We’ve all heard the story.
A parent walks into your ABA clinic confused and frustrated. They just met with another provider—a large, well-known organization promising ABA therapy at no out-of-pocket cost. “They said we don’t have to pay the deductible,” the parent explains, expecting you to match the offer. When you show them the actual patient responsibility based on your billing system and insurance contracts, the conversation shifts from care to cost.
Welcome to one of the most complicated—and legally risky—topics in ABA business news today.
For ABA practice owners, especially those running ethical, sustainable clinics, the idea of waiving...
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deductibles sounds tempting. It feels like a way to compete with big-box companies. But if you’re not careful, it could put your entire business at risk. This article breaks down the legal implications, provides links to real enforcement actions, and gives ABA business leaders the language and tools to ask the right questions before making risky decisions.
Disclaimer: This article is for educational purposes and is not legal advice. Always consult a qualified healthcare attorney before changing your billing or patient responsibility policies.
Understanding the Legal Risk
Here’s what every ABA company owner should understand: routinely waiving deductibles or copays without documented financial hardship can violate federal and state laws. Yes, even with private insurance. This isn’t just about Medicare or Medicaid anymore.
- False Claims Act (FCA): Submitting a claim to a payer while waiving the patient’s financial responsibility—without documented hardship—may be considered fraud. It creates the appearance that the service was provided under full terms when it wasn’t.
- Anti-Kickback Statute (AKS): If you waive fees to attract or retain clients, especially if referrals are involved, you might trigger scrutiny under AKS—even more so in federally funded programs.
- Private Insurance Contract Violations: Many ABA providers overlook this, but most payer agreements prohibit routine waiver of patient costs. Violating these terms can result in clawbacks, audit risks, and network termination.
You can explore the actual guidance here:
- Maryland OIG Waiver Memo
- OIG Advisory Opinion No. 97-1
- Jackson LLP Legal Insight
- Whistleblower LLC Enforcement Breakdown
“But Everyone Else Is Doing It”: The Competitive Pressure Facing Small ABA Practices
If you’re trying to start an ABA company—or grow an existing one—you’ve probably felt the pressure to “compete” with larger providers. These organizations often operate with massive marketing budgets, automated HR systems, and billing departments that seem to bend the rules without breaking them.
So when a parent tells you another clinic waived their entire deductible and offered a quick intake without even mentioning cost, it stings. You’re left wondering: Are they really allowed to do that? And how are we, as small and mid-sized ABA business owners, supposed to keep up?
Here’s the hard truth: what looks like a generous discount may actually be a compliance red flag. And while it may win clients in the short term, it puts that clinic—and potentially their funding—at serious long-term risk. That’s not just speculation. There are documented enforcement cases where health systems were penalized for systematically waiving cost-sharing to boost patient volume.
And let’s not forget: this isn’t just a billing issue—it’s an ethics issue.
If you’re a BCBA®, your commitment to ethical practice includes adhering to signed payer agreements. The BACB’s Ethics Code for Behavior Analysts (1.01 Being Truthful) requires practitioners to honor contractual obligations and maintain the integrity of funding sources. Choosing to ignore a contract’s terms, even under pressure to stay competitive, can be considered a breach of ethical responsibility.
In a compliance-driven industry like healthcare, short-term wins can lead to long-term consequences. For providers navigating ABA billing training, rate negotiations, and the complex world of payer contracts, there’s simply too much on the line.
⚠️ Reminder: The terms you agreed to in your contracts likely require you to collect copays and deductibles unless a family meets documented hardship criteria. If you skip that step, you may be breaching your agreement—and your ethical duties—even if you believe you’re doing it for the right reasons.
This isn’t just about legality. It’s about sustainability, ethics, and your reputation in the community. If a funder audits your practice and finds you’ve waived cost-sharing without a documented reason, you may be required to repay reimbursements—or face removal from the network.
Instead of chasing the competition’s shortcuts, ABA practice owners should focus on tools and resources that reinforce trust and transparency. Things like well-crafted ABA employee handbooks, clear financial policies, and caregiver education scripts can help level the playing field.
How This Impacts Your Bottom Line: Clawbacks, Audits, and Burnout
At first glance, waiving deductibles might seem like a marketing tactic. But when you step back and look at the financial and operational consequences, the real cost becomes clear—and it’s steep.
Clawbacks and Recoupments
If a payer determines you waived cost-sharing without proper documentation, they may demand repayment for claims previously reimbursed. This process—called a clawback—can hit months (or even years) of payments, draining cash flow and jeopardizing payroll. Some ABA business owners don’t even find out until they get a letter demanding tens of thousands of dollars back.
Increased Audit Risk
Once a payer sees irregularities, it often triggers a deeper audit. And let’s be honest: audits are time-consuming, expensive, and emotionally exhausting. Whether you’re new to running an ABA company or a seasoned ABA practice owner, the stress alone can ripple through your leadership and affect your entire team.
Damage to Payer Relationships
Waiving copays without proper justification doesn’t just risk contract violations—it can permanently damage relationships with funders. If you’re pursuing rate negotiations in ABA or hoping to expand in-network contracts, that history matters. One misstep could limit your options down the road.
