By Christopher Weaver and Anna Wilde Mathews:
The billing abuses run wide. Aetna said the number of investigations that found likely fraud or abusive billing by autism-therapy providers in its private-plan business shot up by 300% between 2024 and 2025—and is on track to rise by another 50% this year.
The issues detected by the insurer’s probes include poor documentation, billing for multiple services for the same hour and claiming to provide care at home addresses that don’t really exist, said Katerina Guerraz, Aetna’s chief operating officer.
“We’re seeing just a massive inflation,” especially when providers are not in-network, Guerraz said.
In bills reviewed by The Wall Street Journal, a daily charge for one child reached more than $30,000.