Oct 11, 2023
On October 3, The Capitol Forum hosted a conference call with éclat Law founder and managing partner Kevin Ross-Andino for a conversation on the allegations raised against LifeStance Health by his clients in ongoing litigation against the company. The full transcript, which has been modified slightly for accuracy, can be found below.
LISA EPSTEIN: Good morning, everyone. Thanks for joining us for today’s conference call. I’m Lisa Epstein, Correspondent at The Capitol Forum. And with me today is Kevin Ross-Andino, the founder and managing partner of éclat Law. Today, we’ll discuss the allegations raised against LifeStance Health by his clients in ongoing litigation against the company. The cases include individual cases and class actions on behalf of former and current mental health professionals who worked or still work at LifeStance Health.
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So, thank you, Kevin, and welcome. I am really excited to have this conversation. Let’s start by you telling us a little bit about the allegations in your lawsuits against LifeStance. And we’ll start off by maybe talking about the compensation practices regarding inflated job postings, how LifeStance calculates pay in a confusing manner. And then we can get into the wage issues and paying less than required minimum wage.
KEVIN ROSS-ANDINO: All right. Thank you, Lisa. And good morning to everyone that’s listening in. Let me start by putting in some general context and kind of walk you through in layman’s terms. Because lawyers, we like to pull out legalese and things on things. So I have three different lawsuits. I have a lawsuit that was brought on behalf of a psychiatrist. That was the first one I filed at the end of 2022. I have a lawsuit in Florida that was filed by six nurse practitioners on behalf of themselves and to be a class action that would encompass everybody in Florida. And then I have one that I filed in Arizona in June where LifeStance is headquartered, which is really on behalf of a much larger group that would kind of encompass Florida in some regards. But it’s clinicians — and that’s a term used by LifeStance and I’ll explain that in a minute — clinicians that are in every other state other than Florida. And LifeStance does business in about 33 of the 50 states.
And so this is not your typical case where you have just wages and things like that. This case, in all three instances, is really the same problem. The medical industry has changed in the way that they decide to compensate doctors, nurse practitioners, PhD’s, therapists, in the context of LifeStance, their mental health organization. So they’re all considered therapists with different degrees and different delivery of service. But in general, they’re helping the patients with mental health issues.
They all have similar compensation packages. Or that’s what they try to call them. But they’re not really packages or we wouldn’t be here. And the way they compensate them. In the traditional sense, most mental health therapists ‑‑ and I’m going to refer to them as therapists because I think that’s really what they’re doing. Clinicians makes it sound like there’s some scientists mixing up a formula to give somebody, but they’re really to help the patient and help the client and the person out with some mental health issues, which I take very seriously, and think is very important.
They would traditionally pay them as independent contractors so I can work a little bit for this hospital. I can teach. I can do a variety of things. You know, you’re talking about people with PhDs, master’s degrees and medical degrees. And so, they usually have the flexibility to do various different things.
LifeStance’s business practice or style was to, hey, I want to eliminate the competition. They started off as one of the biggest ones and they wanted to be the biggest one. So they started acquiring practices and acquiring practices and acquiring practices. And the way they did that, and to eliminate the competition, is I’m going to eliminate the independent contractor part of it, but I’m going to make you an employee of the company. I mean, when you’re employee, everybody has a job. When you work for someone else, you’re expected to earn a salary. You go to an interview. They tell you this is how much you’re going to make. Here’s your bonus opportunities. And you clearly understand what your compensation is. Because like anybody who goes to work, I go to work, earn certain money. I buy my house based on that. If I have children, I make decisions about their education, health and where we live based on that. We make our decisions based on earnings.
The way LifeStance structured the income for this group of people, which would encompass social workers, nurse practitioners, individuals who have a PhD. So they get a little bit more than a nurse practitioner, similar, but a little bit less than the psychiatrist who has a medical degree and psychiatrists. But it’s all the same kind of compensation, but different levels of services and pay, each of these people go in and take the job with LifeStance assuming.
So, for example, psychiatrists are told in most states you can make anywhere from $200,000 to $300,000 a year. If you tell me that, that’s what I expect to make, between $200,000 and $300,000 a year. Same thing with the nurse practitioners. Everybody has their salary range or compensation range and they’re very careful not to use the word salary sometimes. You’re thinking salary is what I get. They use the word compensation. So they can almost play a game with it, which I’ll get into in a second.
So that’s just kind of the general premise is that their business model is to eliminate competition, unfortunately, using employees to do that. Because if I’m delivering services, they’re the only ones that can service the people that come to see us. And they’re my tool for doing that.
My personal view of their business model is that, giving them the benefit, I don’t think somebody sat down and decided, I’m going to do this very egregious plan to try to screw everybody and to take advantage of people. They were thinking like accountants instead of thinking like businesspeople and doctors. When you have non‑medical people making business decisions for a medical profession, they apply a different analysis to how delivery of medical services should be.
And so basically to get what they do at LifeStance is when any of these people, irrespective of what your category is, social worker, nurse practitioner, PhD, MD, I’m going to call what I pay you an advance. And I’m going to explain the traditional sense of an advance, which is legal, and what they do.
And so basically, almost your first whole year of working, you’re being loaned money to go to work. But you think it’s your money, right? I mean, I come to work. I work 40 hours or more. I should be paid for all my time. And that’s what all of these people I’ve spoken to — at least 100 folks that have worked there, there’s thousands more to go — but the story is just consistent. And I’m talking about I’ve talked to people in 21 different states. And when people from 21 different states tell you the same story over and over again, there’s got to be some big truth to that. And then you start seeing some of the stuff that they publish about it.
So basically, they treat almost your first year of compensation as this loan that I give you and you earn it back. And the way these guys are supposed to be paid is, for example, if I see ten patients today and I bill for those services, LifeStance is supposed to get X percentage of that bill. So, let’s say this visit would cost you 500 bucks based on what we did, LifeStance would take 50 percent and I get 50 percent. And so you’re thinking, oh, I’m making $250 an hour. It doesn’t quite work that way, but that’s what they do.
And so, if you keep somebody busy, which LifeStance tells people that they will, I can keep you super busy and stuff like that, you can hit those numbers. The problem that LifeStance runs into is they’ve acquired so many practices and have so many practitioners.
