Smart Therapy LLC billed $14M in phantom autism therapy over 5 years. The state had all the data to catch it. Nobody ran the queries.
How it worked: teenage relatives billed as clinicians, parents paid $300-$1,500/mo per kid to enroll, forged supervisor sign-offs, billing maximums every single day, transport vendors on the same payroll.
EIDBI claims in Minnesota went from $600K in 2018 to $400M by 2025. 14 Medicaid programs flagged high risk. One Optum-run tightening cut ~$165M in spending across those programs in a couple quarters.
Every signal was loud and public: billing the cap daily, impossible daily hours per tech, same humans across multiple programs, LLC incorporated and enrolled within weeks. Arithmetic, not AI, catches this.
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