What is the program at the center of the FBI raids of Minnesota autism centers?

To care providers, advocates and parents of children with autism, the development of the Early Intensive Developmental and Behavioral Intervention (EIDBI) health care program in Minnesota is so promising and so long-awaited, it’s no wonder its growth has been explosive.

But because of that surge of interest in the program, which serves people younger than 21 with autism spectrum disorder, and the lack of oversight, advocates and providers weren’t completely surprised by the revelations last week that the FBI is investigating alleged fraud at two — and possibly more — EIDBI centers.

“The state was interested in providing access to needed services [and] equity-based access to long-underserved communities,” said Eric Larsson, executive director of clinical services at Lovaas Institute Midwest in Minneapolis. “And, if everyone follows the rules, there’s no problem. Not everyone followed the rules.”

The program is funded by the state and federal government. Since 2017, the state reported nearly $700 million in Medicaid EIDBI reimbursements. That includes nearly $229 million in 2024 payments through Nov. 27. At the same time, the number of EIDBI providers who diagnose and treat people with autism spectrum disorder has increased from 41 in 2018 to 328 last year.

Last week, the FBI raided St. Cloud and Minneapolis autism centers as part of an investigation it said revealed “substantial evidence” of millions of dollars in fraudulent Medicaid claims. No charges have been filed yet.

That alleged fraud overlaps with the massive Feeding Our Future case, which has charged 70 people with defrauding a federal program of $250 million meant to fund meals for low-income kids in Minnesota after school and during the summer. According to the FBI affidavit, at least a dozen of the 70 defendants also “owned, received money from, or were associated” with autism centers.

Now, the alleged fraud of autism centers threatens to set back the many years of hard work by providers and parents in Minnesota, Larsson said, “because people are going to lump it together in one broad category.”

Those alleged “bad apples,” autism experts fear, are not only damaging reputations of honest providers but may also threaten future funding.

“I’m disgusted by the people who abuse this,” said Jenn Diederich, vice president of quality and behavior analytics at the Minnesota Autism Center, which operates at 19 sites in Minnesota. “It’s terrible.”

Earlier this year, state officials acknowledged investigating potential Medicaid fraud among autism services. Autism-related service providers don’t need a state license to provide the benefit services, prompting lawmakers to say they will consider licensing EIDBI providers.

“Sometimes we build things with wings that don’t fly,” said state Rep. Mohamud Noor, DFL-Minneapolis, chairman of the Human Services Finance Committee.

Alexis Dagit, chief development director for the Minnesota Autism Center, said families and providers have “experienced some really lovely things” thanks to EIDBI treatment. She said it provides a comprehensive approach that allows providers to work with families to “build layers of care.”

For instance, the program allows for a team of providers — from occupational therapists, speech therapists and behavioral analysts — to help young people with autism develop skills and behaviors so they can function better and gain some independence.

Previously, providers say, treatment options for children with autism were often limited to meeting with a single therapist at a flat fee.

The success of the EIDBI model, and the state making more funds available for it, has led to a growing number of providers. To many, that’s a good thing. While an estimated one in 34 Minnesota children is on the autism spectrum, the number is closer to one in 16 Somali children.

As a result, attorney David Holt, who works with EIDBI providers, said Minnesota over the past few years has seen an expansion in EIDBI among East African providers.

“The elephant in the room is: Why wouldn’t these families go to providers who are already set up in Minnesota?” Holt said. “They are more likely to go to a provider who speaks the language. It’s a classic supply and demand.”

But that may also have contributed to suspicions of fraud, he said. After the pandemic, officials made it easier to bill for remote services. That, in turn, may have contributed to mistakes in billing and record-keeping.

“I don’t envy the federal or the state governments’ job trying to flesh out fraud,” he said. While not providing services to children whose parents drop them off and pick them up “is clearly fraud,” Holt said, there are other examples where services are being provided, but mistakes are being made.

“It’s not that they’re doing a bad job, but they’re doing a not perfectly documented job,” he said, referring to some providers.

Fatima Abdulkadir and Farhiya Iman want the state to weed out the cheaters. The women, who are licensed social workers, started Arise Autism Center in the St. Cloud area to work with children in their homes.

EIDBI also helps parents better know what to expect for their children in treatment, Abdulkadir said. “We are passionate about helping children and their families improve their lives,” she said.

They have been deliberate, slowly building their business, they said. Arise has two clients and is assessing a third.

Those who are committing fraud, Iman said, “are definitely affecting us negatively. The fraud makes it a lot harder for us to work with the families we work with.”

“We want to do work that is impactful to our clients,” Abdulkadir said. “If that means the government steps in and gets rid of the bad apples, we want that.”