LapseGuard · updated July 2026

The 2026 compliance numbers every ABA practice owner should know

Applied behavior analysis is in the middle of a multi-state federal audit campaign, and the penalty math changed in January. Every figure below links to its primary source — no vendor scare-math, just what the documents say.

$25,595

Per item or service — the 2026 civil monetary penalty for claims involving an excluded individual

Updated by HHS on January 28, 2026 (up from $24,947), plus an assessment of up to three times the amount claimed. One excluded staff member can touch many claims.

Source: Federal Register, Annual Civil Monetary Penalties Inflation Adjustment (2026-01688)

$77.8M

Improper fee-for-service Medicaid ABA payments found in Colorado — with 100 of 100 sampled enrollee-months containing deficient claims

OIG's February 2026 report recommended Colorado refund $42.6M (federal share). Documentation, billing, and credentialing deficiencies were the core findings. Parallel OIG reviews cover Indiana (~$56.5M), Wisconsin, and Maine.

Source: HHS-OIG Colorado ABA report, Feb 2026

~$19M

Recoupment directed across Massachusetts ABA providers this spring

Six-figure demands with 30-day response windows, centered on supervision-ratio and credentialing documentation. Owners on record describe pausing expansion to respond.

Source: Acuity News, MassHealth ABA audit recoupment coverage, 2026

$292,000

One December 2025 settlement for employing a single excluded individual

OIG's enforcement log lists $292,000 (Center at Lowry) and $227,000 (Center at Northridge) CMP settlements for "Employing an Excluded Individual." Exclusion-related penalties hit $26M+ across 35 organizations in 2025 — roughly six times 2024.

Sources: HHS-OIG enforcement log · Exclusion Screening LLC provider guide

Monthly

How often screening is expected — and by whom

Federal law doesn't directly order providers to check the LEIE — but OIG's own advisory bulletin says monthly screening "best minimizes potential overpayment and CMP liability," because liability for anything an excluded person touched is strict. The hard monthly requirements are state-level: Texas ("all service providers should check OIG's exclusion list monthly"), New York (monthly checks under OMIG's mandatory compliance-program rules for providers at ≥$1M Medicaid), and California Medi-Cal managed care ("at least monthly" across six lists). A lapsed BACB certification separately makes a clinician unbillable — "you can't practice, bill your insurance, or supervise RBTs with lapsed certification."

Sources: OIG Updated Special Advisory Bulletin (2013) · Texas HHS-OIG · NY OMIG · Medi-Cal provider manual (Health Net) · Rethink, BCBA CEU guide

Published by LapseGuard, a service of Raserv Enterprises LLC. This page is general information, not legal advice; verify all figures against the linked primary sources. Questions or corrections: raserventllc@gmail.com.