BACB Ethics Code Section 4 in the News: Supervision and Delegation Violations in the OIG Indiana ABA Audit
8 min read Discussion: Section 4 of the Ethics Code for Behavior Analysts in the news
Consider section 4 of the Ethical Code for Behavior Analysts. Look at the ethical code and individual elements being discussed for the week. Do a search for a current event or news story that highlights a violation of one of the specific elements addressed during the week. Because behaviorism addresses all human behavior across disciplines and environments, you may search broadly. Post the article as a link or a document for your classmates and briefly summarize the news story; give a behavioral interpretation of the occurrence or event. What was the human behavior(s) occurring? Was this behavior ethical through the lens of the BACB Ethical Code for Behavior Analysts? If our Ethical Code were applied to this story, what would the violation be?
Section 4 of the BACB Ethics Code: Responsibility to Supervisees and Trainees
Section 4 of the Ethics Code for Behavior Analysts sets out behavior analysts’ obligations when they supervise and train others, including Registered Behavior Technicians (RBTs) and trainees working toward certification (Behavior Analyst Certification Board [BACB], 2020).
| Code | Element | Requirement in brief |
|---|---|---|
| 4.01 | Compliance with Supervision Requirements | Follow BACB and other applicable supervision requirements |
| 4.02 | Supervisory Competence | Supervise only within one’s competence |
| 4.03 | Supervisory Volume | Take on only as many supervisees as can be supervised effectively |
| 4.04 | Accountability in Supervision | Be accountable for supervisees’ professional activities within the supervisory relationship |
| 4.05 | Maintaining Supervision Documentation | Create and keep accurate supervision records |
| 4.06 | Providing Supervision and Training | Provide evidence-based, individualized supervision |
| 4.07 | Incorporating and Addressing Diversity | Address diversity in supervision and training |
| 4.08 | Performance Monitoring and Feedback | Monitor performance, give timely feedback and create improvement plans |
| 4.09 | Delegation of Tasks | Delegate only tasks the supervisee can perform competently and that meet requirements |
| 4.10 | Evaluating Effects of Supervision and Training | Evaluate whether supervision is effective |
| 4.11 | Facilitating Continuity of Supervision | Minimize interruptions in supervision |
| 4.12 | Appropriately Terminating Supervision | End supervision responsibly |
The news story
Federal audit: “Indiana Made at Least $56 Million in Improper Fee-for-Service Medicaid Payments for Applied Behavior Analysis Provided to Children Diagnosed With Autism”
U.S. Department of Health and Human Services, Office of Inspector General (OIG), December 2024, Report A-09-22-02002.
Link: oig.hhs.gov/documents/audit/10123/A-09-22-02002.pdf
Summary: The OIG reviewed a sample of 100 “enrollee-months” of Medicaid-funded ABA services for children with autism in Indiana in 2019 and 2020. It estimated that Indiana made at least $56.5 million in improper payments, plus about $76.7 million in potentially improper payments. Problems included session notes that did not support the services billed (95 of 100 enrollee-months), services provided by staff without the required credentials (26 enrollee-months), including noncredentialed technicians and services requiring a BCBA being performed by lower-credentialed staff, supervision that was not documented, billing for possible nontherapy time such as meals and naps, and group activities billed as one-to-one therapy. The OIG also noted poorly documented RBT supervision and recommended that Indiana refund about $39.4 million in federal funds (U.S. Department of Health and Human Services, Office of Inspector General [HHS-OIG], 2024).
Indiana is not alone. A later OIG audit of Colorado’s Medicaid ABA payments reported $77.8 million in improper payments, with services by staff lacking proper credentials in 18 of 100 sampled enrollee-months and widespread documentation problems (Behavioral Health Business, 2026). These audits show a pattern across the field rather than a single bad actor. Note that the audits identify problems in Medicaid payments; they do not determine whether individual BCBAs violated the BACB Code.
Behavioral interpretation
What human behaviors were occurring?
- Supervisors (BCBAs) and agencies: allowing services that required a BCBA to be performed by lower-credentialed staff; allowing noncredentialed technicians to deliver services; not conducting or not documenting required supervision; submitting or approving inaccurate claims.
- Technicians: delivering services they were not credentialed or trained to provide; recording session notes that lacked required detail.
- Billing staff and administrators: billing nontherapy time, group sessions as individual therapy, and services without supporting documentation.
Why did these behaviors occur? (ABC analysis)
| Antecedents (A) | Behavior (B) | Consequences (C) |
|---|---|---|
| High demand for ABA services, BCBA workforce shortages, large caseloads, productivity targets, limited state oversight and unclear documentation guidance | Delegating tasks to unqualified staff; skipping or not documenting supervision; billing without adequate documentation | Positive reinforcement: more billable hours and revenue, more clients served. Negative reinforcement: escape from time-consuming supervision and paperwork. Weak or delayed punishment: audits occurred years later, so consequences were remote and improbable |
From a behavioral perspective, the immediate, certain reinforcers (revenue, time saved, meeting caseload demands) outweighed the delayed, uncertain punishers (audits, refunds, sanctions). Cooper et al. (2020) explain that consequences that are immediate and probable control behavior more strongly than those that are delayed and improbable, which helps explain why unethical practices can persist in organizations. The lack of effective monitoring also meant there were few antecedent controls or contingencies supporting correct supervision and documentation. These conditions make an organizational behavior management (OBM) approach, with clear performance standards, monitoring and feedback, essential.
