ABA Centers of America is fighting lawsuits from two major health plans — Point32Health and Publix — that accuse the autism therapy provider of fraudulent out-of-network billing, inflated claims, and waived patient cost-sharing, with counterclaims and amended complaints together seeking tens of millions of dollars. The Fort Lauderdale company has also lost Optum as a payer and laid off staff in June 2026. It denies all wrongdoing.
Point32Health’s $19 Million Fraud Counterclaim
ABA Centers sued Point32Health and its subsidiary Harvard Pilgrim Health Care on December 31, 2024, in Suffolk County Superior Court in Massachusetts. The company alleged the insurer parked authorized claims in indefinite “pend status” without formally denying them, withholding payment on ABA therapy services since December 2023, and it sought $80 million while accusing Point32Health of maintaining a “ghost network” of autism providers.1Behavioral Health Business. ABA Centers of America Sues Point32Health for Payer Ghosting, Underpayment The case is before Judge Jackie A. Cowin.2Trellis Law. ABA Centers America LLC vs. Harvard Pilgrim Health Care Inc. et al.
On November 12, 2025, Point32Health countersued for more than $19 million, filing nine counts including fraud, fraud in the inducement, violations of Massachusetts health insurance and consumer protection laws, tortious interference, negligence, unjust enrichment, and breach of contract.3Acuity News. Point32Health ABA Centers of America Fraud Lawsuit $19 Million
The specific allegations are unusually granular. Point32Health claims ABA Centers billed more than $137,000 for non-therapeutic activities including movie screenings (with cited titles “A Bug’s Life,” “Bee Movie,” and “Super Mario Brothers”) and a trampoline park outing. The insurer alleges upcoding as well: use of billing code 0373T (adaptive behavioral treatment with protocol modification) to bill $1.9 million for one patient, despite what Point32Health says was a failure to meet that code’s clinical requirements, which include an on-site physician and a controlled clinical environment.
The counterclaim also alleges the company manufactured the appearance of a network shortage. Newly hired Board Certified Behavior Analysts were, per the filing, required to de-credential from the Point32Health network as a condition of employment, which helped justify out-of-network rates the insurer says reached “up to 2,015 percent above standard in-network fees.” Staff were allegedly coached to place scripted calls to in-network providers designed to produce responses suggesting those providers were unavailable, and those calls were then used to support authorization requests.
Point32Health further alleges the company waived patient copays and deductibles through payment plans as low as $1 a month while representing to the insurer that patients had met their cost-sharing obligations, conduct the filing characterizes as a potential kickback violation under Massachusetts law. The counterclaim describes an assembly-line diagnostic operation in which “Diagnostic Technicians” conducted autism evaluations and supervising psychologists signed off on as many as 80 assessments a week without meeting patients in person. It also alleges the company sorted patients into “super payer,” “mid-range payer,” and “scholarship payer” tiers, with lowest-tier patients facing discharge risk based on profitability.3Acuity News. Point32Health ABA Centers of America Fraud Lawsuit $19 Million
Dueling Publix Lawsuits
ABA Centers and Publix Supermarkets sued each other on August 25, 2025, in separate courts.4Behavioral Health Business. ABA Centers of America Sues Publix Publix operates self-funded employee health plans, and the dispute involves therapy provided to ten children of Publix employees, ages 4 to 17.
ABA Centers filed in Florida’s 17th Judicial Circuit Court in Broward County, seeking full payment for underpaid or denied claims, 12 percent annual interest, and attorney’s fees. The company said it had received prior authorizations for out-of-network services and partial payments until October 2024, when Publix stopped paying.
Publix sued in the U.S. District Court for the Middle District of Florida, alleging more than $7 million in fraudulent billing. The grocer cited rates as high as $990 for a 15-minute increment of therapy, or roughly $4,000 an hour, against a network average of $21.90 for the same 15-minute unit ($88 an hour). Publix called the arrangement a “purely profit-driven scheme” and “price gouging.”
Federal Judge Kathryn Kimball Mizelle dismissed Publix’s initial 27-page complaint as a “shotgun pleading,” a term for a filing so disorganized the defendant cannot reasonably respond. Publix then filed a 221-page amended complaint with exhibits and raised claimed damages to $15 million.5Yahoo News. Publix Autism Therapy Firm War The amended filing alleges ABA Centers did not collect patients’ copays and deductibles and made up the difference by overbilling Publix. Some patients told Publix they had not paid “even $1” toward cost-sharing, even though the company’s billing indicated those obligations had been met. The complaint also alleges duplicate payment requests for the same therapy sessions and billing for services that never occurred or were not covered. Publix reported paying at least $5.8 million to ABA Centers over the two years ending in October 2024 before it says the alleged fraud was detected.
Both Publix cases remain pending.
Optum Break and Layoffs in June 2026
In June 2026, ABA Centers began notifying families covered by Optum, a UnitedHealth Group subsidiary, that it could no longer see certain Optum-managed patients. Discharge notices set an effective date of June 5, 2026.6Acuity News. ABA Centers of America Optum Discharges Fraud Litigation Sources close to the matter indicated Optum would no longer engage with the company. Neither side publicly detailed the reasons, and the number of affected patients and staff is not clear.
The loss of Optum triggered layoffs. The company did not disclose numbers, but workers in “varied roles” reported their positions were eliminated. A company spokesperson attributed the cuts to routine restructuring: “As part of the normal course of business, we regularly evaluate our organizational needs and make adjustments as necessary.”7Behavioral Health Business. ABA Centers of America Lays Off Staff The spokesperson added that the company continues “to operate business as usual and remain focused on providing rapid access to high-quality autism care for the families we serve.” No public litigation has been reported between ABA Centers and Optum.
The Billing Model at the Center of the Disputes
All three payer disputes turn on the same feature of the company’s business. ABA Centers does not join insurer networks at negotiated rates. It treats patients on an out-of-network basis and uses single-case agreements with commercial payers, charging rates that far exceed what in-network providers receive.8Behavioral Health Business. ABA Centers of America To Double Its Footprint Without PE Backing Point32Health’s figure of rates “up to 2,015 percent above standard in-network fees” and Publix’s $4,000-an-hour example both describe that model in practice, and both insurers’ cost-sharing-waiver allegations describe the same alleged mechanism for making high out-of-network bills palatable to patients.
Where the Cases Stand
ABA Centers of America has denied all allegations of fraud and wrongdoing in every proceeding. Its suit against Point32Health and the insurer’s $19 million counterclaim are active in Massachusetts Superior Court, with no publicly reported rulings on motions as of mid-2026.3Acuity News. Point32Health ABA Centers of America Fraud Lawsuit $19 Million The Broward County suit against Publix and Publix’s amended federal complaint in the Middle District of Florida are both pending. The Optum relationship appears severed. The company continues to operate clinics across multiple states.