Medicaid spending on a top autism therapy has surged past $5 billion, drawing scrutiny over fraud and how taxpayer dollars are being spent.

Applied Behavior Analysis (ABA), one of the most common treatments for children with autism, uses structured, one-on-one sessions to build communication, social and daily living skills. Between 2018 and 2024, Medicaid providers paid out more than $5.15 billion under an ABA billing code. Three providers received roughly $685 million in Medicaid reimbursements during that period.

The data alone does not explain why those reimbursements were so high, and billing experts say unusually large payments can reflect a variety of factors.

Officials at the Centers for Medicare & Medicaid Services (CMS) told Fox News Digital it has observed “significant growth” in Medicaid spending on ABA therapy in recent years.

“While access to medically necessary services remains a priority, rapid program growth also underscores the importance of ensuring services are clinically appropriate, delivered by qualified providers, and supported by strong program integrity safeguards,” a CMS spokesperson said.

As spending has grown, federal prosecutors have pursued multimillion-dollar fraud cases involving ABA providers.

In May, two Minnesota autism clinic operators were charged with allegedly billing Medicaid $46.6 million for services prosecutors say were unnecessary or never provided. Another Minnesota woman pleaded guilty in a separate $14 million Medicaid autism fraud scheme.

Investigations by The Wall Street Journal and The New York Times have also documented allegations that some providers billed for services that were never provided, inflated therapy hours and aggressively expanded as Medicaid spending surged.

The scrutiny comes as the Trump administration has made it a focus of his second term to eliminate fraud, waste and abuse across federal programs, including Medicaid, a central policy priority.

Meanwhile, states have responded differently.

Florida says it recovered more than $72 million in improper Medicaid payments over the past year.

Republican Florida Gov. Ron DeSantis recently announced a statewide Medicaid Integrity Initiative to strengthen provider screening, enhance fraud detection and increase oversight.

While Florida has focused on strengthening fraud enforcement, Georgia lawmakers have focused on reimbursement rates, even as industry representatives testified that use of autism therapy services has increased by more than 300% in recent years.

The debate reflects the difficult balance between rooting out fraud and preserving access to a therapy that many families say has been life-changing for children with autism.