Let me take a step back. Put in context from before 2019, LifeStance had 2,000 people across the country working a lot more efficiently. When they decided they wanted to go public and become a big public institution, they changed their business model. They went from that simple, not really simple, but that more controllable 2,000 base up to 5,000, and now 8,000 people across 33 states, without really having the infrastructure or the systems in place to manage those people.
So, the reasons my people reached out to hire me is because they were in practices where, yeah, those numbers look great in fantasy. But the reality is I can never hit the metrics and the goals. And so, after working there for four or five months, all of a sudden I owe them $50,000. So I’ve been working 40 hours a week for six, seven months. And all of a sudden this is worse than a student loan, right? At least with a student loan, I get an education and I can go out and get jobs and stuff like that. Here I came to work and you’re devaluing my work and you’re saying I owe you money if I leave. And they kind of hold them hostage there for a period of time to pay them back.
So if you don’t stay with LifeStance for at least two years and build up your book of business, you will always owe them money. And this is public. So, I don’t mind using their names and stuff. So, in the case of Dr. Ryder, he worked there for two years. He couldn’t get enough patient visits and encounters – they call them patient encounters — to pay back the so-called loan that he had. So even though he left after 24 months, he still owed them $120,000, which is basically half of a year’s salary if he was under your traditional sense of what a psychiatrist would have earned as a new psychiatrist.
And so, of course, they’re suing him and they want the money back. He’s also claiming that — and I know you’re going to ask me questions into the wages, but I just want to set the context. And, of course, he countersued and said, wait a minute. You underpaid me. Because if based on the formula you’ve put forth and the number of patients I know I saw, I should have made that $120,000 plus more money.
So that’s the dichotomy you have. You have the employees who are coming to work putting their full week’s worth of work, some of them doing on call services and other things to be available for patient but receiving no compensation.
So under the laws of the United States — we sued under the federal statute. There’s an equivalent in the state ones. But since we’re doing on a larger scale type of litigation, you have to pay employees, except if they fall under certain defined categories, for all the time that they worked. You can’t have a full time employee unless, for example, I own my law firm. I cannot pay myself. But everybody who works for me has to be paid for their full time here. And if they work overtime, if they qualify, what they call nonexempt employees, managers or CEOs and stuff, they don’t get overtime. But there are certain people who don’t get over time, but they should at least get a full wage for their full amount of time that they work. LifeStance doesn’t do that, and they try to cover some of that up by calling this money that they give them a loan. And that’s just the basic premise of the lawsuit and stuff like that.
So, I’m going to stop there and let you ask some questions. I know I’ve spoken for a lot of time. That’s a lot of information. And maybe we can dissect it back so that everybody can understand some of the specifics and nuances of what the lawsuit is about. That’s generally what it is. It’s an unfair compensation system where I’m not getting my full week’s worth of money. And yet, when I leave the job because it’s not working out for me financially, you expect me to pay ‑‑ and I can tell you I’ve seen some as small as $15,000 and I have one as large as $120,000 ‑‑ that I have to pay you back for the privilege of coming to work every day.
LISA EPSTEIN: So, we did some reporting on these exact issues for the subscribers that are listening, I’m sure they’ve read our coverage. And from what I understood from the former therapists that I spoke with, this inflated salary is presented as like, let’s say you have the opportunity to earn $100,000 to $150,000 a year for a nurse practitioner. And then the nurse practitioner, during the hiring process, they talk about what floor is expected, what the nurse practitioner expects or LifeStance can offer. They set this floor and then they compensated her — or not just her — they compensated them based on some — they said it was a percentage, like 50 percent of the billings. But it really wasn’t 50 percent of the billings. It was 50 percent of some regional LifeStance chart of what billing codes should get what compensation, which was proprietary and confidential and not shared with the clinicians and subject to change at LifeStance’s whim.
And so, then if she had set her floor at $5,000 a year, but she was only earning, according to LifeStance’s calculations, $3,000, she would be loaned the $2,000. But it’s not clear based on the paystubs. It’s not clear, like I was loaned this. And then when she starts making $6,000 from visits, she’s only getting paid $5,000 because they’re taking a thousand back. Is that what you’re seeing? So not the entire salary, but a good portion of it is the loan, because they can’t see enough patients based on the payment wage scheme or how they’re paid.
KEVIN ROSS-ANDINO: Yeah, that’s a good point. And I’m glad you clarified it. Like I said, I put a lot of information out. So, this is really, I’m going to tell you — and again, I have the benefit of speaking to a lot more people in a lot more detail. So basically, let’s say Kevin goes to work for LifeStance and I’m supposed to make $180,000 a year. That’s $15,000 a month. They’ll agree to pay as your advance, $15,000 a month, boom. Well, you know what? In your first six months because there’s a process to get credentialed — and credentialed means there’s a third-party provider that actually paid for the expense, basically insurance or some employee assistance, but whatever the program is, a third party pays for it. But you have to qualify. You have to give them information, background checks. That can take anywhere from three to six months. That’s why those first four or five months you work for LifeStance, you can’t possibly see enough people to earn the $15,000 and pay them their portion because you’ve got to see people to do it. And so they’re already at a disadvantage from the moment they showed up. And you’re right.
So their contracts say — and here’s the interesting thing. I’m going to explain the advance versus what’s permissible, what their contract says and what they do. So under your contract, and the number varies by region. So let’s say XYZ insurance company pays the bill. This billing code for a basic therapy session is $250 that the provider will pay. I get 50. You get 50. So that should be $125 for each one of us.
However, that’s not what LifeStance does. They create an arbitrary chart that applies to a region where they normalize the amount. So instead of $250, it’s more like $190. So you’re getting 50 percent on $190 instead of $250. So, you’re really not getting 50 percent. You’re getting like 40 or 30 percent. And it changes without your knowledge. And there’s no way for the employee to track.
Because here’s the difference. When I have a salary and I know it’s $15,000 a month, I can look at my pay stub. It says gross, $15,000 a month. And it doesn’t say that I can call you, Hey, what happened?. And see your deductions because they tell me the same thing and you see your net amount. And when you make a salary, your paystubs look the same almost every time. But for, hey, I got more insurance or I got a reimbursement or I had unpaid time off. But it’s generally easy for the employee to look at a pay stub and determine what they’re being paid.
When you look at theirs, you don’t have any clue what it is and the paystubs change from pay period to pay period. So, the employee never knows how much I owe them in advance, how much is loan. I just don’t understand the specifics of my pay and my gross number can change drastically. You even have some that get onto this whole advance stuff and say, don’t pay me in advance because I’m getting further in debt with you and I don’t want to do that. They either do it anyway or you just don’t get paid for your services.
