In October 2018 we ran a live ethics session on billing and asked practitioners to send in the situations they were actually stuck in. They did not send questions about the code. They sent questions about their jobs.
"Is it an ethical practice for healthcare and other benefits to be contingent on a number of billable hours/month (i.e. full-time status)?"
"How should a behavior analyst operate when that model within the organization they are a part of itself may be somewhat responsible for susceptibility of Medicaid fraud... companies that place pressure, or rather 'highly encourage,' their employees to fulfill a certain number or hours or provide services to nearly any person with developmental needs?"
"I am a small organization, in my 4th year of operation, I am in the middle of the Medicaid Audit. None of our errors have been intentional or fraudulent. In our file reviews, mistakes with billing have happened with human error... What is the ethical answer?"
Those three questions are published in full, in the words they were asked, on our Q&A page from that session. We have kept them published, in full, because they have not stopped arriving.
They have one thing in common, and it is the thing the ethics code is least equipped to answer. In every one of them the person asking is not the person who built the situation.
The code binds the person who signs
The BACB Ethics Code for Behavior Analysts applies to individual certificants. It is a condition of holding the credential, not a standard an employer signs up to. The RBT Ethics Code works the same way for technicians. A company does not hold a BACB certification, so a company cannot lose one.
That matters, because the code is direct about where responsibility lands. Its opening section states that "lack of awareness or misunderstanding of an ethics standard is not a defense against an alleged ethics violation." On billing specifically, standard 2.06 requires that behavior analysts "identify their services accurately and include all required information on reports, bills, invoices, requests for reimbursement, and receipts," and that where inaccuracies are found they "inform all relevant parties (e.g., organizations, licensure boards, funders), correct the inaccuracy in a timely manner, and document all actions taken in this circumstance and the eventual outcomes."
Read that against the first question. Whether it is ethical for a health plan to be tied to a monthly hours target is a question about the employer. Whether a billed hour is accurate is a question about the certificant, and the code does not offer a compensation-plan exception. If the month comes up short, it comes up short.
The same asymmetry runs through the second question. Standard 3.08 tells behavior analysts to "place the client's care and welfare above all others," and says that where a third party asks for services incompatible with the analyst's own recommendations, the analyst resolves the conflict in the client's interest — and if it cannot be resolved, may seek consultation, discontinue services with appropriate transition, or refer the client elsewhere. A caseload target set by someone who has never met a particular child does not change what that child's data say.
None of this is specific to one country's funder. Funders, audits and billing rules differ everywhere; the BACB code is the same standard for every certificant who holds the credential, wherever they practice. The Florida case below is a worked example of what happens when the pressure wins, not a description of a rule that only applies there.
Why "the code binds the individual" is not a complete answer
Here is the part the field has been slower to say out loud: if the pressure is manufactured upstream, telling the individual to be stronger is not a control system. It is a hope.
That is not our opinion alone. A 2025 tutorial in Behavior Analysis in Practice describing one provider's organizational ethics network opens by stating plainly that certificants "may experience possible conflict between engaging in ethical practice and organizational policies at their place of employment," and that an ethics coordinator, an ethics committee or an ethics network can help mitigate that conflict. The underlying model — a standing internal group whose job is to make ethical discussion routine rather than exceptional — was set out by LeBlanc and colleagues in 2020 and updated by Valentino and colleagues in 2025; Cox published a companion guide to establishing ethics committees in behavioral health settings in the same 2020 issue.
We said the same thing before the literature caught up with it. Reviewing four years of ethics case scenarios sent in by practicing BCBAs, we wrote that "in many instances, actions taken by organizations caused the ethical dilemmas," while the code "applies only to individual practitioners." That gap is the whole subject of this page.
What the code tells you to do, and it says it nine times
Read the Ethics Code looking for one phrase and it becomes hard to unsee. Standard 1.11, on multiple relationships: document all actions taken in this circumstance and the eventual outcomes. Standard 2.06, on billing: document all actions taken in this circumstance and the eventual outcomes. Standard 2.07, on fees. Standard 3.08, on third-party contracts. Standard 1.10, on your own biases. Standard 3.03, on accepting clients. Standard 3.14, on continuity of services. Standard 4.12, on ending a supervisory relationship. Standard 5.04, on public statements made by others. That same sentence, word for word, nine times, in nine different kinds of trouble — and a tenth, standard 2.10 on collaborating with colleagues, says it in the plural.
