Alex commented online in 2011 that it was "one of the most deceptive books ever",[4] and wrote an extensive repudiation in an open letter to Christian bookstores in 2015,[5] describing his near-death experience as a fabrication.

[16][17] Beth Malarkey later stated that her husband, Kevin, got the idea for writing the book after the media attention paid in 2009 to Alex's surgery, and that she resisted his bringing Matt Jacobson, a literary agent, to meet their son.

[22] The Boy Who Came Back from Heaven sold 112,386 copies in the first year,[23] and received a platinum award from the Evangelical Christian Publishers Association in 2013 for over a million sales.

[5] According to Benjamin Radford, a paranormal researcher, part of the reason for which the story was so well received and accepted by its American Christian audience is that it reinforced their existing narratives and beliefs.

By sticking closely to a widely accepted interpretation of heaven, God and demons, Malarkey was assured that his story would meet his audience's expectations and be popular.

[4] In November 2012, Alex's mother, Beth Malarkey, wrote several blog posts saying that her family was not in agreement with the content of the book.

"[25] Later that month, she said that the book's account had been embellished, adding "The truth is getting twisted, distorted, and packaged to be sold to the highest bidder."

[27] On May 9, 2014, Beth Malarkey appeared on a Christian radio show, The Bible Answer Man, where she said that the book was deceptive and embellished the story of the accident.

[16] Kevin Malarkey did not speak publicly after his son retracted the book's claims and rebuffed efforts by journalists to contact him until a Slate interview in 2019.

He claimed that royalties from the book had come to approximately a million dollars, half of it from the advance, but most of it had been spent on Alex's care, or given to his church and other Christian charities, and none of it was left.

[18] In 2018, Alex Malarkey filed a lawsuit against Tyndale House, the main publisher based in suburban Chicago, accusing them of charges including defamation and exploitation, seeking an award at least equivalent to the book's profits.

Beth says she and Alex are in a difficult financial situation and cannot guarantee that they will be able to remain in their house; she would like an accounting of how Kevin spent the money from the book.