By skyforbes Hello!
I hope this is the right community. My daughter is 10, on PA Medicaid (Phila) to be exact. This pertains to the behavioral health management program in Phila under Medicaid (Community Behavioral Health.)
My daughter has been receiving ABA therapy for a diagnosis of autism, ADHD & ID. She had an agency that was bought out by a huge nationwide agency last year. The new agency had my daughter with a 1:1 Behavioral health tech who was falsifying documents and timesheets in their system for billing (families have access to this system.) I brought it to their attention about the 1:1 billing for more hours than allotted and also the 1:1’s supervisor for billing for sessions at home that did not occur.
The agency stated they reversed anything that did not occur and stated that they did find some false billing (those providers were let go.) This was last November/December of 2024. Now, we are in June of 2025 and my child is in a summer camp and receives the 1:1 services and their supervisor is new to my daughters case. This supervisor I have seen on their billing system & notes, stated she did home sessions 2 days in June (my daughter was with me) and these did NOT occur. They also billed for 7/3/25- where my child was at the beach with her father this day.
The actual billing and notes clearly states it was at home, the sessions, and also mentioned specific things my daughter did and behaviors she exhibited. At first, I thought, maybe they are billing for work they completed outside of sessions with my child- I know this field this happens often.
However, as mentioned, these timesheets and notes were extremely specific in that the supervisor traveled to the home, me with me or my child’s father, and specific things that occurred.
I sent an email to my child’s case manager with the agency.
I’m so angry and upset. In Philadelphia, Medicaid for behavioral services is so backlogged and it can be hard to be approved for hours that you need.
I don’t know how to address this further and this is now the THIRD provider that has done this. The way they document also, there is no oversight. Usually a teacher or staff at camp would sign the providers sheet at the end of sessions, but this agency does not do this.
Thanks for any advice!