Cara Santamaria

And if I'm billing for a 60-minute therapy session, legally it has to be 53 minutes or longer.

These are like very specific cutoffs that can mean the difference between getting reimbursed for your services or not.

You have to bill them exactly correctly.

Apparently in a lot of these autism clinics, they are billed at the 15 minute increment.

And there are some really interesting cutoffs.

They tell a story about visiting a clinic where a child is napping and they're waking the children up just before the seven minute mark, right?

Because if they're asleep for longer than seven minutes, they can't bill for that 15-minute increment.

Because you can't bill while a child is asleep.

You can't bill while a child is in recess.

You can only bill while a child is in therapy.

Wow.

Clinics are serving in a lot of cases as de facto daycare.

But unfortunately, they don't have the same required oversight as most daycares.

And they are also bringing in much, much, much more money because these are clinics where therapy is being offered.

But we also have to remember that ABA therapy can be delivered by a psychologist, by a social worker, maybe even by a psychiatrist.

But it can also be delivered by somebody with a high school diploma who went through 40 hours of training.

You do not have to be a licensed provider to offer ABA therapy directly to children.

And so what this investigation showed is that there are clinics across the country with a surging spending that the actual coffers, the amount of money in the state budget for these Medicare programs is being taxed significantly.

For example, they said last year in Colorado,

Their Medicaid spent more on care for children in autism treatment last year, specifically in therapy clinics, than for all emergency room care across the state.