Published in “Health Affairs,” the official journal of Project HOPE, a U.S. private volunteer organization that funds medical training and resources across the globe, a recent research article, entitled “Admission Practices And Cost Of Care For Opioid Use Disorder At Residential Addiction Treatment Programs In The U.S.” has found numerous questionable practices being employed by addiction rehab centers across the nation in their bid to attract new clients.
Using their own researchers posing as uninsured, cash-paying heroin addicts who were looking for addiction treatment, Health Affairs decided to investigate recent claims regarding high costs and misleading recruitment practices. In total, 613 residential programs nationally were contacted, and the audit survey revealed that the concerns that had previously been raised were more than justified.
In fact, many of the practices used to attract clients ranged from illegally offering rehab places without a full, in-person assessment, to potential fraud by signing up clients using highly expensive credit terms, all arranged by the rehab center themselves.
Official findings in the report included:
- A third of callers were offered admission before their clinical evaluation (usually within a single day)
- The majority of programs required up-front payments; for-profit programs charged nearly 3 times as much as their nonprofit counterparts – $17,434 on average, compared to an average of $5,712
- For-profit programs used specific recruitment techniques, such as paid transportation, whereas nonprofit programs did not
- Practices such as these (the admission offers, the expensive up-front payments, and the recruitment techniques) were even employed by programs with third-party accreditation and state licenses – completely contrary to these organizations’ rules and regulations
Fraudulent Activity Fueled By the Continuing Opioid Epidemic
Like any other multi-billion dollar industry (and the business of addiction treatment currently stands at around $42 billion per year), you will always find or uncover cases of fraudulent activity. Now, with over 15,000 private addiction treatment facilities currently operating within the U.S., just the sheer volume of rehab centers makes fraud more likely to occur.
Additionally, with the U.S. in the midst of the opioid epidemic, and with the increased insurance coverage now offered under the Affordable Care Act and Medicaid, there has never been such a public need and subsequent demand for treatment. Sadly, however, many of the rehab facilities and sober housing projects being seen now are clearly opening for one purpose only – profit over care.
What makes this particular report such a damning indictment of profit-over-care is the actual customer base that is being targeted by these practices – vulnerable and desperate people who are looking to change their lives for the better.
The more each drug addict has to lose, such as their family, their partner, their kids, their employment, and even their liberty, to name the primary concerns, the more vulnerable and desperate they become.
“It’s not all kittens and rainbows. As we have seen countless times in other frenzied health care sectors, when the money flows in, so do the ne’er-do-wells, which can bring the sector the kind of attention it doesn’t want.” – Addiction Treatment Investment Brief (2014) by The Braff Group, a leading mergers and acquisitions advisory firm for health care services
It is important to understand that suspected and proven fraudulent activity has always existed within the addiction treatment industry. However, it was hoped that the formation of organizations like official accreditation entities, which promote and regulate best practices and, ultimately, standardize the industry to a higher level of care, would cut down and, to a degree, control this type of activity.
However, it appears that serious work still needs to be done to protect these vulnerable and desperate people.
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“Surprising” & “Troublesome” Recruitment Techniques
Clearly, the main driver of this fraudulent activity is the continuing national opioid epidemic, which, given the rise of the use of illicit fentanyl and fentanyl analogs and rising drug overdose mortality across the nation, is not going away anytime soon. In fact, recorded opioid-related deaths last year, clearly exacerbated by the coronavirus pandemic, have never been so high.
Furthermore, the fact that even accredited and state licensed rehab facilities are going down this illegal route, solely for the purpose of increasing profits, should be particularly concerning to the authorities who attempt to regulate the industry.
When a healthcare service for public use demonstrates that 43% of its addiction treatment programs were using techniques which this report called “surprising” and “troubling,” it becomes critical that any necessary action needs to be taken immediately – by both the accreditors and the states who allow these businesses to operate.
Furthermore, it is in the best interests of all that potentially criminal fraudulent activity is dealt with quickly by the relevant legal authorities at the federal level, including the police and the courts.
Case Study: Brianne, 20-Year-Old Heroin Addict
Here’s one particular example of criminal fraudulent activity, known within the addiction treatment community as “The Florida Shuffle,” that was to involve the local police and the Federal Bureau of Insurance Fraud.
Imagine, if you can, you are a 20-year-old heroin addict – like Brianne. You are offered a thousand dollars in cash (yes, $1,000) to stay in drug rehab for just one week. Stay longer, and it’s $500 every week afterward. If you were an active heroin addict, you’d probably come to the same conclusion as young Brianne did, back in early 2017.
$1,000 buys a lot of heroin.
After admitting her opioid addiction to her mother 6 months before, Brianne was approached by what is known as a “patient broker” – someone who aggressively targets the vulnerable to fill addiction treatment beds, and then collects the insurance money.
Accepting the broker’s offer, Brianne spent the next year and a half either in Florida rehab centers, from Palm Beach to Miami, or in local hotels, where the broker would supply her and others with heroin and Narcan (the naloxone opioid overdose reversal medication). Brianne was later offered $400 for every “patient” she herself managed to recruit.
The “Florida Shuffle”
These “patient brokers” are invariably current or former drug users themselves, who make money by trolling for potential customers, like Brianne, on social media, at NA meetings, and in geographical areas packed full of treatment facilities, like the Florida coast and southern California’s so-called “Rehab Riviera.”
Jen, Brianne’s mother, quickly became aware of the exorbitant claims being submitted to her insurance company, such as $3,000 for a routine drug test and, on one occasion, $22,000 of rehab charges in a single day.
