Congress Is Investigating ABA Medicaid Billing in 10 States. Is Yours One of Them? \| StreamABA [ ![StreamABA](https://streamaba.com/build/assets/logo-dark-Bta4omRy.svg) ](/) [Home](https://streamaba.com) [Blog](https://streamaba.com/blog) [ Log in ](https://streamaba.com/login) [ Goto the Live Demo ](#get-started) [Home](https://streamaba.com) [Blog](https://streamaba.com/blog) [Log in](https://streamaba.com/login) [ Goto the Live Demo ](#get-started) 1. [Blog](https://streamaba.com/blog) 2. / 3. Congress Is Investigating ABA Medicaid Billing in 10 States. Is Yours One of Them? compliance Congress Is Investigating ABA Medicaid Billing in 10 States. Is Yours One of Them? ==================================================================================== House E&C Committee sent ABA fraud investigation letters to 10 states in March 2026. What the probe covers, why Congress acted, and what providers in CA, CO, MA, ME, NE, NY, OR, PA, VT, WA need to do now. 8 min read April 22, 2026 StreamABA Team Share [ ](https://x.com/intent/tweet?url=https%3A%2F%2Fstreamaba.com%2Fblog%2F2026%2F04%2Fhouse-energy-commerce-aba-medicaid-probe-10-states&text=Congress+Is+Investigating+ABA+Medicaid+Billing+in+10+States.+Is+Yours+One+of+Them%3F) [ ](https://www.linkedin.com/sharing/share-offsite/?url=https%3A%2F%2Fstreamaba.com%2Fblog%2F2026%2F04%2Fhouse-energy-commerce-aba-medicaid-probe-10-states) [ ](https://www.facebook.com/sharer/sharer.php?u=https%3A%2F%2Fstreamaba.com%2Fblog%2F2026%2F04%2Fhouse-energy-commerce-aba-medicaid-probe-10-states) compliance medicaid state-policy industry-news legislation ![](/images/blog/2026/04/house-energy-commerce-aba-medicaid-probe-10-states.jpg) Congress Just Added Its Own Layer of Scrutiny --------------------------------------------- You’ve been tracking the OIG audit series. Four states, 100% deficiency rates across every sampled claim, nearly $200 million in documented improper payments. The pattern has become familiar enough that each new audit report almost reads like a template. Congress isn’t waiting for the OIG to finish. On March 3, 2026, Republican leaders on the House Committee on Energy and Commerce sent formal letters to the governors and state Medicaid directors of **ten states**: California, Colorado, Massachusetts, Maine, Nebraska, New York, Oregon, Pennsylvania, Vermont, and Washington. The letters demanded records covering every year from 2021 to the present on fraud, waste, and abuse in their Medicaid programs — with **Applied Behavior Analysis services singled out by name** as a program area of particular concern. This is a Congressional investigation. That’s a different category of scrutiny than what HHS OIG does. Understanding the distinction matters for how ABA providers in these states should be thinking about their compliance posture right now. --- Why Congress Acted, and Why ABA Was Named Specifically ------------------------------------------------------ The House Energy and Commerce Committee held a hearing on February 3, 2026, titled “Common Schemes, Real Harm: Examining Fraud in Medicare and Medicaid.” Witnesses testified about fraud patterns across several Medicaid service categories. ABA for children with autism spectrum disorder was specifically identified as a program with “high rates” of fraud, waste, and abuse. The context that informed that hearing: - The HHS OIG had, by February 2026, completed audits of four states (Indiana, Wisconsin, Maine, and Colorado) and found improper or potentially improper payments in **100% of sampled claims** in every state - The Minnesota Medicaid fraud scandal — involving phantom billing, identity theft, and falsified records — had drawn national attention to how vulnerable high-growth Medicaid programs can be when state oversight doesn’t keep pace with spending - Between 2019 and 2023, Medicaid spending on ABA grew by 150%–1,800% depending on the state, with no corresponding increase in audit infrastructure One month after that February hearing, on March 3, the Committee sent its letters. The request was signed by three Committee Chairs: Brett Guthrie (KY-02, full Committee), John Joyce (PA-13, Subcommittee on Oversight and Investigations), and Morgan Griffith (VA-09, Subcommittee on Health). The letters asked states to provide written responses to ten questions about their Medicaid program integrity efforts, specifically: - What