So you’re right. So on how I’m paid, they, they trivialize what the contract says I get. I really get a percentage of what we bill out. We’re not really partners that way. You’re getting a smaller percentage. So irrespective of what your contract says, I can make this arbitrary document and I can change every pay period if I want and base it on that, not what’s actually billed to the third party. And your paystubs don’t reflect what you get paid.
With the advance, under typical when you work for somebody, hey, I know that I’m going to get paid $1,000 next Friday, but I need to pay rent this month. Can I take an advance against my thousand dollars? We know definitely it’s going to be paid, yes. Here’s 500 bucks and you’ll see that deduction from your pay stub.
Under the LifeStance model — and their contract actually contemplates it. That’s why I say you have contracts that say one thing and behaviors that can do another thing. Under their contract, they get paid once a month. So if I work for the month of September, we close books on September 30th, I get my paycheck on October 15th to reflect my billings for the month of September. Technically, under what their contract says, we know we won’t collect all that money until the end of October, maybe November. But we know that you did X amount of dollars. So we’re going to go ahead and pay you in advance and then worry about collecting it ourselves after the fact.
That would be perfectly legal and fine to do that. Because you know you billed $10,000 to the carrier. You’re going to get your money. I’m going to get my money. So, I really don’t owe you any money because I worked and I put in that effort and it just needs to be paid.
The same thing as a law firm. My lawyers work for me. We anticipate that our clients are going to pay. So, there’ll be money to cover payroll and stuff. But that’s the traditional sense of an advance. It’s not really meant to create a debt obligation and it’s not meant to continue on and on and on and on. Because then that’s a loan. It’s not really my wages. It’s not really an advance against something I know I collect. It’s I’m loaning you money so I can keep you trapped here. That’s what LifeStance is doing.
So I don’t think the person who originally came up with this concept thought, hey, let’s go on here and let’s get everybody in debt. I think that’s just the practices that have come into play. And when you have a big organization and you do that on such a massive scale, you’re kind of locked into that behavior now because you don’t want to admit you’re wrong and have to spend millions of dollars to fix it because the average person doesn’t sue you. They just move on and get another job. They kind of locked themselves into a world of, oh, my goodness. We owe millions of dollars to our employees. What are we going to do? And if we change those habits, we’re admitting it. So they just continue to do it.
LISA EPSTEIN: So normally I wait until the end for audience Q&A, but there’s a really good question that fits in perfectly right here. The management during earnings calls and other conference calls constantly touts how the clinicians actually have the end control over their schedule. They can determine how many days they work, how many patients they see. That the clinicians control the schedule and they can indicate what hours they’re available. So does this contribute to the build up of the amount of outstanding balances or weigh into the issues at law? I have something to add after I hear your response, because I’ve had a couple of clinicians tell me some enlightening information about this.
KEVIN ROSS-ANDINO: Well, I will tell you, that’s a more recent change, and I think some of that is responsive to our lawsuits, to be honest with you. Because if you look at their contracts that they have — and they’re all the same, it’s a form document — that’s not true. Because if you’re a full-time employee, you have to be available full time for them.
And in some regions, they have on call duty. So I have certain therapists who work, especially the PhD ones, they get stuck working on Saturdays and Sundays, being on call in the crisis centers. So they can call them and stuff like that, That’s not negotiable. You don’t have a choice. It’s either that or don’t work,
And the scheduling and stuff like that is not true. They say flexibility because you can work remotely. You don’t necessarily have to go into the office because people like the virtual visit. But they expect you to be available to them for the period of time you’re available to them.
And you can’t have a second job. You can’t moonlight. You can’t do these other things. They don’t permit it because they have non-competes. You can’t work for this. They have a lot of restrictions of what you can do in your free time.
And all of their contract provides unpaid vacation. So, if you take time off from being there, you don’t get paid for it. So, of course, if you want to not be here for a week and not get paid, that’s no skin off my apple. If you want to call that flexibility, then that’s great. But that’s not flexibility. That’s, am I inclined to take the next two weeks off without getting a paycheck and further being in the hole with my personal bills? Or am I going to make myself available for work? That’s not flexibility. That’s a phantom vacation. Nobody wants to take unpaid vacation two or three weeks a year because that doesn’t help us pay the bills.
And so I would say that’s not true, even as they’re trying to migrate to a more flexible schedule. Because I know that some of my clients are employees, and they say it’s still not workable because it’s a phantom time off. It’s phantom flexibility and it’s not really applied across the board. Because if you’re in a smaller group, there’s only five of you in this place, versus the place that has 20 people, I can’t afford for the five people, to have two of them not to be available. So they don’t provide that at all.
LISA EPSTEIN: I mean, I can tell you a story a clinician, or therapist as you prefer, told me. And this therapist said she put in availability for five days a week from 8 to 5, didn’t even want a lunch break scheduled. She said she could eat in between. And LifeStance blocked off two or three days of her schedule without her authorization that she was available to work. And she could never get that block removed. And when she tried to go up the chain to find out why are you blocking off let’s say Wednesday, Friday, this week and Monday, Tuesday, Wednesday, next week, the answer that she was finally given was they didn’t want her productivity numbers to look bad because they couldn’t fill her schedule. So to avoid making the productivity numbers look bad, that they couldn’t fill her schedule, they just on their own, unilaterally limited her schedule. So it looked more full for the days that she was available. And that was a really eye opening story that I heard.
KEVIN ROSS-ANDINO: And that’s consistent with what I said and with the experiences of my people. Here’s the lack of flexibility too. They can take your client — because that’s how they refer to them instead of patients because it’s a little less doctor‑ish and it makes it more comfortable to refer to someone who’s getting mental health therapy as a client as opposed to a patient.
They can take and just give the person to somebody else. I mean, some of my people are leaving and they’re taking all their clients. And when somebody develops a relationship with their therapist, it really is therapy. It’s hard enough to get people to admit that they need some help. And when they actually step out and get the help, they form a bond with the person helping them. That’s important for the trust factor. So, I can actually help myself. I can actually get the therapy, the counseling, the advice, the direction. There’s just a lot of things that go into therapy. But it’s a relationship that builds up. When people leave, they’re arbitrarily sent to another person. Or if you’ve been you’re on sick leave, you lose your client.
