Part I: A Solopreneur Business Plan for Building Medicaid Fraud Detection Software Aimed at the Early Intensive Developmental and Behavioral Intervention Autism Scam

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.Subscribe to www.onhealthcare.tech for free and paid articles, podcasts, and more. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.onhealthcare.tech/subscribe