Examining Patient Brokering and Addiction Treatment Fraud Concerns

On December 12th, 2017 the Oversight and Investigations Subcommittee (115th Congress) of The House Energy and Commerce Committee (E&C) held a hearing entitled Examining Concerns of Patient Brokering and Addiction Treatment Fraud.

Watch video of the hearing here.

The hearing involved testimony from various law enforcement, government, and treatment representatives including the following: State Attorney, 15th Judicial Circuit FL; Chief Assistant State Attorney, 15th Judicial Circuit FL; Assistant Attorney General, Chief Health Care Division, Office of The Massachusetts Attorney General; CEO of the California Consortium of Addiction Programs and Professionals; and the President and CEO of Caron Treatment Center.

The hearing summarized patterns of unethical marketing and treatment practices occurring nationwide that create windfalls for egregious operators at the risk to individual’s suffering from drug addiction desperately in need of help. Several recommendations for improvement in regulations and enforcement where discussed.

Among these are suggestions for the following: outcome based reimbursement models; clarification and expansion of ADA (Americans with Disabilities Act) and FHA (Federal Housing Administration) rules and regulations as they relate to sober homes; amendments to the federal Anti-Kickback statute; amendments to the Bonified

Employee Safe Harbor statute in order to prohibit bonuses to admissions and marketing employees based upon value and/or volume of admissions; and increased effort of federal agencies to enforce brokering and fraudulent practices.

After lengthy testimony highlighting the negative aspects of addiction treatment abuses, the Vice Chair of the committee, Mr. Griffin, raised the question of how to solve the problem. Mr. Griffin asked how to determine legitimate providers while getting rid of the bad ones without limiting much needed access to substance abuse treatment centers. Suggestions included insurance carriers developing a formula to reward good providers while punishing the bad ones.

Other suggestions included the following: A focus on evidenced based practices; weeding out manipulative websites that do not show credentialed staff providers; lists by agencies such as NAATP (National Association of Addiction Treatment Providers) that show ethical providers; providers that show outcomes; greater regulation of call centers; and greater enforcement of licensure and credentialing standards.

While hearings such as these are heartbreaking to legitimate providers attempting to help those suffering, they are extremely necessary. Addiction treatment is more needed then ever in order to save lives of the masses suffering in America. It is unfortunate that most of the media coverage and publicity goes towards addressing unscrupulous activity rather than educating the public on where to seek good care. 

The legitimate provider is not getting rich on the backs of suffering addicts. To the contrary, most of the ethical and legitimate providers are struggling to remain afloat due to the combination of negative press, enhanced insurance regulations, and decreased payments to combat the fraud carriers have experienced.

Let’s hope for some very positive changes in 2018 so those of us putting all of our efforts into trying to help those suffering can continue to provide optimal treatment that is no longer deterred or overshadowed by egregious profiteers.