So, they play with the clients almost like a commodity to move them around to a different therapist. And some people I’ve spoken to, a couple of patients – obviously, we’ve never mentioned their names. But a couple of the clients, they were like, you know, I bounced around so much from therapist to therapist and never made any progress. I said the heck with it. I’m just not going to do it anymore. I just show up once in awhile to get my medication, my prescription, refilled. Like I do my yearly visit with my doctor. And that’s what it became like. And that’s not the whole idea behind mental health therapy.
But yes, they do that. They book schedules even when you don’t want to be booked. They double book people. Or if they have a no show. So, they’re supposed to be paid if somebody doesn’t show. They don’t get paid. They just reschedule the people. the clinicians, therapists, they don’t actually book the appointments. It’s done by a booking service. So you can’t pick your therapist. I want to see Susan on Thursday. That’s not your choice. You’ve got to go to scheduling. And scheduling decides that you have time on Thursday because they have so many people stuck on your thing.
So, to suggest that you actually have the flexibility to see your clients as you need to or as you want to is just not true. And if their insurance only allows you one visit per week and the person wants to see you twice, they aren’t going to allow you to see them twice a week. So you don’t have the flexibility to service your clients the way you’d like to. It’s just not true.
LISA EPSTEIN: Another question that I have is many of the therapists I spoke with had never been paid by a W‑2 scheme before. As you had said earlier, most of the mental health professionals were under like a 1099. If they were paid W-2, it was more of a traditional salary. They would go into like, let’s say, a community mental health outpatient center. They would be there at 8:00. They’d walk out at 5:00. They get an hour for lunch and they get a certain salary every paycheck. It didn’t matter if they saw 1,000 patients that week or three. But they never just saw three.
So how does LifeStance use the W‑2 system or W‑2 offering, which traditionally you would think is better. You get benefits. You know what you’re going to make. You have access to the unemployment system if, G-d forbid, you lose your job or need it, worker’s compensation and a lot of other benefits for being a W‑2. So you would think being a W‑2 is better. But how does LifeStance promote that their employees are W‑2s, but actually treat them almost like 1099s?
KEVIN ROSS-ANDINO: And that’s the thing. They employ a hybrid system. So you can take the benefits of both. So if you ever look at any of their public offerings — I like looking at those. I like to see what they say. And they still haven’t disclosed any of my lawsuits, which is interesting. Since they’re being sued for securities fraud, and they have a trial next month.
So what they do and what’s the benefit? In their annual report for 2022 – and they kind of cut and pasted it into the quarterly reports, but it was a really nice little write up. The hybrid system is beneficial because they are employees, they don’t treat them like independent contractors. They’re not working for multiple people. They’re always available. So it’s a sales pitch to the clients. Hey, we’ve got people who are here. They’re dedicated. They’re working hard. They’re full time employees. They don’t have to be chasing the nickels and dimes like they had to do traditionally. They know they’re going to get paid and they’re going to be comfortable.
So they can make those bold statements in their public documents. Because that’s one of the things that they did when they went public is look at this robust group of people that we have available. No matter where you move, LifeStance is there to take care of you. We’re in 33 different states and growing. We hope to be in all 50 states so we can service our clients all over the place. We’re the Microsoft of the mental health industry. And that’s how I feel when you go hospitals, traditionally are not for profits. It’s about the patient, not about the money. But that’s what they’re doing when you go public. It’s about making money so you tell this to investors.
So you’re telling the investors, I have this secure group of people that are available because that’s all I sell is mental health therapy to people and stuff. I don’t get any other money. I sell these people, my employees, to provide services. They’re available. They’re locked in. They work full time schedules. They’re happy because they have reliable income and stuff. That’s a great little sales pitch to your investors and to the people you’re trying to bring into the door.
But in actuality, you’re still using the 1099 model, right? Because if you don’t pay me for paid vacation, I don’t know about you, but in other industries I can’t get anybody here to come work for me for three weeks of unpaid vacation. That’s not something people do when you have a salary. Because when you’re locking me into a weekly schedule that I don’t have the flexibility to show up, and if I want, I am an employee and I have certain expectations of being an employee. They kind of skirt that by having this contract that looks exactly what you would do with an independent contractor.
And why don’t they want you as a 1099? Well, one, they’re trying to buy out their competition because they’re heavily invested. That’s why they have so much negativity on their books. They’re running at a $45 million per quarter loss because they’re just throwing money out there, throwing it out there to acquire and limit their competition. I don’t want you to go work for somebody else. I want you stuck here. Because if I get rid of the competition, that’s more money for me.
Like I said, the traditional therapists, some of mine would love to teach a couple of hours at a university a week, especially the psychiatrists. I would like to teach a little bit because I like the student interaction. I want to do a little bit of my own little clinic on the weekends at church or synagogue or what have you. I want to do this. So they just compartmentalize to do several different things. You’ve eliminated their ability to do that. You have them trapped in because they’re a W‑2.
So they want the best of both worlds. I don’t have to pay you if you’re not here. I don’t have to pay you if you’re not making me money. But I’m going to lock you in so you can’t compete with me. And I’m going to put non‑competes on you. when you’re a 1099, you’re competing, right? When you’re not a 1099, you’re an employee, a W-2 employee. I can lock you into non-competes. So if you leave Life Stance, you can’t take any of your clients with you.
And so they take advantage of both systems which really contradict one another. They’re not meant to be an all in one. They’re meant to be separate. And the tax laws, that’s why they they’re called a 1099 versus a W-2. Those numbers come from tax forms, the forms the IRS create, to classify the taxpayer how you’re compensated.
LISA EPSTEIN: So let’s talk a little bit about this growth strategy. Because LifeStance constantly focuses on their clinician ads. They have had a severe problem with clinician attrition. And what’s interesting, Kevin, is that LifeStance has said many times like we’re doing a deep dive. Every time a clinician puts in their notice, we’re doing a deep interview, an exit interview, to find out what we’re doing wrong. We’re going to get to the bottom of this attrition. As if they had no idea, right? As if they do not understand that compensating professionals this way is not going to be tolerated for a long period of time, especially if you are in a profession that there is a massive demand for. There’s a massive demand.
KEVIN ROSS-ANDINO: Lisa your mike got unplugged.