Internal Burnout from Chasing Revenue Gaps
Here’s something most people don’t talk about: when you waive deductibles or copays, you’re effectively lowering your reimbursement rate. Unless your expenses also drop (they won’t), this loss has to be made up somewhere—often by increasing caseloads, rushing sessions, or pushing staff harder. Over time, that culture of burnout erodes your quality and reputation.
🧩 Want to learn more about optimizing your billing strategy ethically? Check out our ABA Billing Training for real-world solutions that don’t cut corners.
When viewed through the lens of sustainability, waiving cost-sharing routinely isn’t a smart move—it’s a slow bleed. As ABA business news continues to highlight the challenges of funding instability, ethical providers must focus on clarity, consistency, and compliance if they want to build a resilient future.
When “Compassion” Becomes Coercion: Why Transparency Is More Ethical Than Discounts
Let’s be real: many ABA business owners got into this field because we care. We want to help families. We want to remove barriers. So when a parent flinches at their deductible or coinsurance, it’s tempting to say, “Don’t worry about it.” But here’s the uncomfortable truth: waiving patient responsibility under the banner of compassion can sometimes cross the line into coercion—even if it’s unintentional.
Financial Confusion Undermines Trust
Parents already face a confusing maze of insurance terms, treatment plans, and funding decisions. When one provider says, “You’ll owe $0,” and another sends a clear, accurate cost estimate, families don’t always understand why. That confusion can feel like a bait-and-switch, even if you’re doing everything right.
Being transparent isn’t always easy—but it’s ethical. When you walk parents through their ABA billing responsibilities with clarity and respect, you empower them to make informed decisions. That’s not just good business—it’s trauma-informed, family-centered care.
Discounts as Pressure Tactics
Some large providers advertise “no out-of-pocket costs” as a selling point. But here’s the issue: if that promise wasn’t made in writing by the insurance company, it may not be legally allowed—and it can push families into decisions based on distorted information.
For parents comparing options, a waived deductible might sound appealing. But what they’re really choosing is a provider who might be violating payer contracts or skirting the law. That puts the family—and the continuity of their child’s care—at risk.
Compassion ≠ Concessions
Let’s shift the narrative. Compassion in ABA isn’t about bending the rules. It’s about providing high-quality ABA services, maintaining professional ethics, and helping families understand how to access care sustainably.
✅ Need help explaining costs clearly during intake? Our ABA Practice Handbooks include customizable scripts and workflow tools for setting up ethical financial conversations from Day 1.
When you honor contracts, uphold transparency, and prioritize client-centered care, you’re not being rigid—you’re modeling what sustainable, ethical ABA looks like.
Building an Ethical, Sustainable Practice: What ABA Business Leaders Can Do Right Now
If you’ve read this far, you probably care deeply about doing things the right way. You’re not just trying to grow your ABA company—you’re building something ethical, something sustainable, something that actually helps families thrive. So how do we navigate a system where some providers cut corners, while you’re trying to do what’s right?
Here’s what ABA practice owners, directors, and startup founders can start doing today:
- Revisit Your Contracts and Policies If you haven’t looked at your payer contracts recently, now is the time. Many explicitly prohibit routine waivers of patient responsibility unless there’s documented financial hardship. As a BCBA, supervisor, or owner, you’re bound by both the BACB Code of Ethics and the agreements you’ve signed. If you’re unsure what’s in those contracts—or how they interact with your intake process—our ABA Practice Handbooks break it down step-by-step.
- Train Your Team on Ethical Billing Whether it’s intake coordinators, billing teams, or even clinical staff, your entire organization should understand why you don’t waive deductibles or copays. Make sure your team can explain this clearly to families—with empathy and professionalism. If you need help getting started, our ABA Billing Training Course walks through billing for ABA services, ethical decision-making, documentation, and real-world case examples. It’s built for ABA business owners who want to lead with clarity.
- Use Financial Transparency as a Strength Families appreciate honesty—even when the news isn’t what they hoped to hear. When you explain costs up front, give realistic expectations, and offer financial guidance (within ethical limits), you build trust. You stand out. You can also point families to official statements about billing law and patient responsibility, like:
- Speak Up—Even When It’s Uncomfortable If you see providers advertising waived deductibles as a benefit, report it. Speak with payers. Educate families. And share your concerns publicly through ABA business news, community forums, and professional networks. This isn’t about calling people out—it’s about raising the standard across our field. Because if we let unethical practices slide, we all pay the price: lost trust, lower reimbursement, and a system that prioritizes volume over value.
Final Thoughts
It’s tough out there. We get it. Running an ABA practice is hard enough without competing against companies that bend the rules. But you’re not alone. And you’re not wrong for doing the right thing.
Being a true ABA business leader means holding the line—even when it’s not easy. It means building with ethics, advocating for fairness, and remembering why we’re here: to help families, serve our clients, and leave the field better than we found it.
If that’s your mission, we’re here to support it.