investigatory processes the state uses to detect fraud, waste, and abuse - What the state’s prior improper payment findings and recovery efforts have been - What audits are ongoing or have been completed - What actions the state is taking to strengthen Medicaid program integrity States had until **March 17, 2026** to respond. The same day, the Committee held a second hearing: “Protecting Patients and Safeguarding Taxpayer Dollars: The Role of CMS in Combatting Medicare and Medicaid Fraud.” --- The 10 States — and What’s Already Happening in Each ---------------------------------------------------- Not every state on this list has the same exposure profile. But all ten received the same letter. StatePrior OIG AuditCurrent ABA Policy Context**California**None completedLargest US ABA market; no prior federal audit**Colorado**Yes — $77.8M improper, Mar 2026OIG audit published the week before the letters; state faces $42.6M refund demand**Massachusetts**None completedState AG has pursued multiple ABA fraud cases; Ubuntu and ARTC settlements in 2022; Randolph indictment June 2025**Maine**Yes — $45.6M improper, Jan 2026OIG audit published six weeks before the letters; $28.7M federal refund recommended**Nebraska**None completedImplemented 48% rate cut on direct therapy reimbursement (Aug 2025); 30-hr/week cap**New York**None completed25% rate cut now complete (April 2026); Autism Learning Partners closed Medicaid panels April 17**Oregon**None completedExplicitly allows concurrent billing of 97153+97155 with documentation requirements**Pennsylvania**None completedNo prior federal audit; one of the largest Medicaid programs in the country**Vermont**None completedBanned concurrent billing January 2026 citing the Wisconsin OIG audit**Washington**None completedMajor ABA market; no prior federal audit Two of the ten states — Colorado and Maine — were named in the Congressional probe within weeks of their OIG audit reports dropping. Colorado’s audit was published March 2. The Congressional letters went out March 3. The sequencing is not coincidental. --- Why Congressional Oversight Is Different from an OIG Audit ---------------------------------------------------------- The HHS Office of Inspector General is an executive branch agency. It audits programs, issues findings, makes recommendations, and can refer cases to DOJ. State Medicaid agencies can disagree with OIG recommendations and often do. Colorado, for example, disagreed with one of five recommendations in its March 2026 audit report. The House Energy and Commerce Committee is Congress. It holds oversight authority over federal programs, including Medicaid. Congressional investigations can: 1. **Lead directly to federal legislation.** If committee members determine that CMS oversight of ABA billing is inadequate, they can attach requirements to budget reconciliation or authorization bills — mandatory audit thresholds, prior authorization standards, or federal lifetime caps that supersede state-level decisions. 2. **Create political pressure on state executives.** A governor who receives a letter from Congress requesting ABA fraud records — and provides a response that reveals weak oversight — becomes politically exposed. States under Congressional scrutiny have a strong incentive to demonstrate enforcement activity. 3. **Accelerate state-level policy changes.** Nebraska implemented its 48% rate cut in August 2025, explicitly citing OIG findings from Indiana. States named in a Congressional probe now face an additional motivation to show visible corrective action: rate cuts, caps, moratoriums, and audit activity that they can point to in their responses. 4. **Feed the CMS accountability chain.** The March 17 hearing asked CMS directly about its role in Medicaid program integrity. If CMS is put on the record about what it expects from states on ABA oversight, that creates a basis for CMS to tighten its oversight guidance — which then flows down to every state Medicaid program, not just the ten named in the letters. For providers in these states, the relevant implication is simple: the scrutiny pressure on your state Medicaid agency just went up. Whatever enforcement actions, rate changes, or documentation policy updates were already under consideration at the state level, they are now happening against a backdrop of Congressional attention. --- What Providers in These 10 States Should Do Now ----------------------------------------------- The Congressional letters asked state agencies about their program integrity efforts. States that want to show they’re taking the probe seriously have every incentive to demonstrate active enforcement. For providers, that means the probability of pre- or post-payment reviews, prior authorization tightening, and credentialing scrutiny has increased — not because of what individual practices did, but because their state is under a Congressional spotlight. **1. Get your documentation in auditable shape now.