03/21/2026
When Meghann Mitchell first launched her autism-therapy business in 2019, she took aim at an unlikely source of profit: Indiana’s taxpayer-funded Medicaid program, the public insurance system for the poor.
The bet paid off. In 2023, the state paid Mitchell’s company, Piece by Piece Autism Centers, $29 million to provide therapy to just 84 patients—about $340,000 a child—according to a Wall Street Journal analysis of Medicaid billing records.
That amount surpassed what Indiana Medicaid typically spends in a year treating a newly diagnosed lung-cancer patient or covering a year of nursing-home care.
Piece by Piece became one of Medicaid’s most expensive providers in part by raising its prices, triggering reimbursements as high as $640 an hour for routine therapy that can be administered by workers with little more than a high-school diploma. Its highest payments were more than 10 times higher than the nation’s average.
Mitchell said her company complied with Indiana’s rules and the state never objected to her prices.
“I don’t think Indiana really had any oversight, or not much,” said Mitchell, who bought a series of properties, including a $2.5 million home on Florida’s Sanibel Island and a $600,000 waterfront house on the Tippecanoe River in Indiana, while her company’s Medicaid billings soared.
The business of providing therapy to children with autism has surged in recent years across the U.S., fueled by taxpayer-funded Medicaid payments.
Some companies have found lucrative opportunities to capitalize on the growing need for such care, sometimes outpacing regulators’ oversight, the Journal’s analysis found.
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