By James C. Sherlock
The author has completed a detailed survey of individual Applied Behavior Analysis (ABA) providers in New Jersey licensed by Virginia Medicaid to provide services to children with autism. He picked New Jersey for reasons familiar to readers of his work on nursing home chains. The survey revealed that most of those providers live in Lakewood and surrounding Ocean County.
In this case, record-keeping, the fundamental building block of government business, and oversight have failed to meet even this skeptic’s low expectations.
The overall implication of the survey is that licensing out-of-state providers located far from Virginia’s borders to deliver ABA services in Virginia may not be worth the risk. The other major failing shown by the full survey is that, while neither government tracks nor oversees ABA companies, they must do so. While individual providers make errors in submissions, companies that employ them have been proven to be the primary source of fraud.
The implications of the full survey will be discussed in two parts: records and out-of-state providers. This is about the effects of record inaccuracy.
The full survey will not be provided here to protect providers’ identities, but even the abridged version attached shows that individual providers failed at a very high rate to update their practice address records with the Commonwealth and the federal government. Sometimes they updated one but not the other. The full version shows that many of the women surveyed failed to update their maiden names upon marriage.
Widespread record inaccuracies effectively eliminate computerized analysis as an oversight tool. All other methods, such as those used to complete this survey, are far too manpower-intensive to be replicated at scale. With millions of records and the inability to conduct computerized analysis, both federal and state governments are seriously hamstrung in basic oversight and in eliminating malpractice and fraud.
