How insurance fraud and patient brokering hurt addicts.
Drug addicts and alcoholics lie. We cannot abuse drugs and alcohol without also abusing the truth.
Our careers as addicts and alcoholics begin with denial. We lie to ourselves about being able to control our drug and alcohol use. We lie to ourselves about our role in the pain we cause others.
We lie to others about being high. We tell anyone who asks that we just had a “couple” drinks. We lie to our bosses. We lie to our kids. We lie when we relapse.
That is why sobriety requires us to not only stop taking drugs and drinking but to quit lying. Just as we must stop hanging out, working and living with people who use drugs – we must do the same with dishonest people.
That means we must stop lying to insurance companies and stop paying and taking kickbacks for referrals to drug treatment centers and sober homes.
Corruption in the drug treatment industry is rampant. As an investigative reporter, I have spent the last two years uncovering unscrupulous treatment center and sober home operators.
Many are themselves young addicts who came to Florida to get clean. They have seen other young addicts who have opened treatment centers and sober homes make fortunes filing bogus insurance claims for unnecessary – sometimes non-existent treatment and urine drug screens.
They, too, crave fine watches, expensive cars, vacations, fine-dining and women. They are willing to do what addicts do best to get the lifestyle – lie.
Here’s how the insurance fraud works in South Florida.
Treatment centers provide a free plane ticket to young, insured addicts from chilly northern states. After 30 days of inpatient treatment, the newly recovered addicts are sent to sober homes, where the addicts lives rent free.
They pay no rent because the treatment center has agreed to pay the owner of the sober home a kickback for every addict they enroll in outpatient treatment at the treatment center.
If another treatment center offers to pay more for an addict, the sober home operator will send the addict to the treatment center that pays more – regardless of whether the other treatment center actually provides better treatment.
There are also independent “body brokers” – also known as “junkie hunters” – who troll 12-Step meetings and coffee shops. They promise addicts cigarettes, gift cards, gym memberships, cell phones and free rent if they will move into the sober home and enroll in the treatment program that pays the biggest kickback.
How much is an insured addict worth? A finder’s fee of at least $500 plus as much as $1,000-a-week for as long as the addict remains in treatment.
This is patient brokering. It is a felony. It is dishonest. Why? Because the junkie hunter and sober home operator deceive addicts by telling them a particular treatment center – which happens to be offering a kickback- will give them the treatment they need.
These junkie hunters and sober home operators – who may or may not have a high school diploma or criminal record or training in addiction treatment – pawn themselves off as being medically qualified to know the kind of treatment an addict needs and the recommend treatment center that will provide that treatment.
If you had cancer, would you rely on the recommendation of a stranger – who offered you gift cards and a gym membership – to tell you where you can get the best treatment?
This crime is particularly heinous because research has shown that at least one-third of addicts also suffer from a companion mental illness, such as depression and bipolar. Left untreated, relapse is common.
Every time an addict pees into a cup at an unscrupulous drug treatment center – the kind that pays “junkie hunters” for patients – insurance fraud is likely being committed.
Like patient brokering, insurance fraud is dishonest and a felony.
The dishonesty begins when the treatment center tells a patient that he or she must be drug tested three times a week. Often, the urinalysis drug screens are not medically necessary. Sure, a doctor has signed an order saying the drug screen is necessary, but often that doctor is also being paid a kickback by the treatment center. Sometimes, the doctor signs the order without ever seeing the patient.
Even though an addict may be clean and sober for months – or maybe never abused drugs, only alcohol – an expensive drug screen is ordered that tests for virtually every drug under the sun.
The treatment center also bills the insurance company for therapy – even though the therapy may be nothing more than watching a movie, attending a 12-Step meeting or a group discussion led by another recovered addict who has no degree and only a few months more recovery that the addict in treatment.
Sometimes, treatment centers continue billing for treatment and urine drug screens even after a patient has left or died. Another lie.
More lies are committed when the bill from the insurance company arrives. The patient is supposed to pay premium and deductible. But often the treatment center pays the premium and waives the deductible.
What is wrong with that? When a treatment centers bills an insurance company for costs it has no intention of collecting from a patient, then the treatment center has lied about the true cost of the service.
To avoid being accused of insurance fraud, some treatment centers require patients to sign promissory notes, promising to reimburse the cost of airfare and insurance co-pays. Or, a treatment center will send three letters to an addict or addict’s parents demanding payment.
But the treatment center makes little – or no – effort to collect. Some even tell parents, “don’t worry about the letters you will receive. You don’t have to pay that.” (Imagine if hospitals – which pursue debtors to the gates of hell – simply waived the costs not covered by insurance!)
Finally, there are those who justify committing insurance fraud by pointing their fingers at the insurance companies. They say insurance companies wrongly deny claims, delay payments, ask too many questions, and pay only a fraction of what they should.
“If insurance companies are going to screw me, what’s wrong with me screwing them?” they ask.
All this brings me back to my elementary school days at St. Stephen’s in Grand Rapids, Michigan. At an early age the sisters taught us that there are sins of commission and omission.
Sins of commission are sins that you commit. Sins of omission are sins that you allow to be committed – turning a blind eye to a wrong and denying it is your responsibility.
Both are wrong and have consequences. For the addict, the consequences can be relapse and death.