The U.S. Centers for Medicare & Medicaid Services (CMS) will soon begin a push for states to initiate provider revalidation in “high-risk areas.”
Speaking at Politico’s Health Care Summit, CMS Administrator Dr. Mehmet Oz said his organization would soon send notice to state Medicaid programs requesting that they submit a plan for widespread provider revalidation within 30 days of the notice or risk additional scrutiny by federal auditors.
“I’ve heard this complaint from red and blue governors: they care about these programs as well. They don’t want widespread fraud, but oftentimes they’re not quite sure how to get their arms around it,” Oz said. “So this is a step, as an example, of what we’d like them to do to prove that they’re serious about this.
“And if you don’t take it seriously, it indicates to us that we might have to take the audits that we are doing in the states more aggressively.”
CMS has not yet returned Behavioral Health Business’ request for more information. The agency has not announced more details to the public as of when this article was written.
In previewing this effort, Oz did not explicitly state that “high-risk areas” would include autism therapy. However, in referring to other anti-fraud, waste and abuse efforts, he pointed to questionable activities within hospice and in autism therapy that federal authorities have addressed.
Within autism therapy, Oz referred to the ongoing nutrition, housing assistance and autism therapy fraud investigations in Minnesota. In September 2025, the Department of Justice charged Asha Farhan Hassan and her company, Smart Therapy LLC, for allegedly defrauding the government. The DOJ says she was also involved in the Feeding Our Future scheme.
Oz said that when children are “dishonestly categorized as having autism, then the kids who really have autism can’t get the services that they need, and the funding for these programs dries up. So if you really love these programs, like when you love your kids and people in your life, you have to make difficult choices to protect them, and we’re asking governors to work with us.”
How state Medicaid programs handle the authorization, payment and oversight of autism therapy services has been in the spotlight for several months now, with an ongoing audit series led by the U.S. Department of Health & Human Services’ Office of Inspector General. In this audit process, investigators are finding that most claims and underlying documentation are so poor — if they exist at all — as to mask whether or not services were actually performed, let alone the quality of those services.
Some industry insiders fear that the state’s poor oversight of both cost increases and compliance processes will lead state leaders to question the legitimacy of applied behavior analysis (ABA), the cornerstone of the autism therapy industry, as a benefit.