LISA EPSTEIN: — a massive need for mental health professionals and given that they knew this compensation scheme and employer generated debt and aggressive non-compete and anti-competitive practices, I’m not sure their clinician ads would be so high. But as far as their growth strategy and the touting the clinician ads, how do you think that plays into the way that the clinicians are compensated or lured in under these inflated salary projections — not salary, I’m sorry, compensation projections and this very confusing payment scheme?
KEVIN ROSS-ANDINO: So if I understood the question correctly, what you really have here is you have a lure to bring people to work for you. And I will tell you many of these people are recent grads. For example, one of my guys, he was a regular floor nurse. That’s how he referred to himself. Even though I think that at the hospital they’re one of the most important people to have around. But he said I was a floor nurse. I got my master’s in psychotherapy. So I’m a nurse practitioner and he’s got multiple different disciplines that he’s got his master’s and his certifications in. He’s an eating disorder kind of person.
And so when you see this, this is going to be my first job. And I’m going to go from making $10,000 a month to making $15,000 to $20,000 a month because I went and got educated and did all these things. So now I’m going to go make this money.
So when you see these ads, nobody else is advertising like that, right? Because most of these mental health practices are very local. I live in the Orlando area. You’ve got several little small ones. And then you have a LifeStance. It’s kind of swooping in and they’re trying to eat up all the smaller ones. But when the other ones can’t afford to pay you what looks like a big wage like that, because if you work at the hospital, it’s a big hospital chain, you’re an employee. They will literally pay your ten grand a month. LifeStance doesn’t have the same model as a hospital and they don’t have the same availability with getting insurance to cover everything.
But it’s a hook. If you say I can make more than what you were making before, you’re going to take that, especially if you’re new into the business. So people will get lured into it and they go onto the websites and the different things and they see these numbers. This is what I went to school for. This is what I got that extra set of student loans to do. But I’ll make it up. I’ll do this. That’s why they advertise it.
Their growth strategy is just very simple. If we eliminate competition, almost forming a monopoly in the mental health, we can generate — if there’s a potential $2 billion industry and we have almost a billion of it, if we eliminate competition, we’ll get all $2 billion and everybody makes money. You make value for things. And then if the population increases, that number goes up with the population. If you read their investment documents, that’s kind of what their hook was to investors, And I agree it can be done and they can grow it.
I think the biggest problem is they didn’t plan how to do it on the back side, the infrastructure. Because I don’t think it’s as much going to pay the people as much as the fact is I didn’t put things in place so they can generate things efficiently. If you give me a real busy schedule — because I’ve had clinicians that they were able to pay theirs faster because they were in New York, bigger population, especially during COVID, where more people were inclined to get some therapy and stuff like that. They can keep themselves busy. So they didn’t ever owe the debt because they kept their things full.
They also were in a practice that was acquired by LifeStance. it was already established. Those people don’t experience the same thing. Because I’m already in an established practice. I have my clientele base. And I can hit those projections and numbers because circumstances allowed me to. The problem that LifeStance has is that administrative wise, again, like I said, I don’t think it’s some evil guy sitting in Arizona saying, let’s see what I can do to get everybody. It’s somebody sitting there, I acquired this mess and I don’t know how to fix it. They don’t have the infrastructure to support 33 different states. And in some states, you have as much as ten or 15 locations. So you have 400 shops versus four years ago you had 100 or 50 of them. All of a sudden, everything is Internet based, where it was more local based in the billing.
So, for example, I know for a fact because I represent several billing people that have issues with LifeStance, if you take from let’s say Maine all the way down through Virginia, just cutting off in the Carolinas, you have five people that bill for all of those states as opposed to each office having it. So they’re always behind. There’s always errors. Any kind of medical billing, I don’t know anybody — I doubt there’s a person on this call that has not had an issue with their bills when they’ve gotten medical service. They didn’t bill their insurance correctly. Somebody imported a code incorrectly. There’s always billing issues. When you have so few people servicing such a massive numbers, they’re behind months and months and months in their billing and the errors and the back and forth. They’ve been audited. They’ve had a lot of headaches with billing. Well, the infrastructure wasn’t in there to accommodate a thousand billers. People were generating revenue versus five people trying to manage all that for themselves.
Scheduling is the same office. So you have that same 13 state group has a handful of people scheduling for all of those offices. They don’t have somebody in the office. They don’t. So when they have their brick and mortar, maybe you have a receptionist. I went to the one here in Orlando, just out of curiosity, because it happened to be not too far. They don’t have a receptionist. You walk in and you’re standing there and a doctor came out. Then I ran because I didn’t want to get in trouble. But a doctor came out. That’s not what you want. You don’t want a doctor saying, hello, can I help you? And stuff like that.
So as opposed to the original practice, how things are done, you walk into a facility. There’s a receptionist. He or she greets you, gets you set up, makes sure you all your insurance is taken care of, making so many calls and stuff. And then you go see your therapist. It’s not like that at Lifestance. Especially since a lot of it is done virtual in the Teladoc, they don’t have it. So all that’s done in some place, I believe it’s in Rhode Island where they have these people sitting. So you’re servicing 13 states with ten people, five people in Rhode Island, but you’ve got 30, 40, 50, maybe even 200 or 300 facilities that you’re doing. It’s just doesn’t work. You can only do so much work with so few people. Nobody thought that part of the process through. And now what do I do to fix that? Because now people don’t like their job. And in some ways your best recruiting is your employees. Hey, I work at LifeStance. You guys should come. You’re not getting that. You’re getting, Oh, that place sucks.
LISA EPSTEIN: Yeah, look at the Glassdoor and Indeed, reviews, right?
KEVIN ROSS-ANDINO: Exactly. Exactly right. And so you’re experiencing that. they’re having trouble even keeping the numbers up so they can do their current work, let alone to deal with the growth that they’ve had. And their growth was so fast, which looked good on the books at first for investors, but your infrastructure wasn’t there and so you’re failing to hit your numbers. And when you fail to hit your numbers, people can tolerate a lot of things at work long as the environment I work in is not stressing me out because I’m working with a bunch of bad people, and I get paid what you said I was going to get paid. If you can do those two things, you can keep people happy and they’ll just come to work and do their thing forever and ever and ever and ever. Especially people who dedicate themselves to helping others.
But you don’t have that. You have an infrastructure that’s weak. So therapists can’t get their patients scheduled correctly. There’s always a scheduling error. Or, hey, I’m online and Susan’s not online. Or, where the heck is my doctor? Those things aren’t matching up. The billing is atrocious. You know, you and I once talked, Lisa, how some patients can’t get to see their therapist because they have an outstanding bill. But I’ve got an invoice that says it’s all current. Well, too bad. You can’t get in to see the therapist today.
