This post summarizes publicly reported allegations. No court has made final findings. Treat everything below as allegation and reporting—not legal fact.
Why this story matters to ABA practice leaders
Late August 2025 brought a headline that quickly moved through ABA Business News feeds: Publix Super Markets and ABA Centers of America filed dueling lawsuits over payment for out-of-network applied behavior analysis (ABA) services. Publix filed a federal complaint alleging fraudulent billing; ABA Centers filed in state court alleging non-payment for authorized claims. For ABA Practice Owners , the dispute surfaces practical questions about billing integrity, documentation, and how to protect...
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families when payer conflicts erupt.
The allegations—at a glance
In its federal suit, Publix claims ABA Centers submitted inflated claims , used improper coding , and failed to meet requirements around medical necessity and prior authorization . The complaint cites examples alleging bills of approximately $500 per 15-minute unit (vs. reported network averages around $13 ) and instances as high as $990 per 15 minutes —nearly $4,000 per hour —compared with network averages quoted at $21.90 to $88 per hour (source: Behavioral Health Business coverage, linked below).
On the same day, ABA Centers of Florida filed its state suit in Broward County seeking full payment for allegedly underpaid or unpaid out-of-network services for ten children covered under Publix’s benefits. Their statement says services began in 2022, partial payments flowed until October 2024, and care has continued “in the interest of caring for children with autism” despite non-payment (see BHB link below).
Important: These claims are allegations , not findings. The federal court dismissed Publix’s original complaint as a “shotgun pleading” and granted leave to amend by September 11, 2025. The state action by ABA Centers remains active.
What “out-of-network” usually looks like in ABA
In day-to-day consulting with ABA practices, out-of-network care typically runs through a Single Case Agreement (SCA) . In an SCA, the payer authorizes services for a specific member at the funder’s established rates —not at a provider’s chargemaster rates. It’s a practical bridge when the network lacks capacity or a specialty match.
- Rates: The provider generally accepts the plan’s rate (or a negotiated SCA rate).
- Member cost sharing: Families may still face higher deductibles or coinsurance out-of-network, but they are typically not exposed to the provider’s full billed charge if an SCA is in place.
- Documentation: SCAs spell out codes covered, units, time frames, and authorization/renewal rules.
That’s why the allegations of charges approaching $4,000/hour immediately raise practical questions: Were SCAs in place? If so, at what rate? And what did families owe out-of-pocket if the payer didn’t pay? While we don’t have those answers from the filings, they’re central to the business and ethical analysis for any ABA organization working out-of-network.
Families caught in the middle
Payer-provider conflicts often spill risk onto families. If claims are denied, there is at least an appeal pathway. If claims are not processed (sometimes called “ghosting” in broader payer-behavior discussions) or are left in extended “pend” status, families can be left in limbo:
- Will care be covered after all?
- Are we accruing balances we won’t be able to pay?
- Will our child be discharged if payment never comes through?
ABA Centers states it continued treating children of Publix employees despite non-payment. That continuity supports clinical stability—but it magnifies financial exposure if reimbursements don’t arrive. It’s a stark reminder for providers to communicate clearly with families about financial responsibility and to keep authorizations, coverage checks, and SCA terms in writing.
The court posture (as of publication)
According to the federal docket, the Middle District of Florida dismissed Publix’s initial complaint as an impermissible “shotgun pleading” and gave Publix until September 11, 2025 to file an amended complaint. If the amended complaint repeats the same pleading issues or isn’t filed, the case could be dismissed without further notice.
The state case filed by ABA Centers of Florida remains active and seeks full payment, 12% per-annum interest, attorney’s fees, and recognition as a third-party assignee for out-of-network payments (per BHB coverage). Again, none of this has been adjudicated; these are allegations and stated positions.
How much would families pay if charges were that high?
The public reporting quotes allegations of charges near $4,000 per hour . In typical ABA operations:
- With an SCA , families usually owe out-of-network deductibles/coinsurance based on the SCA rate , not on the provider’s list price.
- Without an SCA , families may be exposed to balance bills if the plan pays less than the billed charge—or denies/doesn’t process the claim. Many providers cap or discount balances to protect families, but policies vary.
We don’t have line-item detail for the Publix matters (what was contracted, what was authorized by code/unit, or how member benefits applied). That’s precisely why transparent SCA terms, pre-treatment financial counseling, and written financial policies matter. They reduce shock for families and provide a paper trail if disputes escalate.
Compliance and reputation: the real business risk
Whether or not a court ultimately sides with a payer or a provider, the reputational stakes are real. Headlines about billing many multiples above market averages—even if defensible in context—create payer skepticism and family anxiety. For leaders, three disciplines are non-negotiable:
- Defensible rate strategy. Know your market benchmarks. If you bill out-of-network above network norms, document why (e.g., specialized staff credentials, rural travel, intensive supervision). Avoid “set-and-forget” chargemasters detached from payer reality.
- Rock-solid documentation. Authorization records, medical necessity rationales, treatment plans tied to target behaviors, accurate time/unit capture, and compliant coding. If it’s not documented, it didn’t happen.
- Proactive payer relations. If issues arise, escalate early and in writing. Keep timelines of calls, emails, and portal messages. When appropriate, work toward an SCA rather than relying on pure out-of-network submissions.
Rapid growth vs. sustainable growth
ABA Centers has been profiled for extraordinary growth—Inc. 5000 rankings and massive revenue expansion. Rapid out-of-network scaling can work in the short term, but it often invites payer scrutiny and public disputes. Many ABA organizations choose the slower path—in-network contracting, rate negotiations, and Billing for ABA Services systems that trade peak revenue for stability, auditability, and long-term trust.
For most practices, especially those led by clinician-founders, sustainable growth looks like:
- Right-sizing rates to the market and building a Rate Negotiations in ABA playbook.
- Standing up revenue-cycle controls: eligibility, benefits checks, authorizations, coding QA, denial management.
- Limiting balance-bill exposure and giving families clear, written financial expectations.
Key takeaways for ABA practice owners
- Everything here is alleged. The federal complaint was dismissed (with leave to amend); the state case continues. No final decisions have been made.
- SCAs are your friend out-of-network. They typically anchor payment to funder rates and shield families from list-price exposure.
- If you bill above benchmarks, expect scrutiny. Have a documented rationale and ensure coding and time capture are bulletproof.
- Communicate with families. Offer pre-treatment financial counseling and written policies to avoid surprises.
- Document, document, document. The strongest courtroom arguments start with the cleanest administrative records.
Final word
However these cases unfold, the message to the field is consistent: your billing model is not just a back-office choice—it shapes payer trust, family experience, and your brand. If you operate out-of-network, lead with SCAs, clarity, and compassion. That’s how ABA Practice Owners build durable businesses that serve families well—no matter what makes headlines.
