Cara Santamaria

And so there was a federal requirement that required that all state Medicaid programs pay for autism treatment.

Right.

Which is a good thing with kids need autism treatment.

We got to make sure it gets paid for and it's not getting denied or rejected.

The problem is an industry popped up around that saying, oh, there's dollars to be had.

Let's see how we can extract those dollars.

And guess who's investing?

Private equity firms.

So once this regulation passed and private equity firms kind of got in on this opportunity for billing, what the New York Times investigation found is that oftentimes the way that these services are billed and extracting as much money out of these government funds as possible...

seems to, I'm going to say sometimes, maybe often, I don't know if those numbers are in yet, but take priority over the wellness of the children.

And so what are some of the major ways that they're doing it?

Well, one is by over prescribing what are called hours.

So I'm a government biller.

I see patients in psychotherapy and I bill Medicare, different than Medicaid, but we also bill Medi-Cal here in California.

And your CPT codes, the codes that you use when you're charging for services, are usually in different increments, like time increments.

So I can do a 30-minute session, a 45-minute session, or a 60-minute session.

But...

There are very specific cutoffs for that.

So if I'm billing, for example, for a 30-minute therapy session, legally it has to be between 16 and 37 minutes long.

If I am billing for a 45-minute therapy, legally it has to be between 38 and 52 minutes.