And so those are failures because they don’t have the systems in place. So that’s going to frustrate the therapist. I’m not getting paid. And I got into this business to help people. And if I’m not helping people, I can’t even get job satisfaction from that. And I think that’s where the real problem is. They haven’t figured out how do I fix LifeStance so we can be productive? And we’re in denial because Kevin’s suing LifeStance in four lawsuits. They’ve got a security lawsuit in New York that they’re dealing with. They’ve got a cyber fraud one in Arizona because they were selling patient information because somebody put something on their website to allow the confidential patient data to be sold. So you’ve got multiple lawsuits going and you’re trying to plug all those holes. But you’re not accepting it, like I messed up, right? My stock price will rebound if I can plug these holes and get them done and then I can grow in the right way. I do think there is, at some point in management, there is a desire to get there. But it’s always a painful process that people have to go through the larger the corporation before you can heal yourself. And they ain’t there.
LISA EPSTEIN: And they’re not even admitting there’s a problem.
KEVIN ROSS-ANDINO: Right.
LISA EPSTEIN: I’ve wondered myself as we’ve gone through this reporting on the complete chaos and mismanagement of this billing and insurance claim processing, how reliable their financials are.
KEVIN ROSS-ANDINO: Correct.
LISA EPSTEIN: If a large portion of the bills are incorrect, billed to the wrong party, billed too late, billed in excess, trying to collect from patients when it’s really their health insurance’s responsibility but they aren’t billing the insurance correctly, I don’t know how that all, in aggregate, filters down into their financials.
KEVIN ROSS-ANDINO: It doesn’t. I mean, I study them all the time, and so do the securities lawyers that are dealing with that part of it. That’s kind of what we’ve all kind of stared at. And unfortunately — so just to give you a little context, about 20 years ago, I’m dating my age, but I worked for a company called Ryder Systems, the newest in-house lawyer, always got stuck doing all the securities compliance stuff. It’s horrible work, right? And that’s why the baby lawyer got to do that for a year.
And the way accounting works and how you can conglomerate things and consolidate things and do things, you have to be almost an accounting professional to be able to dig through the numbers. The way they disclose it in securities documents isn’t sufficient to really give you enough data to make really good decisions unless you’re super, super, super, super sophisticated in accounting and finance and stuff so you can dig through and ask the right questions and stuff like that. And since most investors are people who invest in mutual funds and other things, we don’t ask questions. We expect the stockbroker or the financial planner or whomever to do those, and they don’t really do it. They just kind of look at what’s going to make money. So, a lot gets lost. And so you can’t really delve into the numbers and stuff like that. And that’s why a lot of these companies, these law firms sue them. Because that’s how you get behind the numbers.
And none of that really translates in there. Because I know somewhere on the books in there, you have to be accounting for these debts. When I’m sitting there thinking, if you have about 5,000 people that owe an average of $30,000, that’s about $14-$15 million that you’re carrying as an asset. And you shouldn’t be carrying that and stuff like that.
And so my lawsuit is nowhere reflected – they haven’t even disclosed it. What lot of companies will do, they’ll move to dismiss your lawsuit. And because there’s a chance the court might throw it out — which we all know doesn’t usually happen — they don’t disclose it until they have to, until they’re forced to answer. And with my two suits, that will be a few months from now, maybe toward the end of the year. And my guess is they’re hoping to get the securities case off their books so then they can deal with me and then they can go to the next one, do the next one.
So these things don’t disclose and they don’t have to make accounting changes or anything like that. And I don’t think they will. And I don’t even think they’re giving it that kind of level of attention to detail. Because I can’t even get them to acknowledge that the way they do the advance — even in a lawyer/lawyer conversation so we can have a point of reference to move forward.
I’ll tell you, they’ve threatened to sanction me, you know, And so in federal court, if you believe a lawyer has filed a frivolous lawsuit, there’s this thing called Rule 11. So Rule 11 requires the plaintiff lawyer to always do due diligence and to check your P’s and Q’s before you file a lawsuit, especially a class action lawsuit, and to make sure that what you’re seeing is plausible and that you can prove it. They haven’t filed it because I’ve showed them my proof and so they have backed off. But I will tell you, I have been threatened since last December at least four or five times, well, we’re going to get you under Rule 11.
I welcome them. I said, I’ve been doing this for 30 years. No one’s been successful. Maybe, hey, you may be the first. But I can tell you, speaking to 100 people is a lot more due diligence than most lawyers do before they file lawsuits. So I’m pretty comfortable that what I’m saying is not made up. I may not be right. I could be wrong. You know, I’ve lost lawsuits. But I’m sure as heck not making things up.
And so they’ve never filed. That’s just a typical defense thing. But they’re not going to acknowledge it. Because to acknowledge it means I have to move forward and resolve it. And they’re not prepared to resolve my lawsuits under any circumstance. We had a – and it’s public. So I can say it. We’ve had a couple of mediation conferences over the summer to discuss it. While I can never discuss the contents or anything about the mediation, it’s very clear we didn’t settle the case because I’m still suing them. And so that’s what we’ve got.
And to me, you can’t make progress until you have a plaintiff that realizes maybe my number is not as big as it is, and a defendant that realizes I have some responsibility for this. So I need to make an overture to bridge the gap between this. I’ll accept my lofty number and your zero. Somewhere in there, there’s a reasonable number to get there. But first you have to have a defendant that’s willing to accept some culpability or responsibility before they’re going to write a check.
Because my Arizona lawsuit, we’re suing them for $50 million. My Florida one, we’re suing them for $5 million. And Dr. Ryder is suing them for a few hundred thousand dollars. And you haven’t been able to — I mean, his should be easy. He’s one guy, one contract, and it’s still not settled. We’re litigating that to death. And I will tell you, I do a lot of employment stuff. They don’t last that long. His has lasted almost a year. These other ones are ongoing for a period of time. And so there’s just some recognition you have to do on your part to get there. They may have done it internally. But I can tell you in terms of us dialoging, they’re not there because they continue to fight me on everything. And they are about to get ready to dig into some of these documents over the next couple of months. And again, I keep getting threatened to be sanctioned, which is kind of one of my fun things to talk about when people threaten me. That usually means you’re a little scared.
