received.” She said the company intended to fight the state’s decision and had done nothing wrong, according to the email, which was viewed by the Journal.
For years, Indiana reimbursed autism-therapy providers 40% of whatever list prices they set, effectively allowing them to determine their rates. Before the system was overhauled in 2024, Piece by Piece and other providers drastically increased prices to command higher payments.
“FSSA knew exactly what Piece by Piece, and other providers have billed and FSSA shared the same in public presentations,” Mitchell said in her note to employees. “And yet, only today—years later—is FSSA taking this punitive action,” she wrote. In the earlier interview, Mitchell said her company followed Indiana’s rules and increased prices as costs rose.
Barlow, the FSSA’s deputy chief of staff, said: “There were no guardrails under the prior administration, and they weren’t doing the job of oversight they should have been doing. But, we are.”
It couldn’t be determined how many Medicaid patients would be affected by Piece by Piece’s termination. The company cared for 84 children with autism in 2023, the latest year of Medicaid data available to the Journal. Former employees said most of the company’s patients were covered by Medicaid.
The therapy, known as applied behavior analysis, is one of the fastest-growing areas of Medicaid, the state-run health program for low-income and disabled people. State Medicaid programs’ direct payments for the therapy grew to $2.2 billion in 2023, from $660 million just four years earlier, according to the Journal’s analysis of Medicaid billing records.
The therapy often involves teaching children basic skills such as following directions or communicating. Much of it is delivered by registered behavior technicians, who can have little training beyond high-school diplomas in some states and may earn less than $20 an hour.
In 2024, Indiana set a flat rate of $68 an hour for routine autism therapy services rendered by the lower-wage workers. The state is slated to further curb that rate and impose a cap on the number of lifetime hours of therapy a patient can receive as part of an ongoing overhaul.
Mitch Roob, secretary of Indiana’s Family and Social Services Administration and acting Medicaid director, said he presented an ultimatum to autism-therapy providers to self-report any past abuses or fraud by April 3 during a recent meeting.
Those that do so, he said in an interview, could expect his help to “make amends with the federal government and us.”
Those that don’t, he said, could expect scrutiny from federal health agencies, the Justice Department and the Federal Bureau of Investigation. While states run Medicaid programs, federal taxpayers finance the majority of their costs.
Officials from the federal Department of Health and Human Services and the Centers for Medicare and Medicaid Services have “expressed their significant dismay” to the state following the Journal’s reporting, Roob said.
“They’re going to take it out of our hands,” he said. “They intend to deal with this sternly.”
Spokespeople for the Centers for Medicare and Medicaid Services, which oversees Medicaid programs, didn’t respond to a request for comment.