This isn’t a threat. It’s not a lawsuit announcement. It’s an explainer for anyone running (or lurking in) the ESA letter space and quietly wondering where the next line of scrutiny is coming from.

Right now, Florida’s Patient Brokering Act is where I’m looking.

Not fraud.
Not vibes.
Not whether your website looks sketchy.

Structure.

What Patient Brokering Actually Means (in simple terms)

Florida’s Patient Brokering Act (PBA) is blunt:

You can’t pay or get paid because you sent patients to a healthcare provider.

That’s it.

It doesn’t care if:

• your therapist is licensed,
• your intentions are good,
• you pay a flat fee,
• you don’t guarantee approval.

It only asks two boring questions:

1. Were patients routed to a provider?
2. Did money change hands because of that routing?

If the answer to both is yes, regulators stop smiling and start reading contracts.

Why ESA Letter Platforms Are Getting Looked At Differently

A lot of ESA platforms follow the same basic model:

• The platform takes the money
• The platform assigns the therapist
• The therapist never bills the patient
• The platform says it’s “not healthcare”
• The product being sold is the letter

That setup creates a problem.

Because now the obvious question is:

What did the patient actually pay for?

Healthcare?
Or access to a signer?

That question matters more than your marketing copy.

Enter: the Superbilled Elephant in the Room

A superbill is just a normal healthcare receipt.
Real providers issue them every day.

If a patient asks:

Can I get a superbill for my evaluation?

There are only three possible answers:

• “Yes, here it is.”
• “Ask the therapist.”
• Silence.

When nobody can provide one, that’s not drama — it’s evidence of how the transaction really works.

No superbill doesn’t automatically mean wrongdoing.
But it does mean the payment wasn’t treated like normal healthcare billing.

And that matters under patient brokering law.

“But Therapists Get Paid No Matter What”

Good. That removes outcome-based incentives.

But it doesn’t end the analysis.

If:

• therapists only get clients through the platform, and
• the platform only makes money by routing patients, and
• the platform controls payment and access,

then compensation is still tied to referrals, even if approval doesn’t matter.

That’s not my opinion.
That’s how the statute is written.

Why This Isn’t About BetterHelp

People might ask:

“What about BetterHelp?”

Here’s the difference:

BetterHelp sells therapy.
ESA mills sell paperwork.

If the letter disappeared tomorrow:

• therapy platforms still function.
• letter mills don’t.

That distinction is everything.

Final Thought (Read This Carefully)

I’m not accusing anyone of crimes.
I’m not naming companies.
I’m not threatening regulators.

I’m explaining why structure now matters more than speed.

If your business:

• sells care instead of documents,
• lets providers bill patients directly,
• doesn’t profit from routing patients,
• and can produce normal healthcare records,

you’re probably fine.

If not, ignoring Patient Brokering Act questions won’t make them disappear.

Sharp elbows don’t mean wild accusations.
They mean asking the right questions and letting the answers speak.

PS Superbill, here I come.