LISA EPSTEIN: Somebody sent in a question that’s really interesting. And we did some reporting about one of the anti-competitive practices that former therapists have told us about is that when a therapist leaves — and you alluded to this earlier — when a therapist leaves, their patients are essentially held hostage by LifeStance. They’re not given the appropriate information how to contact their therapist who is no longer with LifeStance. One of my sources put it as they hold onto their — I forget how she put it — like they hold onto the patients as if they were a company asset, an asset of LifeStance, instead of viewing a patient as a vulnerable person seeking mental health care who has formed a relationship with their therapist.
So the therapists that come to LifeStance with their roster of patients and bring them in, wrap them into the LifeStance system, then when they leave, those patients are walled off from their therapist who just left LifeStance. Have you heard similar stories from the mental health professionals you’ve talked to?
KEVIN ROSS-ANDINO: Oh, yeah. And LifeStance actually evolved in how they’ve done that. So when I first started talking to people a year ago, it was more on the line of you’ve got your non-compete and you can’t talk to these people and tell them where you’re going. I mean, they literally, that was a big you can’t say anything. You’ve just got to say, hey, you’ve got to go through LifeStance. That has only so much value in doing that.
So they’ve evolved it to — because you have to give 30 and 60 days, in some cases, advance notice — because they’ll sucker these people into doing 60 days even though their contract says 30 days. And what they do during that period — because I’ll tell you my newest clients experienced this frustration. I give notice in let’s say May 1st that I’m out of here August 1st. During that period of time, they’ll just take your patients and stick them on other people. Over that period of time, they’ll transition them. And once they’ve transitioned to someone new and you haven’t left, guess what? You can’t take them now anyway, right? And so they’ve evolved into that. Meanwhile, I’m not paying you for sitting here because you’re not seeing patients.
So I have one person that’s actually sat there for two months and she called me first because she said her husband freaked out. You got paid $25 this month for March. What do you mean I got paid $25? Look at this. It’s $25. So she makes the phone call. She realizes they have rerouted everybody and they just didn’t pay her during that period of time. So here she thinks I’m here 40 hours a week. You’re not allowing me to do anything else. And I know you want the opportunity to reroute my patients. But darn it, don’t I get paid something for sitting here? Nope. She went two months and made $25 one month and a big goose egg for the next month. And then they sent her a bill for $46,000 on her last day because she owed them because she left before she paid back her advance.
So they’ve evolved to a point where during the notice of termination period – and this is what I allege in my complaint because that came up as I was doing the Arizona one — is that now you’ve got a new system to get me. You don’t have to worry about non‑competing because I’m going to reroute all of your clients before you even leave. And once they’re comfortable with a new therapist, they don’t tell you why they’re rerouting you. They don’t really give the patient any reasons why. Now you’re going to go see — instead of seeing Susan. Susan has some things — so now, here’s Lisa. Lisa’s fantastic. And so, of course, by the time Susan leaves, I’ve seen Lisa four or five times and now we have the relationship. So I’m just not going to go move to Susan if I like Lisa.
And so that’s their new way of handling it. Because they don’t even have to bother enforcing non-competes because I already took the people before you left. And so, yes, you have people that form relationships. They do all these things. They have relationships with the client. But meanwhile, when I’m ready to leave — because face it. A lot of people are very honorable. I’ve told many of them, the heck with them. Say I’m done Thursday. Catch me if you can and give them my name and walk out. But you know what I mean? These people were — and I honor my clients for being these kind of people. No, that’s not right. That’s not how you do things. And they stay. And invariably, the ones that I’ve counseled to get the heck out of there got burned just like I told them they would get burned. And Lifestance has since taken all their patients. And one person was contemplating moving to another state and doing his or her– because I won’t define male or female — own practice and had no patients. Even though they had the book before they left and they couldn’t contact those people. So they were literally like, I’m starting from scratch, but I’ve been doing this for 20 years and I have nothing. And they already rerouted all that person’s patients.
LISA EPSTEIN: Yeah, I don’t know if you saw it. I think it was the most recent article, or a few articles ago, that we published, I found a provider’s lawsuit suing to get their clients — really to get their clients back. They had been fired by LifeStance. And LifeStance sent out a letter to the patients under this physician psychiatrist’s name saying I’m leaving, I’m moving on. And please contact LifeStance to be rescheduled, with the physician’s name, which was without her authorization, not what she intended to do. And she intended of keeping these patients, many of whom she brought with her when she was hired for LifeStance. So that really just tracks to what you’re saying. That litigation was ongoing the last time I checked.
KEVIN ROSS-ANDINO: Yes, it’s still ongoing. I know which one you’re talking about.
LISA EPSTEIN: Is there anything else I didn’t touch on or that you think our listeners might be interested in or should follow? And also, just let us know the status of your cases. Like what’s the next step and when we should have an eye out for the next step?
KEVIN ROSS-ANDINO: I would say as far as things that people should be aware of and know — because I think not just because of this lawsuit and what we’re doing, because this is obviously about my clients getting their wages — is a thing for us all to look at as human beings that get medical help, medical care. Because it’s not just LifeStance. It’s just not the mental health. It’s happening in health care all the way around. I have some medical things I’m dealing with and just my own personal frustrations and dealing with it. I’ve had the same doctor for a long time. And she’s a great person and a friend of mine. When her practice got bought out by a big hospital corporation, all of a sudden our ability to do what we do to keep me healthy is not the same. And it’s almost like she has to conveyor belt me through my visits with her and stuff like that. Because now she has to see so many patients in a day to make her money as opposed to I own the practice and we split the profits at the end of the year. Life has changed.
This is affecting all of us and how we get health care. It’s not just the insurance companies. They’re a big — I’m not a big fan of insurance companies. I need insurance to pay for things, but I’m not a big fan of how they do their business. But now you also have the hospital systems themselves doing it. And now when you’re buying private practices and doing it. So you have different aspects of your experience as a patient, as somebody who needs health care, you’re being affected by these practices no matter what it is, whether it’s LifeStance.
There’s a big lawsuit in Ohio where they’re bringing nurses from other countries and holding them hostage there for five years. If they leave, they’ve got to pay all their visas and all their stuff back. It’s almost like $20,000. It’s a breakup fee, as they call it. It’s affecting how these people are also delivering the care. When you take away my passion and my enjoyment for what I do, I will tell you, I’ve noticed as a 59 year old man, the difference between going to the doctor when I was 19 playing football in college to who I am now, which you think would improve, I actually can look back 40 years and like it was much better then with less things. Because my doctor actually cared about me.
