Billed $800 Million, Paid $160 Million, Elevance Says. Now It’s Suing The Perfect Child.

NEW YORK – Elevance Health, the parent company of Anthem health plans, sued The Perfect Child in New York state court on November 4, alleging the Brooklyn-based autism-therapy provider used misleading claims to collect $160 million from the insurer over five years, The Wall Street Journal reported. The civil suit alleges the company’s conduct amounted to fraud, breach of contract, and conspiracy, among other claims.

BreakingNewsABA has not reviewed the complaint; the details below are from the Journal’s account of it.

A contract is at the center of the case. Elevance says The Perfect Child was in its network until June 2026, under an agreement that required it to accept in-network rates when treating Elevance members. Instead, the suit alleges, the company billed through more than 100 limited-liability companies that were not in Elevance’s network and charged far higher out-of-network rates. In one example, those affiliates charged an average of about $1,700 an hour for assessments conducted by autism-therapy workers, though The Perfect Child’s contracted rate was a little over $400 an hour, according to the court filings as described by the Journal.

The affiliated companies billed Elevance $800 million from 2021 through March 2026, according to the lawsuit. Elevance says it denied many of those claims, including $102 million it identified as duplicate bills, but still paid out $160 million. The suit also cites 2,000 instances in which the company claimed to provide a single patient more than 12 hours of therapy in a day.

Elevance’s suit claims the company's misrepresentations to the insurer and its members triggered excessive payments.

Alan Schabes, a Cleveland lawyer who said he represents The Perfect Child, told the Journal on November 5 that he was still reviewing the lawsuit. Founder Simcha Bendet did not respond to the Journal’s requests for comment, and an Elevance spokeswoman declined to comment.

The suit puts a private insurer alongside the government scrutiny already on the company. The Journal reported on November 3 that the FBI was investigating The Perfect Child. House Committee on Education and Workforce leaders requested information on July 6. Their August 21 follow-up said no response had arrived as of that date, set a September 4 deadline, and warned that a subpoena could follow. Records reviewed by the Journal show the company also billed Aetna, units of UnitedHealth Group, and Cigna Group through its LLCs.

Families have also faced large payment demands. The Journal’s earlier investigation found the company charged insurers rates that could exceed $30,000 a day, then tried to collect directly from families who had been promised little or no out-of-pocket cost. WSMV in Nashville reported on November 4 that one Tennessee family received a $1.48 million payment demand from the company, and that another family was taking part in a proposed class action that lawyers expected to file that week. WSMV said Bendet and The Perfect Child had not responded to its inquiries when it published the report.

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