Piece by Piece Autism Centers will close by mid-May after Indiana barred the firm from billing Medicaid, marking the end of the nation's costliest autism therapy provider. The company received $340,000 in Medicaid payments per patient in 2023, the highest rate in the country, according to billing records. The closure follows revelations that Piece by Piece had extracted excessive payments by inflating list prices to as much as $640 per hour for services often performed by high-school graduates.

Once Piece by Piece ceases operations, its centers will be taken over by Applied Behavior Center for Autism, a rival provider that settled federal civil fraud allegations over billing issues just three years ago. From 2019 to 2023, Indiana directly paid Piece by Piece $58 million for autism-therapy services. State officials have accused the company of abusing the taxpayer-funded Medicaid program for low-income individuals through its aggressive billing practices.

The shutdown highlights ongoing concerns about oversight in the fast-growing autism therapy sector. Piece by Piece's business model, which involved charging rates far exceeding industry norms, outpaced regulators and drew scrutiny from federal investigators. The transition to Applied Behavior Center raises questions about continuity of care for families who relied on Piece by Piece's services, particularly given Applied Behavior Center's own history of billing disputes.