WASHINGTON — “Brokering” of addiction treatment patients is becoming a nationwide problem, but there are actions the federal government could take to help states and localities crack down on this activity, experts told lawmakers.
“In July 2016, our office formed a task force to crack down on this,” Dave Aronberg, the state’s attorney for Palm Beach County, Florida, said at Tuesday’s House Oversight and Investigations Subcommittee hearing. He noted that the task force has arrested 41 people and scored 10 convictions so far. “But we can’t fix this problem alone.”
Because treating addiction can be a lucrative business, some companies that operate in Florida and purport to treat substance abuse patients will hire people as marketers or call center operators; their job is to encourage patients to come in from out of state to receive treatment at an addiction center, or to stay at a “sober house” to integrate back into society once they have finished treatment, Aronberg explained.
Often, these facilities provide little or no addiction treatment, and the sober houses are more like flophouses and don’t provide the help they advertise, but the marketers get paid commissions or kickbacks for each person they sign up. They lure patients with offers of free travel, free rent, and other benefits.
“Together, the ACA [Affordable Care Act] and the [mental health] parity act cover rehabilitation on a traditional fee-for-service basis with no yearly or lifetime limits,” he said. “In recent years, there is a surge of people who have enriched themselves by using these laws to prey on addicts, who are often willing to participate in patient brokering, illegal kickbacks, and insurance fraud in exchange for illicit benefits such as cash, free rent, transportation and [even] drugs. This is the ‘Florida Shuffle.'”
And, because relapses are also covered, companies have an incentive for people not to get well — and will even go so far as to offer sober house residents drugs in order to make them relapse. “We are incentivizing failure,” Aronberg said.
Massachusetts has seen the problem from the other side, with patients leaving the state to get what they think will be effective treatment for their addictions, said Eric Gold, an assistant attorney general for healthcare in the state. “Our office began hearing stories of men and women from Massachusetts lured out of state by recruiters who promised free travel to addiction treatment centers, [but] when they arrived, they found that treatment was low-quality or non-existent, and they were left thousands of miles from home with no treatment, no resources, no insurance, and no way to return home.”
The witnesses had several recommendations for committee members to consider. “Address private insurance abuses by adopting the ACA’s outcome-based reimbursement model — which is used in Medicare — instead of the current fee-for-service model,” said Aronberg. “That will reward the best recovery centers while shuttering rogue operators. It could also improve outcomes as providers are incentivized to offer longer, lower-level care instead of ineffectual short bursts of intensive treatment with no follow-up.”
He also suggested clarifying the Americans with Disabilities Act (ADA) and the Fair Housing Act (FHA) to specifically allow localities to enact regulations for the health and safety of sober home residents. “These agencies [tried to clarify the rules] last year, but they seemed to miss the point … [Their clarification] seemed to ignore the realities on the ground and did not give any good guidance … We want to know, can we require mandatory certification of these facilities? They didn’t answer that.”
The city of Boca Raton tried to zone sober homes into an industrial area a few years ago, but the city got sued and lost, and was forced to pay out $3 million, he added. “The ADA and FHA were designed to protect individuals, but in reality they are used as a shield to protect the people who harm these folks.”
Douglas Tieman, president and CEO of Caron Treatment Centers, an addiction treatment provider, said that lawmakers “must [enforce] the laws currently on the books and must come up with other regulations that address [treatment] website accuracy and transparency … We need to establish standards in the treatment field and work with associations to establish standards for marketing, evidence-based treatment, and ethical billing.”
Currently, the National Association of Addiction Treatment Providers and the American Society of Addiction Medicine are developing standards in these areas, and hope to soon release a list of treatment providers who follow ethics standards, Tieman said.
Subcommittee member Morgan Griffith (R-Va.) said he was concerned because his district is already short on addiction treatment facilities, “and I know at least one in my district that pays either on volume or commission … If we eliminate [payment based on] commissions and volume, I fear we may be limiting access to substance abuse treatment itself.”
But Alan Johnson, the chief assistant state’s attorney in Palm Beach County and a colleague of Aronberg, said he had “not heard a compelling argument for why an employee needs to have commissions or bonuses. When you give someone a commission, you incentivize overutilization.”
Rep. Raul Ruiz (D-Calif.) suggested that the Substance Abuse and Mental Health Services Administration (SAMHSA) could develop best practices for addiction treatment facilities, and allow places that meet those criteria to receive certification for it. “I think SAMHSA could provide something like this, and I know I could get bipartisan support from the committee as well,” he said.