** Every OIG audit in the current series found the same categories of deficiencies: session notes that don’t support the CPT code billed, units that exceed what documentation can justify, missing notes entirely, and missing provider signatures. These are not documentation problems unique to providers who were engaged in fraud — they’re systemic, industry-wide gaps. Practices that have clean documentation won’t attract post-payment review attention. Practices with documentation gaps will. Specific areas to check: - **97155 session notes** must document the specific protocol modification, clinical decision, or real-time guidance provided by the BCBA. “BCBA supervised session” is not sufficient. See the [Colorado OIG audit findings](/blog/colorado-oig-audit-285-million-improper-aba-payments) for the exact language auditors use. - **Concurrent billing of 97153 and 97155**, if your state allows it, requires documentation that both services were genuinely and distinctly rendered. Vermont banned concurrent billing in January. Other states are watching the same OIG findings Vermont cited — [and silence on concurrent billing policy is no longer a safe position](/blog/vermont-concurrent-billing-ban-aba-medicaid). - **Rendering provider signatures** must be present on every session note. Missing signatures were a specific finding in the Colorado audit. **2. Request your state Medicaid program’s response to the Committee.** States that submitted responses to the Committee’s March 17 deadline are public records. In some states — Nebraska, Vermont — the state’s response and the Congressional probe have already been covered by local media. Know what your state said, or didn’t say, about its ABA oversight practices. If your state acknowledged deficiencies or committed to new enforcement measures, that’s an early signal about what policy changes may be coming. **3. Understand your accreditation status if you’re in these states.** Congressional scrutiny of ABA program integrity often translates into accelerated accreditation mandates. North Carolina began monitoring accreditation status on April 20, 2026 — [tied directly to a policy update that came after the state’s own ABA quality hearing](/blog/aba-accreditation-becoming-mandatory). If your state Medicaid director is looking for enforcement mechanisms to demonstrate to Congress, accreditation requirements are one of the fastest policy levers available. Practice agencies in these 10 states that don’t have national accreditation — BHCOE, CARF, or equivalent — should assume the runway is shortening. **4. Review your billing for the look-back period the Committee requested.** The letters asked for records from January 1, 2021 to the present. That’s your audit window. If your billing practices from 2021 forward include the same documentation failures the OIG has flagged in Colorado, Maine, Indiana, and Wisconsin, you should know what your exposure looks like before a state or federal auditor does. --- The Bigger Picture ------------------ The OIG audit series operates at the executive branch level — seven states, one at a time, moving through a methodical process. Congressional oversight is lateral and simultaneous: one set of letters, ten states, one month. The two systems are reinforcing each other. Colorado got OIG-audited in February and received a Congressional letter in March. Maine was OIG-audited in January and received a Congressional letter in March. The states that have already been through the OIG wringer are now also under Congressional scrutiny. The eight states that haven’t been OIG-audited yet — including major markets like California, Oregon, Washington, and Pennsylvania — are now on the record with Congress about their program integrity capabilities. If their responses reveal weak oversight, they become logical candidates