Clinics specializing in therapies for children with Autism Spectrum Disorder (ASD), covered by health insurance plans, are at the center of a São Paulo Civil Police investigation for suspected multimillion-dollar fraud. According to the investigation, the scheme may have caused losses of up to R$ 60 million to the insurance companies.
The suspicions involve charging for sessions that did not take place, overbilling for services, and falsifying attendance and time records. Documents and recordings analyzed by investigators point to inconsistencies between the services actually provided and the amounts billed.
The case gained notoriety after audits identified patterns deemed incompatible with standard clinical practice, raising suspicions about a possible structured scheme to maximize financial transfers.
Inflated charges raise suspicions during audits.
According to investigators from the State Department of Criminal Investigations (Deic), some clinics reportedly recorded session numbers up to almost 100 times higher than the actual volume of patients treated.
In one of the units investigated, audits revealed that 66% of patients were registered with more than 80 hours of therapy per month. This percentage drew attention because it deviated from the national average, which, according to investigators, does not reach 3% for this type of intensive care.
One of the cases analyzed involves a six-year-old child. The health plan identified records of 416 hours of therapy per month, but upon contacting the family, received information that the boy attended the clinic only once a week, with sessions of approximately 50 minutes, totaling about 16 hours per month.
Families report pressure to sign documents.
In addition to the audits, testimonies from parents reinforce the suspicions. One mother stated that, in two different clinics, she was instructed to sign documents indicating three daily sessions for her son, although only one had been carried out.
According to her, those in charge claimed that the agreement paid insufficient amounts for just one session, making it impossible to retain the professionals.
The family also reported that the situation exploited the emotional vulnerability of the caregivers, who seek to ensure continued therapy for their children.
Former employees denounce alleged irregularities.
Among the clinics mentioned is a unit located in the western part of the city of São Paulo. The defense stated that there was no falsification of documents, signatures, or improper charges, and affirmed that all services have auditing and control mechanisms.
Other cases are also being investigated in cities like Mogi das Cruzes. In one unit, records indicated that an eight-year-old child had received 200 hours of therapy in a single month, information disputed by the mother herself, who stated that the child only visited twice a week, with sessions lasting about 40 minutes.
Former employees also reported to the police the use of login credentials and passwords for health insurance company apps to register patient attendance. There are even suspicions of attempts to bypass facial recognition using photographs taken inside the clinics.
Psychologist reportedly logged 706 hours in one month.
One of the most serious incidents investigated revealed that a psychologist recorded 706 hours of consultations in a single month, including 56 hours in just one day—something physically impossible.
According to the Civil Police, these records reinforce evidence of systemic fraud and possible deliberate manipulation of information to improperly obtain resources.
Those involved could face charges such as fraud, organized crime, money laundering, and crimes against public health.
Fraud impacts families and the healthcare system.
Experts warn that the problem goes beyond financial losses for the operators. The suspicions directly affect families who depend on ongoing therapies for the development of children with autism.
According to experts in risk management and fraud in supplementary healthcare, irregular practices in this sector compromise trust in the system and can affect patients' access to legitimate treatments.
In a statement, the defense of the partners of Espaço Singular declared that it has never condoned any practice contrary to the law and reaffirmed its commitment to the legality and transparency of the services provided.
Leave a comment