The code is telling practitioners something specific about how these situations end. They end in a reconstruction — by a funder, a board, an employer, or a lawyer — of who knew what and when. The ethics decision-making guidance in the code's own front matter asks for dates, times, locations, relevant individuals, and summaries of observations and meetings, stored with confidentiality protected.
The practical translation for a clinician under pressure is unglamorous and it is the single most useful thing on this page. Write the clinical recommendation, and the data behind it, before the conversation about hours, not after. A note dated the week before the pressure arrived is evidence. A memory of having disagreed is not.
What an organization can build so this happens less
If the dilemma is manufactured at the organizational level, the fix belongs there too. Four structures appear repeatedly in the peer-reviewed literature, and they are ordered here from cheapest to most demanding:
A named ethics contact. One person whose job explicitly includes fielding "is this okay?" questions. The point is not their seniority; it is that asking has an address instead of being a favor someone asks their supervisor.
A route that is not the person applying the pressure. The 2025 tutorial reports an ethics hotline used across levels and departments in its first year, and describes organizational changes that followed from what came in. If the only escalation path runs through the manager whose target created the problem, the system is decorative.
A standing ethics group rather than an incident response. The LeBlanc model, and Cox's guide to ethics committees, both start from the same premise: routine discussion of ordinary cases is what makes an unusual case reportable. Groups that meet only when something has gone wrong teach staff that raising something means accusing someone.
Compensation design that does not make honesty expensive. This one is not in the code and no board will audit it, which is exactly why it is the owner's problem. If benefits, status or bonuses ride on a monthly billed-hours figure, the organization has attached a personal financial penalty to holidays, cancellations and a client's hospital stay. That is a design choice, it can be changed, and a documented set of assumptions about light months costs far less than the alternative.
What the alternative costs: Florida, 2018
In May 2018, following billing fraud by some agencies providing ABA services, Florida's Agency for Health Care Administration imposed a six-month moratorium on adding new ABA service providers to the state's Medicaid program. In July 2018 it announced action against four named agencies and said further investigations were ongoing.
The relevant detail is who a moratorium falls on. It does not fall on the agencies that were sanctioned; their conduct had already been addressed. It falls on every provider that had not yet been enrolled, on the agencies competing for the same funder's confidence, and — this is the part worth keeping — on the families waiting for a provider to be available to them. Enforcement lands on an entire market. That is the shape of the risk an organization takes on when it decides the hours target is the real standard.
Where this leaves a family or an employer choosing a provider
Someone choosing a provider cannot see any of this from the outside. A credential tells you a person is permitted to practice; it tells you nothing about whether their employer has built an ethics route or a billing target. Our guide to what every ABA provider is held to covers the questions worth asking, and describes ESBAP, the voluntary transparency scorecard we operate — which is not a credential, not a license, and not a requirement any provider must meet.
For a practitioner, the more useful reading is our page on ABA supervision and who keeps the records, because the answer to "who keeps the records" is you, for seven years, and that turns out to matter most in exactly the situations described above.
If your organization's answers to the three questions at the top of this page are not written down anywhere, that is the first thing to write.
References
- Behavior Analyst Certification Board. Ethics Code for Behavior Analysts (Updated 08/2024). https://www.bacb.com/ethics-information/ethics-codes/
- Glodowski, K. R., Hockenberry, N. L., Anthony, D., & Hinckley, C. (2025). Disseminating ethical applied behavior analysis within a human-service organization: A tutorial. Behavior Analysis in Practice, 18(1), 260–274. https://doi.org/10.1007/s40617-024-00966-6
- LeBlanc, L. A., Onofrio, O. M., Valentino, A. L., & Sleeper, J. D. (2020). Promoting ethical discussions and decision making in a human service agency. Behavior Analysis in Practice, 13(4), 905–913. https://doi.org/10.1007/s40617-020-00454-7
- Valentino, A. L., Gayle, R. I., George, A. J., & Fuhrman, A. M. (2025). Promoting ethical discussions and decision making in a human services agency: Updates to LeBlanc et al. (2020). Behavior Analysis in Practice, 18(3), 1–9. https://doi.org/10.1007/s40617-023-00785-1
- Cox, D. J. (2020). A guide to establishing ethics committees in behavioral health settings. Behavior Analysis in Practice, 13(4), 939–949. https://doi.org/10.1007/s40617-020-00455-6
General educational information about professional standards. Not legal advice, and not advice about your situation or your contract. The BACB codes are reissued periodically; read the current version at the link above before relying on any summary, including this one.