Your kid's therapy center can change what it offers, cut a service, or swap out who is treating him, and you do not get a vote. Nobody at the front desk has to tell you who actually made that call.
In this episode of The Ashleigh Report I walk through a rule that has been on the books in more than 30 states for over 100 years, the workaround that gutted it, and what that workaround has already done inside autism care.
The rule: a corporation cannot own your doctor
There is a legal principle called the Corporate Practice of Medicine doctrine, CPOM for short. The idea is simple. A corporation's legal job is to make money for its shareholders. A doctor's legal and ethical job is you, the patient. Put two competing bosses in the same room and only one of them can win.
CPOM is not one federal law. It is a patchwork, state by state. Over 30 states have some version of it, and the strength varies enormously. Some states have real teeth and an enforcement history. Some have a version that exists on paper and has basically never been tested. A handful have no meaningful version at all.
The workaround: the friendly PC and MSO model
Here is the mechanism, slowly, because once you see it you will recognize it everywhere.
A licensed doctor holds 100% ownership, on paper, of a professional corporation, or PC. A PC is the kind of entity legally allowed to practice medicine and bill for it. That PC then signs a Management Services Agreement, an MSA, with a completely separate company: the Management Services Organization, or MSO. The MSO is what the corporation or the private equity firm actually owns.
The MSA does the real work. It can route hiring and firing, billing and coding, revenue targets, and sometimes which services stay on the menu, to the MSO.
The rule? The company cannot own the doctor. The trick is, we put a doctor's name on the building, then we write a second contract that lets the company run the building anyway.
Notice the word the industry uses: friendly physician. Not compliant, not cooperative. Friendly. When a doctor gets a little too independent, there is often a mechanism to remove them and put in a friendlier one. The person whose name is legally attached to your care can be the most replaceable part of the whole arrangement.
A federal judge called it a shell game
This past spring a federal judge in Oregon looked at exactly this kind of arrangement and called it, on the record, a shell game. A federal bill trying to close the loophole now carries that same language.
What this has to do with autism care
The same capital playbook has already bought its way into autism therapy: 574 centers across 42 states, as of data from 2024. In the industry, the buyer does not have to put its name on the clinical license. It buys the management company. The clinician can still own the professional corporation on paper while the decisions move to the management agreement: hiring, which sites stay open, what gets billed.
That is how a clinician keeps the title and loses the practice.
My opinion: I do not mind private equity as a category. Capital is allowed to show up, and more capital is good if it is for a good reason. It is not good when we have lost the plot of why that capital is there.
The other side of the argument
To be fair to the research, economists raise a real selection bias question. Private equity often buys facilities that were already struggling, so a decline after purchase might have happened anyway. Studies that compare acquired hospitals against matched controls were built to answer that question, and researchers still debate how fully any design can separate the two. It is a real argument, not a talking point.
What you can do before you sign on anywhere
Who owns a practice on paper, and who controls it in practice, is not bureaucratic trivia. It is the upstream decision that determines whether a family ever gets a real say in how their kid is treated. Before you sign on with any provider, medical or behavioral, ask:
- Who owns this clinic?
- Who sets the session hours?
- Who do I call when something goes wrong?
Have you tried to find out who owns your child's provider and hit a wall? Tell me in the YouTube comments.
Next step
Want one table instead of six separate plans?
Who owns a practice decides whether your family gets a real say in your child's care. On a care mapping call we look at the providers you already have and what one shared plan could look like.
Book a family care mapping call Agency leaders: book an agency callAshleigh Dominguez, MS, BCBA, is licensed in North Carolina, Georgia, and Iowa. This article is general education based on the episode. It is not clinical, legal, or treatment advice for your child or your state. Corrections and sources are listed in the YouTube description.