Was the behavior ethical through the lens of the BACB Code?
No. To the extent that behavior analysts were involved, the practices described in the audit conflict with several core principles of the Code, especially benefit others, behave with integrity and ensure competence (BACB, 2020). Children with autism may have received services from staff who were not qualified or adequately supervised, which risks ineffective or harmful treatment, and public funds were spent on services that could not be verified.
If the Ethics Code were applied: the violations
| Code element | How the story illustrates a violation |
|---|---|
| 4.09 Delegation of Tasks (primary violation) | Services that required a BCBA were performed by lower-credentialed staff, and noncredentialed technicians delivered services. Delegating tasks to people who are not qualified or credentialed to perform them violates the requirement to delegate only tasks the supervisee can competently perform and that meet applicable requirements. |
| 4.05 Maintaining Supervision Documentation | Supervision was not documented and RBT supervision records were poor. |
| 4.01 Compliance with Supervision Requirements and 4.06 Providing Supervision and Training | Failure to provide and document required supervision of technicians, as RBT and payer requirements demand. |
| 4.04 Accountability in Supervision | Supervising BCBAs are accountable for supervisees’ professional activities, including the accuracy of session notes and services billed under their supervision. |
| 4.03 Supervisory Volume and 4.08 Performance Monitoring and Feedback | If caseloads were too large to monitor technicians effectively, supervisors could not provide timely feedback or catch documentation and billing problems. |
| Related: 2.06 Accuracy in Service Billing and Reporting and 2.17 Collecting and Using Data | Billing nontherapy time and group sessions as one-to-one therapy, and inadequate session notes, also conflict with requirements for accurate billing and data. |
How the Code would prevent this
- Verify each supervisee’s credentials and competence before delegating tasks (4.09).
- Keep caseloads at a level that allows real supervision (4.03).
- Provide and document regular, evidence-based supervision with direct observation and feedback (4.05, 4.06, 4.08).
- Review session notes and billing for accuracy before submission (4.04, 2.06).
- Build organizational contingencies, such as audits, checklists and feedback, so that correct supervision and documentation are reinforced immediately rather than discovered years later.
Sample discussion post
I selected a December 2024 HHS Office of Inspector General audit, which found that Indiana made at least $56 million in improper Medicaid payments for ABA services for children with autism (HHS-OIG, 2024). Among the problems, services were provided by staff without required credentials, including services that required a BCBA being performed by lower-credentialed staff, and supervision was not documented. The behaviors involved included supervisors delegating clinical tasks to unqualified staff, technicians providing services outside their credentials, and agencies billing without adequate documentation. Behaviorally, these practices were likely maintained by immediate positive reinforcement (more billable hours and revenue) and negative reinforcement (avoiding time-consuming supervision and paperwork), while consequences such as audits and refunds were delayed and uncertain (Cooper et al., 2020). Through the lens of the BACB Ethics Code, this behavior was not ethical. The primary violation would be Code 4.09, Delegation of Tasks, because tasks were delegated to staff who were not qualified to perform them. Related violations include 4.05 (Maintaining Supervision Documentation), 4.04 (Accountability in Supervision) and 2.06 (Accuracy in Service Billing and Reporting) (BACB, 2020). This case shows why supervisors must verify competence, keep manageable caseloads, and document supervision to protect clients and the integrity of our field.
Related reading: mentalistic vs. behavior analytic statements and ethical challenges in therapy.
Conclusion
The OIG audit of Indiana’s Medicaid ABA payments illustrates what can happen when supervision and delegation standards break down: unqualified staff providing services, undocumented supervision and inaccurate billing. A behavioral analysis shows that these practices were maintained by immediate reinforcers and weak, delayed consequences. Applied to this story, the BACB Ethics Code’s Section 4, especially Code 4.09 on delegation and 4.05 on supervision documentation, would identify clear violations and point to the solutions: competent, well-documented and accountable supervision.
References
Behavior Analyst Certification Board. (2020). Ethics code for behavior analysts. https://bacb.com/wp-content/ethics-code-for-behavior-analysts/
Behavioral Health Business. (2026, March 6). OIG report finds $77.8M of improperly documented claim payments for ABA. https://bhbusiness.com/2026/03/06/oig-report-finds-77-8m-of-improperly-documented-claim-payments-for-aba/
Cooper, J. O., Heron, T. E., & Heward, W. L. (2020). Applied behavior analysis (3rd ed.). Pearson.
U.S. Department of Health and Human Services, Office of Inspector General. (2024). Indiana made at least $56 million in improper fee-for-service Medicaid payments for applied behavior analysis provided to children diagnosed with autism (A-09-22-02002). https://oig.hhs.gov/documents/audit/10123/A-09-22-02002.pdf