It’s not just this blatant insurance fraud that still concerns the professional and law-abiding rehab facilities of the addiction treatment industry, either.
At one rehab facility, and after a short period of sobriety, Brianne was prescribed Klonopin, a benzodiazepine, and Suboxone, an opioid treatment to deal with intense withdrawal symptoms. This dangerous benzo-opioid combination of medicines is specifically warned against by the FDA (the U.S. Food and Drug Administration), as both can severely impair respiratory function when taken together.
Needless to say, there are many, many more potential patients like Brianne still being brokered across the U.S. to stay in drug rehab facilities, to claim health insurance, and, at the same time, being given cash and illicit drugs as incentives to do so.
Keith Humphreys, a former drug policy advisor to then-President Obama, was once speaking about how the basic rules of medicine have seemingly not been applied to the field of addiction treatment, as some rehabs were not even employing one licensed physician on their staff, and stated wryly, “Imagine trying to license a clinic or a hospital, and saying, ‘We have zero doctors or nurses.’”
It’s a sentiment that has been mirrored by the senior author of the new Health Affairs report, who stated, “If a hospital was admitting anyone who walked into the emergency room regardless of how sick they are, giving them treatment that may or may not help them, we’d find that absurd. But for some reason, we tolerate it in this residential rehab community.”
Accreditation Organizations: A Sign of Excellence or a Placebo?
One of the rehab industry’s primary accreditation and trade groups – the National Association of Addiction Treatment Providers (NAATP) – finally revised its code of ethics in January 2018, to reflect the growing concern about the “patient broker” problem.
The group prohibited its members from both “buying and selling…patient leads” or “offering inducements and non-clinical amenities to prospective patients,” and actually directed the change in ethics to 76 organizations in particular. In other words, the NAATP was saying we are aware of what is happening now, and, if it doesn’t come to end, your memberships will be revoked.
Its executive director at the time, Marvin Ventrell, acknowledged the stand against the practice of patient brokering had cost the NAATP around $100,000 in membership fees, but “people are dying and nobody else is doing it. Our association can’t survive a holocaust of corruption.”
Accreditation is still an important element of assessing the professional standard of care you should expect and receive from an addiction rehab facility; however, potential rehab patients need to be aware that even with an official accreditation, dubious recruitment techniques may still be used to “guide” their decision.
The Importance of Awareness & Due Diligence
Many addiction treatment websites deliberately “ignore” the issue of fraudulent activity, dubious hard sell tactics, poor ethics, and inducement-laden recruitment techniques (as well they might, in some cases).
However, SpringBoard Recovery believes it is only by providing real awareness through a focus on unsavory issues like these for our current and future clients that the problems raised can be clearer to detect and more noticeable to all concerned, particularly those who may be in a vulnerable position personally.
Furthermore, it demonstrates to possible addicts seeking recovery that these “brokers” do exist, they will unscrupulously and criminally use you to make money for themselves, and they will keep you addicted to the substances that are ruining your life, just as they did with Brianne in the case study above.
Choosing Your Addiction Treatment Program
In tandem with awareness comes the equally important matter of due diligence – your due diligence when choosing the drug addiction rehab program you wish to help you reach recovery. The National Institute on Drug Abuse (NIDA) has an excellent list of the principles of effective addiction treatment, and these are the elements that all professional rehabs fully address within their programs. The principles include, among others:
- Addiction is a chronic, complex but treatable disease, affecting brain function (and resulting in changes that persist long after drug use has ceased) and behavior – this explains why drug abusers are at risk for relapse even after long periods of abstinence, despite the potentially devastating consequences.
- No single treatment is appropriate for everyone, as treatment should vary according to the type of drug, and the characteristics and needs of the patient.
- Effective treatment must attend to the multiple needs of the individual, not just the drug abuse, eg. any associated medical, psychological, social, vocational, and legal problems, and it must be appropriate to the individual’s age, gender, ethnicity, and culture.
- Staying in treatment for an adequate period of time is critical, as research shows that most substance addicts need at least 3 months in treatment to significantly reduce or halt their drug use
- Behavioral therapies, eg. individual, family, or group counseling, are the most commonly used forms of drug abuse treatment.
- Medications can be an important element of treatment for many patients, eg. opioid addiction especially when combined with counseling and other behavioral therapies.
- An individual’s treatment plan must be continually assessed and modified to ensure that it meets their changing needs.
- Many substance addicts also have other mental disorders, which need to be treated simultaneously with their addiction. The combination of a mental health disorder and addiction is known as co-occurring disorder (or dual diagnosis)
- Although medically assisted detox (the first step of treatment) can safely manage the symptoms of withdrawal, the process alone will rarely achieve long-term abstinence.
SpringBoard Recovery: Refreshingly Human
At SpringBoard Recovery, located in Scottsdale, Arizona, near the city of Phoenix, you’ll find professional, highly qualified, and dedicated staff to help and guide you on your road to recovery from substance addiction.
Many of our staff have stood where you are standing right now, conflicted and concerned about what the future holds, yet immensely proud they took the real step to seek addiction treatment themselves, and, having found their own sustainable, long-term recovery, want only the very same for you.
Our full range of addiction treatment programs present the ideal opportunity for you to take the very same step towards your own lasting recovery. Call us today to find out more. However, you can rest assured – we’ll need to complete a full medical assessment of you, your needs, and your substance addiction before we’re able to offer you a place on one of our programs.