Lackawanna Connect | February 2025

Earlier today, DOGE HHS open-sourced what they called the largest Medicaid dataset in department history. 227 million rows of provider-level claims data covering over $1 trillion in Medicaid spending from 2018 through 2024. The agency specifically pointed out that this kind of data could have been used to detect the large-scale autism therapy fraud uncovered in Minnesota, where small clinics billed hundreds of millions for services that were never provided or were delivered by unqualified staff.

We downloaded all 10 gigabytes of it and decided to focus on our own backyard: Lackawanna County.

What the Data Contains

Each row in the dataset represents a specific provider billing a specific medical procedure code in a given month. It includes the billing provider's NPI (a unique national identifier), the servicing provider's NPI, the procedure code, the number of patients, the number of claims, and the total amount Medicaid paid.

It doesn't include patient names, diagnoses, or addresses. It does include enough to spot patterns.

How We Approached It

We pulled every registered healthcare provider NPI in the Scranton, Carbondale, Dunmore, Clarks Summit, Dickson City, Old Forge, and Moosic area from the federal NPPES registry - over 2,200 unique providers. We then filtered the full national dataset for any claims involving those NPIs.

For standard Medicaid claims, the Lackawanna County totals were modest. About $475,000 across 75 billing providers over seven years. Most local healthcare billing flows through the large health systems - Geisinger and Commonwealth Health dominate.

Then we looked specifically at the billing codes flagged nationally for fraud risk: ABA therapy codes (the treatment for autism that was at the center of the Minnesota fraud), personal care services, and behavioral health codes.

That's where the picture changed dramatically.

$75.8 Million in Fraud-Prone Codes

Six Lackawanna County-area providers billed a combined $75.8 million through codes commonly associated with fraud nationally. The breakdown:

Provider	Location	Total Billed	Primary Codes
Bright Beginnings Therapeutic Services	Carbondale	$46,755,305	ABA therapy
Family Enrichment Center	Scranton	$11,701,455	ABA therapy
Caregivers America Home Health	Clarks Summit	$8,230,287	Personal care
Friendship House	Scranton	$6,898,603	ABA therapy
Bayada Home Health Care	Clarks Summit	$1,737,160	Personal care
Compass Adult Programs	Carbondale	$525,731	ABA therapy

To be clear: billing these codes is not inherently fraudulent. ABA therapy is a legitimate and important treatment for children with autism. Personal care services are essential for homebound patients. What draws scrutiny is the volume, growth rate, and billing patterns relative to the provider's size and location.

The Standout: Bright Beginnings Therapeutic Services

One provider accounted for more than 60% of the total: Bright Beginnings Therapeutic Services, LLC, registered at 41 North Main Street, Suite 310, in Carbondale.

The company was founded in 2017 and registered its NPI in April 2018. On LinkedIn, it lists 2 to 10 employees. It provides ABA therapy for children with autism ages 2 through 21.

According to the Medicaid data, Bright Beginnings billed $46.7 million from November 2020 through December 2024. Here's the yearly trajectory:

2020 (two months): $153,206
2021: $2,212,649
2022: $9,128,777
2023: $13,493,054
2024: $21,767,620

That's a growth rate of over 14,000% in four years. Their peak month was October 2024 at $2.58 million.

Nationally, there are 3,032 providers billing ABA therapy codes to Medicaid. Bright Beginnings ranks 21st in the entire country. The 20 providers above them are large multi-state healthcare organizations. The national median for an ABA provider is about $291,000 in total billings. Bright Beginnings billed$ 46.7 million.

Questions the Data Raises

Several aspects of the billing patterns stand out.

Missing servicing providers. Every Medicaid claim should identify both the billing entity and the provider who actually delivered the service. For Bright Beginnings, 75% of claims - $34.9 million - have no servicing provider NPI listed. Nationally, only about 12% of claims in these code categories have that field blank. For 75% of Bright Beginnings' billings, there is no record in this data of who actually provided the therapy.

Scale relative to location. Carbondale has a population of roughly 8,600. Lackawanna County has about 215,000. Even accounting for a service area that extends beyond the county, the billing volume is extraordinary for the geography.

Billing structure. All $46.7 million flows through a single NPI that has been registered to the same Carbondale address since 2018 and has never been updated. The company is also listed in Philadelphia's behavioral health provider directory under the name "Attain ABA Therapy," which is a national ABA company based in New Jersey. However, Attain ABA's regional entities bill under their own separate NPIs elsewhere - the Philadelphia billing relationship with Bright Beginnings' Carbondale NPI is unusual.

Code concentration. 68% of billings are for code 97153 - direct one-on-one ABA therapy delivered by a behavior technician. This is billed in 15-minute units. At $228 per claim, the volume implies a large workforce of technicians delivering thousands of hours of therapy per month. This is the same code that dominated the fraudulent billing in the Minnesota cases.

Doing the Math: How Many People Does This Require?

This is where the numbers get hard to reconcile.

ABA therapy code 97153 is direct, one-on-one therapy. One technician sits with one child for the session. You cannot bill 97153 without a human being in the room. So the dollar volume directly implies a specific workforce size.

