Patient brokering: a new aspect in America’s addiction crisis
Jordan Ryan | Wednesday, August 30, 2017
America is in the midst of an unprecedented addiction crisis. In the decade between 2000 and 2010, prescription pain reliever overdose deaths increased by more than 400 percent among women and 237 percent among men. Drugs such as fentanyl took over 65,000 American lives last year. That’s 100 deaths per day. If you try, you’ll find that a friend, relative or someone close to you has been directly and adversely affected by this crisis.
Unfortunately, there are collateral aspects of this crisis that will require creative solutions. One of the major roadblocks to solving this problem is the emerging industry of patient brokers. Patient brokers are abusing the vulnerability of the addicted in their local communities and committing insurance fraud to line their own pockets. This horrible and greedy practice leads only to more relapses, struggles and deaths among addicts.
The practice of “patient brokering” occurs when a broker convinces an addict to obtain treatment at a facility the broker is partnering with. In return for steering the patient to the facility, the broker receives significant compensation from the treatment centers.
Patient brokers work in communities all over the country. They approach addicts wherever they can be found, from the street to the grocery store, sometimes even on social media, with a warm smile and encouraging promises. They’ll share a story about how they themselves are recovering addicts. After securing the addict’s trust, the broker offers to send them free of charge to sober houses or rehabilitation programs in places like California or Florida to start on the road towards recovery. They promise free housing, discounted groceries, sometimes even free cigarettes and Xboxes, in return for entering the designated treatment program. They shower the addicts with false compassion and support. They make it sound so easy.
What those needing help unfortunately don’t realize is that these brokers are merely serving as middlemen for the treatment centers. In return for filling the facilities with bodies, these brokers can receive anywhere from $500 to $5,000 per patient referred.
It gets worse. Once admitted, patients are subjected to unnecessary and costly testing to generate revenue for the centers and their brokers. With the Affordable Care Act came the requirement of insurance companies to cover all drug addiction-related treatment. For this reason, treatment centers can charge insurers for whatever tests they decide to perform. This unethical practice racks up hundreds of thousands of dollars in costs that the patient did not need and deflects resources from treatments that are truly necessary.
These treatment mills or “sober homes” rely on the continued charging of insurance companies to fuel their schemes. Insurers are often falsely billed for thousands of dollars every month to pay for unnecessary tests and treatments, or more often, for tests that are never actually conducted. These sober homes often conspire with labs to scam yet more money from insurance companies.
The most shocking aspect of these schemes is the total lack of concern for patient recovery. Successful recoveries at these mills are extremely low. Living conditions at the sober houses offered by brokers are often, at best poor, and dangerous. Many of these facilities do not meet regulatory requirements and become magnets for crime.
The difficulty in overseeing these centers has led to disastrous consequences. Those in need of treatment are sometimes locked inside these facilities in order to cut off all connection to the outside world. Their phones are confiscated in the name of treatment. In an extreme case, some patients at a center in Florida were subjected to prostitution.
Relapses are much more common than successful recoveries. Some of these centers supply drugs in an effort to encourage relapses among their patients. Relapses mean more time in the center, more tests and treatment and more money for the centers. These centers do not seek true rehabilitation. They are perpetuating the revolving door which we are desperately trying to eliminate. This heartless scam has turned into a $1 billion business at the cost of thousands of lives.
This problem is particularly troubling for ethical and professional rehabilitation centers, which are doing good work. Some insurers are simply refusing to reimburse treatment with little or no evidence of fraud. The good are getting punished for the conduct of the bad.
There should be no question as to the importance of rectifying this crisis. Perhaps this may be a point of unity among Americans. Florida has already enacted legislation that makes patient brokering illegal and allows for broader regulatory oversight. Uniform federal action is necessary and should generate bipartisan support.
Patient brokering is unfortunately just one of the many roadblocks which America faces on the road to solving the opioid crisis. The problems underlying the crisis implicate a variety of interwoven causes which will require a coordinated effort by the political, healthcare and social services communities. The result will undoubtedly be worth the effort.
The views expressed in this column are those of the author and not necessarily those of The Observer.