How behavior analyst Samantha Parnham came to investigate ABA Centers of America, what she has documented, and where Reinforcement and Ruin goes next.
Samantha Parnham did not set out to become an investigator. A Board Certified Behavior Analyst since 2015, she runs a small applied behavior analysis (ABA) practice in Oregon, raises a child on her own, and lives behind a fence on two acres with rescue dogs and an alarm system she is quick to say she does not really need. She arrived at investigating by way of a word she never expected to meet in her corner of pediatric health care: racketeering.
The word turned up in a headline last year, attached to a company called ABA Centers of America, and Parnham (who happens to hold two degrees in criminal justice alongside her clinical ones) waited for someone better resourced to chase it. By March, no one had, so she did, first for the fifty or so people then subscribed to her Substack, Reinforcement and Ruin, and, once that first post refused to stay quiet, for the audience that has gathered around it since. She sat down with Acuity in June to walk us through her journey for this profile.
From the clinic to the registry
Parnham traces the work to a long unease with what money has done to her field. She came up through diagnostic work with autistic children in Nevada, moved to Oregon in 2018 (where, she says, she was something like the tenth BCBA in the state), and passed through a few larger organizations before concluding she could not square their appetite for billable hours with what she thought the work required. That year she opened her own company, built, she says, around decently paid and decently trained staff and one principle she refuses to bend, which she states as a duty to put “the tiny humans” first.
Her reporting looks less like shoe leather than like a forensic accountant’s idea of a good weekend. Florida keeps its corporate filings open and searchable, and from a single name she was able to pull dozens of affiliated entities, then follow the registered agents, addresses, and foreign-entity paperwork that tie one to the next. (A company formed in Delaware, she points out, has to register as a foreign entity to do business in Florida, and the registration leaves a trail.) What emerged, she says, was a notebook of overlapping companies that she likens, not entirely in jest, to the corkboard and red string of a television detective. The skill, in her telling, is mostly patience: noticing when the same email address surfaces in two places that have no business sharing one.
What the record already shows
Whatever one makes of Parnham’s conclusions, the litigation beneath them is a matter of public record and is striking on its own terms. In December 2024, ABA Centers of America sued Point32Health, the parent of Harvard Pilgrim, in Massachusetts, seeking around $80 million and accusing the insurer of running a “ghost network” that steered families out of network and then declined to pay for the care it had authorized. Point32Health answered, eleven months later, with a counterclaim for more than $19 million, alleging a systematic billing scheme the company rejects. In Florida, ABA Centers and the supermarket chain Publix have spent the past year suing each other; Publix’s federal complaint, since amended to put the figure near $15 million, reaches for the federal racketeering statute, the same word that pulled Parnham in. The cases are unresolved, and the company has been consistent in its account: that it is a fast-growing provider being starved by payers who approve autism treatment and then refuse the bill.
The strain has lately reached families. The company has confirmed that it is discharging clients covered by Optum, with notices giving some families until June 5, and this month it laid off staff in cuts people close to the company tied to Optum’s departure. The episode sits inside a broader unease about how ABA gets billed. Federal auditors have flagged hundreds of millions of dollars in questionable Medicaid payments for the therapy across several states, states have begun tightening the rules, and private capital has spent a decade buying up autism clinics. ABA Centers is, in one respect, an outlier in that last trend: it grew not on private-equity money but on a de novo, founder-funded model, building its own centers and leaning on an aggressive out-of-network strategy that turned explosive growth into both its calling card and its legal exposure.
The threads she is pulling
Pressed for the findings that anger her most, Parnham starts with transportation. Sources, she says, have described the company sending ride-share cars and taxis to collect young clients from school and deliver them to its centers, billing the time, sometimes without the driver knowing what the trip involved, and, in the accounts that haunt her, leaving children somewhere they should not have been left. Acuity has not confirmed those episodes independently; they are set down here as her reporting, not as fact established.
From there she moves to money. Parnham says parents of clients that received treatment from ABA Centers of America have shown her open-ended monthly agreements, drafted straight from their bank accounts, with no stated total, no purpose, and no end date, the amounts ranging from a few dollars to a few hundred. The effect, she says, is a kind of quiet leverage: a family that wants to leave, or to talk, first has to wonder what it might owe. Such open-ended auto-draft arrangements are not unique to ABA Centers: confusing billing and payment practices run through much of American health care, where insurers as well as providers can make claims hard to parse and families have few consumer protections against what they are asked to authorize. A third thread runs to data, and her suspicion that families do not know their children’s information may be feeding the artificial intelligence built by an affiliated company. None of this has been tested in court, and Parnham is the first to mark the line between what she can prove and what she cannot. The most explosive material that reaches her, she says, she sets aside.
The caution is part self-protection, part principle. She guards her sources, several of whom, she says, are genuinely afraid of what talking might cost them, and she has felt some of that weather herself, including a cease-and-desist letter and an early warning, from someone in a position to know, that the work might not be safe. None of it, she says, has moved her. “We have to put the tiny humans first,” she says again, returning to the phrase she uses for the children at the center of all of it.
Where it goes
Her latest installment, published June 21 under the title Diagnosed, Enrolled, Billed, follows the company’s machinery from a family’s first phone call through diagnosis, enrollment, and the monthly auto-draft, the piece she has described as the hardest to write precisely because it is the one she thinks counts. She is careful to say the aim is not a single company’s head. It is closer to a baseline: that parents should be able to recognize good care when they see it, and to walk away from the rest without fear. She talks about the economics without flinching, setting the roughly four percent margin she says her own practice runs against the far larger numbers she believes the big operators clear, and arguing that no one should be permitted to treat a child as a line on a spreadsheet. The field, she says, has the money to pay its technicians and clinicians well. The question is where it goes instead. Further installments are planned, she says, including one on the people who work inside the network and another on its overseas corporate and data arrangements.
Whether her particular allegations hold is a question for her readers, and perhaps for regulators and judges, to settle. What Reinforcement and Ruin offers now is a way in: one closely worked account of how a quiet stretch of autism care came to read like an organized-crime story, kept by someone who never left the field to write about it. Her work is published at Reinforcement and Ruin on Substack.
