State and federal taxpayers spent $10 billion on applied behavior analysis in 2025
The FBI is investigating the billing practices of the Perfect Child, a Brooklyn, N.Y.-based autism therapy provider, according to documents and people familiar with the probe. Agents from the Pittsburgh field office, which is conducting the investigation, have contacted some of the company’s clients in recent weeks.
The investigation follows a Wall Street Journal account detailing how Perfect Child charged rates that could soar beyond $30,000 a day for therapy services, assured patients they would face little or no out-of-pocket costs and then sought to collect alleged debts, including through lawsuits. In one case, New Jersey woman Carolina Lopez was billed $911,000 after Highmark balked at the bills.
In September, agents interviewed Lopez, and in October, the FBI obtained documents including some of Perfect Child’s bills and other records, according to an email and people familiar with the matter. Lopez, who has since moved to another state, said FBI personnel asked her not to publicly discuss the matter.
The FBI has investigated Perfect Child before, according to former employees who told the Journal they were interviewed by agents in 2023 about its business practices. In 2024, the FBI contacted parent Mike Wu after his insurer, a unit of UnitedHealth Group, determined the company might have forged his signature on an appeal of denied claims, according to Wu and court records. Perfect Child subsequently sued Wu to collect about $20,000; Wu said he later settled with the company.
Alan Schabes, a Cleveland lawyer who said he represents Perfect Child, declined to comment, saying his client would not authorize him to speak on the record. Perfect Child owner Simcha Bendet did not respond to requests for comment. The company continued to operate and bill clients, and it sued at least five patients’ families last week in a New York court. A spokesman for the FBI’s Pittsburgh field office also declined to comment.
The investigation runs alongside reviews by insurers. FBI agents met with representatives of Highmark, a Pittsburgh-based insurer, in late July, according to an email viewed by the Journal and the people familiar with the probe. The insurer’s investigators relayed detailed information about Perfect Child’s practices to the FBI team, the email said. People familiar with the matter said Elevance Health and Aetna also have been investigating the company.
Separately, the House Committee on Education and Workforce sent Perfect Child a letter in July seeking documents about its billing and collection practices. The letter said the committee was “investigating whether certain reimbursement arrangements within the autism therapy industry have contributed to excessive health care costs.” Committee staff have interviewed parents of former Perfect Child patients in recent weeks.
Spending on applied behavior analysis, or ABA as the autism therapy is called, has soared in recent years, the Journal reported. An August report by the federal Centers for Medicare and Medicaid Services showed that state and federal taxpayers spent $10 billion on the services in 2025, up from $2 billion in 2021. In a video announcing the report, agency administrator Mehmet Oz cited Lopez’s experience as an example of abuse in the industry.
Autism therapy consists of therapists working one-on-one with patients at home or in centers and might involve practicing chores, communication and social interaction, the Journal reported. In many states, applied behavior analysis companies face little oversight and there are few barriers for entry.
There is no law limiting how much health care providers can bill insurers and patients for many outpatient services, the Journal reported. Perfect Child did not participate in most insurers’ networks, meaning no contracts governed its rates.
In some cases, the company billed for services parents say were never provided. Last year, it billed Marlene Rosario’s insurer for $20,000 worth of therapy it claimed to provide to her son on Feb. 27 and Feb. 28. A couple of days earlier, Rosario, who lives in Lakeland, Fla., had texted Perfect Child from an urgent care where she was diagnosed with pneumonia to cancel services for the entire week; text messages and medical records show. A Perfect Child representative replied, agreeing to reschedule for early March.
Perfect Child later billed Rosario for more than $1 million for treatment provided to her two sons, despite telling her in earlier emails that she would pay no more than $100 a year even if her insurer denied claims.
In August, Tennessee woman Kirsten Messier received a bill for nearly $1.5 million for about a year of treatment for her daughter, along with a demand that she sign over power of attorney to Perfect Child so it could sue her insurer in her name or face legal action to collect the full amount from her family. Messier declined to sign but kept using the company’s services for weeks because she could not find another provider in her rural area. In a September interview before parting with the company, Messier said, “In my head, I know I need to stop,” before adding, “but it’s my kid, what am I supposed to do?”
Earlier this year, a Perfect Child collections manager emailed a patient’s parent, threatening to report her if she did not pay nearly $20,000 by the end of that week. The email said: “This involves opening an FBI case against you. I suggest you do your research on the consequences.”
Reporter biography: Christopher Weaver is a reporter at The Wall Street Journal. He joined the Journal in 2011 to cover U.S. healthcare companies before moving to the investigations team in 2016. He has reported on the pharmaceutical gray market, the implosion of Healthcare.gov, Medicare fraud, the blood-testing company Theranos, abuses at the U.S. Indian Health Service, failures of nursing homes during the Covid pandemic and safety violations in commercial trucking, among other topics.
Christopher Weaver was a member of the Journal team that won a 2015 Pulitzer Prize for investigative reporting and the team that was a 2021 Pulitzer finalist for national reporting. He is a graduate of Tulane University and the University of Maryland and began his career working with nonprofit healthcare providers in New Orleans. He has taught at the Columbia University Graduate School of Journalism since 2015.
Christopher Weaver lives in New Jersey with his wife, two children and four cats.