NEWS 8 INVESTIGATES
DALLAS Over the last three years, Texas has paid out more than $1 billion for children's speech therapy under Medicaid.Total outlays are up 30 percent since 2010. Speech therapist salaries have skyrocketed to $120,000 a year in some parts of the state and, if you ask, a speech therapist will come to your house to treat your child, whether the child is immobilized or not, at twice the cost to taxpayers.
There is no question that speech therapy changes lives. Treatment can range from speech therapy to individuals who have eating disorders or are autistic.
The problem, some say, is what Texas pays for it.
Under Texas Medicaid rules, the state pays twice as much to provide treatment to some kids as it does others. The total bill for this ask-no-questions therapy last year was $407 million.
Downie Mathis an independent speech therapist in Dallas.
'These are my dollars,' she says. 'And I don't like the way my dollars are being spent.'
Mathis is being victimized by a system that pays three different rates for the same level of therapy, depending on where it's delivered. Mathis owns the Therapy Connection in Dallas and she's on the bottom of the state's speech therapy totem pole.
If a child is treated in her clinic by a licensed independent speech therapist, the state pays about $66 per treatment. Call it Silver Therapy.
If a child is treated by an equally qualified licensed speech therapist in an Outpatient Rehabilitation Facility (an ORF), or a Certified Outpatient Rehabilitation Facility (a CORF), the state pays more about $82. Call that Gold Therapy.
But if the child is treated by a licensed speech therapist in the child's home by a home health agency, the cost to taxpayers is about $132 a treatment. Call that Platinum Therapy.
There's really no difference between Silver, Gold and Platinum therapy, critics say. Medicaid just pays different rates for them.
Mathis could have gotten certified to become a gold provider, an Orf, or a platinum provider, a home health agency, and made more money. Those upgrades would have entailed gaining other licenses, which carry some initial expense.
But she decided charging more money for the same service is dishonest.
'I like money. I like making money. I would like to make a ton of money, ' she says. ' But I don't think it's your job to pay me, it's not the taxpayers job to make me more money.'
Scores of speech therapists turned out for a speech therapy rate hearing in Austin last July. The state was proposing 3 percent rate cuts. The therapists countered with their rising costs.
But state records show rising incomes for many. Among them is Therapy 2000 in Dallas, which collected $11,967,000 for speech therapy last year, according to state records Its speech therapists are paid at the platinum rates under Medicaid.
'I'm here to oppose the 3 percent cuts to home health agencies,' CEO Jerre Van Den Bent said during the hearing.
Michael Twilley of Sage Care Therapy in Dallas spoke out against rate cuts as well.
'We look at increasing costs on a weekly sometimes daily basis,' Twilley said.
Twilley is an MBA, whose company bills as Mockingbird Capital. His platinum level therapists helped him collect more than $2 million from Medicaid last year. He declined to be interviewed on camera. He says on his Linkedin page that his 80 therapists are his biggest asset.
Therapists are commanding high salaries in parts of the state. Companies are advertising salaries of $120,000 a year.
At the platinum level, they are like doctors who make house calls. The state says they get paid more because they may stay for as long as an hour per session.
But News 8 obtained therapists sign-in sheets for Head Start of Dallas, one of the largest employers of home health care therapists in the city. The sign in sheets show the therapists sessions usually run about half an hour.
The state does not know how long home health therapists spend per session, said Chris Traylor of the Texas Department of Health and Human Services. So, why the house calls? Home health care is normally provided in the home as the answer.
Medical need, the state says, is not necessarily a factor. Some children may be home bound and require that care, but the state doesn't know who they are. If a parent wants a therapist to come to the home to treat a child at twice the cost to taxpayers, it happens. There are no rules against it, he said.
Jerre Van Den Bent, the Therapy 2000 CEO, has employees who gives generously to state politicians through a political action committee. The company's website encourages employees to donate to politicians through payroll deductions for the PAC, named the Texas Association for Home Care and Hospice.
In the past three years, Texas Ethics Commission records show donations of at least $10,000 each have been made to Gov. Rick Perry, Lt. Gov. David Dewhurst, State Sen. Bob Duell, R Greenville, and State Rep. John Zerwas, R Richmond.
The .pdf below has copies of each of those donations: