New Jersey mother hit with a $911,400 bill for her son’s autism therapy, as experts say fraud or abuse for autism-therapy is up 300%

Therapists began visiting her home a few times a week to work with her son, Ezekiel.

Then came the bill.

In April, Lopez received an invoice for a whopping $911,400.

“They know there are parents like me who need the help, and we’re so desperate for it,” Lopez told The Wall Street Journal. “You’re trying to do what’s right for your kid, and there’s people who are taking advantage of this.”

Insurers say abuse is growing

Autism therapy has become a multibillion-dollar industry, fueled by rising autism diagnoses, expanded insurance mandates and growing investor interest. But insurers say the boom has attracted companies accused of questionable billing practices, inflated charges and, in some cases, potential fraud.

According to claims data analyzed by the Health Transformation Alliance, annual spending on hands-on autism therapy for roughly 40 large employers covering 3.5 million people doubled between 2021 and 2025, reaching $108 million.

Those rising costs affect families receiving therapy and can contribute to higher healthcare costs for workers and employers. Employer-sponsored family health insurance coverage averaged nearly $27,000 in 2025, up 26% from five years earlier, according to KFF.

For some employers, autism therapy has become a larger healthcare expense than routine doctor visits and even chemotherapy treatments.

“It’s shocking,” said Asha George, CEO of SmartLight Analytics. “It’s all recent.”

Aetna health insurance reported that investigations uncovering likely fraud or abusive billing by autism-therapy providers jumped 300% between 2024 and 2025 and could spike by another 50% this year. According to the insurer, investigators have uncovered cases involving poor documentation, billing for multiple services during the same hour and claims tied to addresses that don’t appear to exist.

“We’re seeing just a massive inflation,” said Katerina Guerraz, Aetna’s chief operating officer.

One factor making the industry attractive to some investors is that regulations can be surprisingly light. The Wall Street Journal reported that in some states, opening an autism-therapy clinic requires less oversight than opening a daycare center.

The workforce who provide the care has also expanded rapidly. The number of registered behavior technicians, front-line workers who often need little more than a high-school diploma and limited training, rose from about 96,000 in 2019 to roughly 535,000 by the end of 2025, according to the Wall Street Journal’s analysis of federal provider data.

Autism therapy, often called Applied Behavior Analysis (ABA), is used to help children develop communication, social and daily living skills. While behavior analysts oversee care plans, a lot of the hands-on therapy is delivered by technicians who earn around $20 an hour.

Yet some providers are billing insurers hundreds or even thousands of dollars an hour.

Blue Cross Blue Shield of Arizona reported that spending per autism patient has risen roughly 30% in the past two years, with much of the increase tied to a relatively small number of providers billing extraordinary numbers of therapy hours.

“When you look at the number of units that some of these providers are billing for, they’d have to be doing these services 24 hours a day, seven days a week,” said Pam Kehaly, chief executive officer at Blue Cross Blue Shield, to the Wall Street Journal.

There are other examples of eye-popping charges. In Lopez’s case, records showed a provider billed her insurer $30,500 for a day when her son received just 70 minutes of therapy involving puzzles and educational toys.

Other cases cited by the Wall Street Journal involved providers charging more than $1,000 an hour for routine services. One lawsuit alleged a provider billed as much as $1,320 an hour, while an analysis of insurer pricing data found the national average paid to in-network providers was about $89 an hour.

The fallout can be devastating for families. When insurers refuse to pay what they consider to be excessive or unjustified claims, some providers go after patients directly for the balance, like in Lopez’ case.

In an industry where demand is high and waitlists are common, families desperate for care have to be cautious.

What to watch out for

Many clinics and therapists provide valuable, evidence-based care. But for desperate families seeking support, there are some precautions to take that could help avoid getting into a situation like Lopez and her son:

Verify the provider’s credentials. Autism Speaks recommends asking whether supervising clinicians are Board Certified Behavior Analysts (BCBAs), how technicians are trained, and how often they are supervised.

Confirm whether the provider is in-network with your health insurance plan. Confirm whether the provider is in your insurance network and ask for written confirmation of coverage. Families should also review their health plan documents to understand what autism-related services are covered and what exclusions may apply.