“These practices are harming patients and their families, and taking advantage of laws intended to increase access to treatment for individuals with substance abuse disorder who are desperately in need of help.”
~ US Congress Committee on Energy and Commerce (July 2013, 2017)
The Affordable Care Act and the 21st Century Cures Act have lofty goals. Among them: to mandate that by law, people struggling with addictive disorders have expanded access to recovery services. One of the most positive achievements of these Acts is that insurance carriers MUST provide coverage for drug and alcohol rehab.
That means that addiction recovery is BIG business–$35 BILLION dollars a year.
It also means, unfortunately, that some so-called providers are engaging in unethical and downright dangerous practices in an underhanded attempt to cash in.
Substance Abuse Statistics in California
According to the most-recent National Survey on Drug Use and Health, published in 2015, California has rates of substance dependence and abuse that are slightly higher than the national average.
Right now, there are over THREE MILLION Californians age 12 and up who meet the criteria for a substance abuse disorder. Sadly, only about 10% get receive proper treatment, even though California has one of highest treatment center-per-capita rates in the country.
Exploiting Addiction for Profit
It’s known as patient brokering—improper financial relationships between “referring agents” and treatment centers. This leads to a number of abuses:
- Targeting vulnerable patients and their families
- Unethical “recruiting” practices involving incentives such as:
- Free/Reduced Rent
- Prepaid Gift/Debit Cards
- Smart Phones
- Video Game Consoles
- The Promise of More Drugs
- Unqualified Assessments
- Incentivized Referrals Based on Payment, Rather than Patient Benefit
- Improper Billing
- Insurance Fraud
Because they are paid to “put heads in beds”, these middlemen—also called “body brokers” or “junkie hunters”—don’t concern themselves with the quality of care, only the number of patients they bring in.
Even more telling, patient brokers usually have no professional credentials that qualify them to make an accurate substance abuse assessment and treatment recommendation. As a result, incoming clients are shuttled off to whatever program was willing to pay the highest referral fee – up to $10,000 per patient.
Right now, patient brokering isn’t a crime in the state of California, but that could change if SB 636 passes.
What All This Means to YOU
There is a line between operating as a successful business and profiteering from the Illnesses of others, and that line is blurred when kickbacks and bonuses are paid for referrals. Such a system as exists currently in California only sets the stage for abuse and poor-quality patient care.
Anyone seeking treatment for a drug or alcohol problem has the right to an initial assessment by a qualified professional, an unbiased referral to the proper rehab program, an individually-created treatment plan, and recovery services from licensed addiction specialists.