Now I feel like I’m just another person that walks into the practice to the way the staff greets you when you walk in. Everybody is tense. There’s tension and everybody’s got to churn and burn them out. And so the delivery of health care in our country, that’s where I live and that’s what affects all of us, is going down. It’s going down. It’s diminishing from the value of just dealing with the staff to — I had a big test a couple of months ago. No one ever called me back. So I went to a different doctor. They just forgot. Like, you know, it was important that we have some communication. Two months later, hey, we’ve got to schedule an appointment. This results are back. I’m already finished and taken care of by then. That’s how it’s become.
So it’s affecting every listener on this call, everyone who views my lawsuits and stuff like that. It’s not just about these people making money because that’s what it seems like. It’s about the delivery of the services. Because when people who are giving you services aren’t happy, they sure as heck aren’t delivering services that are great. It’s one thing to get a bad hamburger at McDonald’s. It’s another thing to get a bad experience at the cardiologist, at your mental health therapist, at the pulmonologist, any of these people, because it affects your physical being or your mental being. You know, that’s how we live.
LISA EPSTEIN: The corporatization of medical practice, right? The takeover of medical practices by entities with a primary financial motive, profit motive, over patient care outcomes is what you’re talking about.
KEVIN ROSS-ANDINO: Right.
LISA EPSTEIN: And there is a lot of focus on that, on private equity and health care and corporate practice of medicine. Some lawmakers on the state level trying to introduce laws. And the FTC just sued a large anesthesiologist group, USAP, United States Anesthesia Partners or U.S. Anesthesia Partners, for monopolizing the market in Texas. So maybe they’ll, you know, you just said LifeStance is doing that in certain areas of certain pockets of the country too, similar type practice of monopolizing. In Orlando, for instance, really growing big enough to really kind of monopolize health care in that area. So there are concerns that I think have risen above just us as patients or professionals doing these jobs in the healthcare system. Please carry on about your lawsuits and what’s the next step.
KEVIN ROSS-ANDINO: So right now, the Arizona case is actually — since I don’t want to repeat the same thing in three different lawsuits, I can’t accomplish them all because the Arizona suit is so big. So we’re about to enter what they call the discovery phase, where I get to ask them for all these wonderful documents that they don’t want to give me. And so what I anticipate is when I send my list of things I would like to see, they’re going to give me a hard time, threaten me again, not give me the documents or dump billions of pages of nonsense on me. So I anticipate the next two to six months is going to be dealing with that.
And then I’ll be taking some depositions of their senior corporate people to get the pulse of what’s going on. You’re taking these positions and you’re saying that I’m wrong, but this is the net effect of what we see. And I believe that the regular person sitting in a jury box would see it. So show me where I’m wrong and I’ll show you where I think I’m right. And that’s kind of the layman’s terms of what you do next. You really go through this process and it usually takes anywhere from two to six, eight months, depending on the obstructionist behavior you get from your opponent. And sometimes that’s a phase where as you’re starting to dig into it, discussions about, hey, this case needs to go away, start to brew.
So anything can happen, I would say, between end of October and March is where something will have to give. Because I’m going to send them out this month. They’ll get them. They’ll have some time to process it. And in December, January, they’ve got to do something with it, hire experts. And so we will get into it toward the end of this year. I would say the beginning of next year is where I think maybe some progress can be made. They’ll have their securities lawsuit behind them. I think we’re next in line in terms of the bad guys, the next big bad guy. And maybe they’ll put some attention to making our issues go away.
Hopefully, the court rules on our motions to dismiss very quickly. And if we need to fix something in our lawsuits because it can go on — I don’t think they’ll outright throw out the lawsuit. Absolutely not. That doesn’t usually happen. Sometimes the court will say, I need you to — I’m going to dismiss it because you didn’t say A, B and C. Or I need you to correct this. Or I need you to take this focus which is beneficial to me because that tells me what the judge wants. I have a male judge and a female judge. I give them what they want and we progressive along the path that the judge is comfortable with. And we do those kind of things. And so that’ll happen over the next couple of months.
Unfortunately, with our federal court system, they both do civil and criminal matters. And both courts are now inundated with lots of criminal matters that take precedence. So they may be a little slower than they would usually be on these matters. But really the next six months is dealing with the court and deciding what my lawsuit gets to look like and says and getting the documents that kind of bring out the evidence of what was done and what was not done. And hopefully, prompting some type of process of let’s talk about how we resolve these.
LISA EPSTEIN: And just one last question, and then we’ll let our very patient listeners go. And I thank you and let you go too. I know you’re hoping to achieve a very positive and favorable outcome for your clients. But are you also seeking to require LifeStance to change these practices for other clinicians going forward?
KEVIN ROSS-ANDINO: Yeah. So the lawsuit really is if I’m right and we get that result, they’ll have no choice but to change their business practices. And that also makes resolving my lawsuit hard, right? Because if I can just write Kevin and his people a check for $20 million, I might not like it, but it goes away. However, if I don’t want Kevin to find new set of people and do this again, I have to make a big correction of my business practices.
What does that mean? That means the last five years of accounting has to change. That’s why I think they have to get rid of the securities one first. Because you open that can of worms and that lawsuit got more expensive. So you have to change some accounting, both from the back end going forward. You’ve got to change some business practices. So there’s more to it than just writing a check. It’s multifaceted, right? It’s going to be a fundamental change in how I do business and correcting my past. So that has a big dollar value and a mechanical value in how I implement that.
So yes, by virtue of resolving my lawsuit or me winning it at trial, if I’m successful at either stage, they have no choice but to change their business practices because then you make it easier for me to do this again. And the last thing you want to do is give me a roadmap to do it again and again and again. Because I will.
LISA EPSTEIN: Got it. Got it. Well, it has been a pleasure. I’ve learned a lot. And you’re a wonderful, engaging guest. I want to thank you so much. And if anyone wants to contact your office, if any clinicians happen to be listening, we’ll put that up. Once we publish the transcript, we’ll put that up for our listeners.
KEVIN ROSS-ANDINO: Great. I appreciate the opportunity, Lisa. And it was fun. Thank you.
LISA EPSTEIN: Thank you so much. Everyone have a nice afternoon.