In 2024, Bright Beginnings billed ** $14.9 million** in 97153 alone. Pennsylvania Medicaid reimburses 97153 at roughly$ 18 to $22 per 15-minute unit, depending on the managed care plan. Using$ 20 per unit as a midpoint:

$14.9 million /$ 20 per unit = roughly 746,000 units of therapy in 2024
At 15 minutes each, that's approximately 186,000 hours of one-on-one therapy
Over 260 working days, that averages 718 hours of therapy being delivered every single working day

A full-time Registered Behavior Technician works about 8 hours a day. After travel time, documentation, and breaks, a productive RBT bills about 6 hours of direct therapy per day. That means Bright Beginnings would need roughly 120 behavior technicians working full-time every day to generate the 97153 volume they billed in 2024.

On top of that, they billed $5.1 million in code 97155 - that's BCBA supervision, which requires a Board Certified Behavior Analyst. At roughly$ 25-30 per unit, that implies about 45,700 hours of BCBA supervision in 2024, requiring approximately 29 full-time BCBAs.

In their peak month - October 2024 - the math is even steeper. They billed $1.8 million in 97153 alone. That translates to roughly 22,500 hours of therapy in a single month, or about 976 hours per day. At 6 billable hours per technician per day, that's 163 behavior technicians needed on any given workday in October. Add in the BCBAs for supervision and you're looking at north of 200 clinical staff needed that month.

Their LinkedIn page says 2 to 10 employees.

Now, LinkedIn employee counts can be outdated or inaccurate. And it's possible the company has grown far beyond that self-reported number. But there should be a visible footprint for a clinical workforce of 150 or more - office space, hiring records, credentialing paperwork, supervision logs. ABA technicians in Pennsylvania require registration with the Behavior Analyst Certification Board. BCBAs require a graduate degree, supervised fieldwork, and board certification. These aren't positions you can quietly staff with warm bodies.

Unless you do what the Minnesota fraud operations did: hire unqualified workers - often teenagers or family members of the patients - list them as "behavior technicians," and bill Medicaid for sessions that either never happened or consisted of untrained individuals babysitting. In those cases, the companies were submitting thousands of claims per month for therapy that existed only on paper.

We are not saying that is what's happening here. We are saying the billing volume requires a workforce that doesn't appear to match the company's visible footprint, and that this specific mismatch is the defining characteristic of the ABA fraud cases that have been prosecuted elsewhere.

For what it's worth, the per-patient numbers are within a clinically plausible range. In October 2024, Bright Beginnings served 417 patients through 97153, averaging about 54 hours per patient for the month, or roughly 12.5 hours per week. That's consistent with a focused ABA program (intensive programs run 25 to 40 hours per week). The question isn't whether 12 hours a week of ABA therapy is reasonable for a child with autism. It is. The question is whether 417 children are actually receiving it, from actual qualified technicians, through an operation based in a small suite in Carbondale.

The Bigger Picture

This is not just a Lackawanna County story. ABA therapy Medicaid spending has exploded nationally. Indiana's ABA spending grew from $21 million in 2017 to$ 611 million in 2023 - a 2,800% increase. When the HHS Office of Inspector General audited Indiana's ABA payments, they found that every single sampled claim contained improper payments, totaling at least $56 million. A similar audit in Wisconsin found the same - 100% improper payment rate, at least$ 18.5 million.

Pennsylvania's Attorney General filed more Medicaid fraud charges than any other state in 2024. The HHS Inspector General has an active audit work plan for ABA therapy in additional states.

The Minnesota fraud cases that DOGE HHS referenced in their announcement involved companies that hired unqualified individuals as behavior technicians, paid parents monthly cash kickbacks to enroll their children, and billed for services that were never provided or were drastically inflated. Multiple prosecutions are ongoing.

What This Is and Isn't

This is a data analysis based entirely on publicly available federal records. We are not alleging that any of the providers identified have committed fraud. We do not have access to patient records, therapy logs, staffing documentation, or any internal business records. There may be legitimate explanations for the patterns we observed.

What we are reporting is that the data contains statistical anomalies that match the patterns federal agencies have specifically identified as fraud indicators in ABA therapy billing nationally. The DOGE HHS team released this data with the explicit purpose of enabling this kind of public analysis.

The Other Flagged Providers

While Bright Beginnings was the largest, the other five providers also showed patterns worth noting.

Caregivers America Home Health Services (Clarks Summit) billed $8.2 million exclusively in personal care services code T1019, serving only 1,673 beneficiaries - a cost of$ 4,919 per patient. They were active for only 17 months before the claims stopped. 94% of claims were self-referred.

Bayada Home Health Care (Clarks Summit) shows a similar pattern - $1.7 million in T1019, only 419 beneficiaries at$ 4,146 each, 100% self-referred, active only 16 months.

Family Enrichment Center (Scranton) billed $11.7 million across six ABA and behavioral health codes. Their volume is more consistent over time and their per-claim costs, while above the national mean, are within a less extreme range.

Friendship House (Scranton) billed $6.9 million across eight codes, with 590% growth in its first year of billing these codes.

What Happens Next

The data is public. Our analysis code is available for anyone to review or replicate. The dataset can be downloaded from the HHS open data portal.

If you have information about any of the providers discussed in this analysis, the Pennsylvania Attorney General's Medicaid Fraud Control Section can be reached at 717-787-4530. The HHS Office of Inspector General fraud hotline is 1-800-HHS-TIPS.

All analysis was performed on the publicly available DOGE HHS Medicaid Provider Spending dataset. Provider information was cross-referenced with the NPPES National Provider Registry.