for future OIG audit selection. The remaining three OIG audit states in the seven-state series haven’t been publicly identified. All seven of the states that were in the original OIG series were chosen in 2022. Eight of the ten Congressional probe states have not had an OIG audit. The targeting logic may not align precisely, but the principle is the same: federal attention to ABA billing is now operating at both the auditor and legislative oversight levels simultaneously. This is not the environment to be running loose documentation practices or billing claims you can’t substantiate. The risk isn’t just a post-payment review letter from a state Medicaid contractor. It’s being in a state that’s under Congressional pressure to show visible ABA enforcement activity — and having your billing be the example that gets used. --- *StreamABA helps ABA practices maintain audit-ready documentation and stay current on payer and regulatory changes. Questions about your practice’s compliance posture in light of the Congressional probe? Reach out at **hello@streamaba.com**.* *Follow us on [LinkedIn](https://www.linkedin.com/company/stream-aba) and [X](https://x.com/streamaba) for more industry updates.* [ All posts ](https://streamaba.com/blog) ![]() Related posts ------------- [Browse all posts](https://streamaba.com/blog) - [ ![](/images/blog/2026/03/colorado-oig-audit-285-million-improper-aba-payments.jpg) compliance ### Colorado OIG Audit: $285 Million in Improper ABA Payments — The Largest Yet The fourth HHS OIG audit just dropped. Colorado's Medicaid program made at least $285.2 million in improper and potentially improper ABA payments in 2022–2023. Every single sampled record had problems. Three more states are still coming. Mar 2, 2026 5 min read ](https://streamaba.com/blog/2026/03/colorado-oig-audit-285-million-improper-aba-payments) - [ ![](/images/blog/2026/04/vermont-concurrent-billing-ban-aba-medicaid.jpg) billing ### Vermont Banned Concurrent ABA Billing. Revenue at Affected Clinics Dropped 17%. Your State Could Be Next. Vermont Medicaid banned concurrent billing of CPT codes 97153 and 97155 on January 1, 2026, citing an OIG audit that flagged $18.5 million in improper Wisconsin payments tied to the practice. Clinic revenue at affected providers dropped 16–17% within 60 days. CASP says the interpretation is wrong. Oregon allows it with documentation requirements. Most states have said nothing — and silence is now an audit risk. Apr 21, 2026 8 min read ](https://streamaba.com/blog/2026/04/vermont-concurrent-billing-ban-aba-medicaid) - [ ![](/images/blog/2026/04/new-york-aba-rate-cut-autism-learning-partners-exits.jpg) compliance ### New York's 25% ABA Rate Cut Is Complete. Autism Learning Partners Just Closed Its Medicaid Panels. On April 1, 2026, the second of two 12.5% Medicaid rate cuts landed for New York ABA providers — completing a 25% reduction mandated in the state budget. Sixteen days later, Autism Learning Partners announced it is closing all New York Medicaid panels to new patients. New York now pays less for ABA than Texas. Apr 20, 2026 7 min read ](https://streamaba.com/blog/2026/04/new-york-aba-rate-cut-autism-learning-partners-exits) - [ ![](/images/blog/2026/03/oig-audit-trail-documentation-failures-by-cpt-code.jpg) compliance ### The OIG Audit Trail: What 4 State Audits Mean for Your ABA Practice's Documentation The Wall Street Journal just put ABA billing under a national spotlight. Four HHS OIG audits have now found documentation failures in 100% of sampled claims across four states. Here's exactly what the auditors flagged, mapped to specific CPT codes, and what your software should be catching before claims go out the door. Mar 11, 2026 9 min read ](https://streamaba.com/blog/2026/03/oig-audit-trail-documentation-failures-by-cpt-code) Live demo · No sales call Ready to Streamline your practice? ------------------------------------ Get instant access to a live demo of the all-in-one ABA platform built by clinicians, for clinicians. No sales call. HIPAA compliant · Signed BAA · Built for ABA Website Work email Goto the Live Demo ![](https://streamaba.com/build/assets/icon-BglRoXWC.svg) [ ![StreamABA](https://streamaba.com/build/assets/logo-dark-Bta4omRy.svg) ](/) The all-in-one practice management platform built specifically for ABA therapy providers. 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