The data shows that substance use disorder is still widespread, but innovations in treatment, prescribing and awareness are helping. USA TODAY
When Gina DeMaria first opened the Dominic House, a recovery home in Hanover, she was approached by a man who offered her $400 in exchange for each patient she referred to his treatment center in Florida.
She said she declined.
“I want to help people, I want to do well for people … and they’ll prey on that,” DeMaria said.
That predatory behavior is known as patient brokering. It’s a symptom of the opioid epidemic that state officials fear has begun afflicting Pennsylvania.
What is patient brokering?
Patient brokering is when someone solicits another person into a rehab, recovery or treatment center. Often, this is associated with “recruiters” who try to lure people seeking treatment to an out-of-state facility – often in Florida, Arizona or California, which have dense populations of rehab treatment centers.
Some people who are lured to out-of-state treatment centers have fallen victim to an insurance scam commonly referred to as the “Florida Shuffle.” Recruiters or fraudulent rehab centers within close proximity of one another will cycle individuals in need in and out of each center to bilk insurance claims and cash.
“It came to light probably about a year or year and a half ago where we heard from some folks about a few issues where people had gone out of state for treatment and/or recovery and unfortunately ended in a bad situation,” said David Buono, Pennsylvania Insurance Department consumer liaison.
Buono said that often, individuals are solicited by familiar faces or “folks they may have met when they were using or in recovery prior.”
On March 25, the Reading Eagle reported on a series of insurance fraud charges at Liberation Way in Yardley. The Bucks County-based treatment center’s co-founder and a number of executives were charged with fraud and conspiracy by the Pennsylvania Attorney General’s Office. According to a report from the Philadelphia Inquirer, Attorney General Josh Shapiro said insurance company Independence Blue Cross was charged over $17 million in claims via Liberation Way.
How serious is it?
Patient brokering has become a symptom of the growing opioid crisis. With an increase in people suffering from addiction, the number of treatment centers has also risen. Not all of the centers are legitimate. And once patients are out-of-state, it can be difficult to track them.
Nearly 17 percent of Pennsylvanians who received substance use disorder treatment did so via an out-of-state treatment center, according to a statement from the Pennsylvania Insurance Department and Department of Drug and Alcohol Programs.
However, there are a number of compliant, state-approved facilities in Pennsylvania.
The allure of getting treatment in a warmer climate or outside an area that initially triggered addiction can be promising for a person seeking treatment. But it can also lead to a potentially dangerous, sometimes fatal, situation if a person is caught in a racket of fraudulent centers.
That’s something DeMaria became familiar with after her son was transferred in and out of various treatment centers when he was in Florida. “I found urine analysis billings that were $8,000,” DeMaria said.
While she believes her son was caught in the “Florida Shuffle,” her larger concern is the hiring process in treatment centers. Often, facilities hire former or recovering addicts. While she believes there is strength in familiarity, that doesn’t necessarily translate to professional care.
“We’ve got these guys in recovery, and two years ago they were stealing from friends and family,” said DeMaria. “Recovering addicts are good for the equation, but you are not a specialist just because you recovered from an addiction.”
A federal law passed in October 2018 makes it illegal for anyone to receive monetary reimbursement for rehabilitation, or recovery treatment center referrals. It is also illegal for any treatment center to pay an individual for said referrals. Perpetrators face upwards of $200,000 in fines and/or a maximum of 10 years in prison.
Telling the difference between fraudulent and legitimate centers
Because there are so many treatment centers opening in response to the epidemic, the only direct solution is to do your homework, said Ron Ruman, director of communication for the Pennsylvania Insurance Department.
“Before anyone chooses a facility, there are questions they should ask and look into when considering an in- or out-of-state treatment center,” Ruman said. “Consumers should be wary and ask questions.”
There are a number of resources at both the state and national level to help learn if a treatment center is legitimate. The Substance Abuse and Mental Health Services Administration offers a list of certified providers based on each state’s governing body on rehabilitation center listings. It also provides a list of tips for “finding quality treatment.”
In Pennsylvania, interested parties are encouraged to reach out to the Department of Drug and Alcohol Programs, which approves licensed facilities and keeps updated records of their inspection results. It also maintains referral options for people seeking treatment and family members or friends seeking treatment for a loved one.
What role does insurance play?
“One of the challenges of being a regulator is we find out by complaints … people have to tell us,” Ruman said.
A big part of that is understanding what is and isn’t covered by your insurance policy. Under the Mental Health Parity and Addiction Equity Act of 2008, individuals covered for substance treatment are entitled to the same level of coverage as physical therapy.
“If your policy covers those issues, it must cover them at what’s called ‘at parity’ with a medical issue,” Buono said. In other words, if your insurance covers 30 days of physical treatment for an injury, you would be eligible for 30 days of insured substance treatment.
Under PA Act 106, the state requires minimum coverage for alcohol and substance abuse treatment, including up to seven days of detox per admission (four admissions per lifetime) — in addition to a minimum of 30 days of residential treatment. These minimums must be met even if days covered under the parity law are less.
The Pennsylvania Insurance Department can only help with insurance policies and claims. Buono and Ruman noted that if a treatment center or institution is flagged by an insurance company for fraud, that case would move outside their jurisdiction due to criminal law.
Helpful tips and useful links
The Pennsylvania Insurance Department encourages individuals to be wary of:
- Any unsolicited referral to an out-of-state treatment facility.
- Someone offering to pay for airfare or other travel expenses to an out-of-state facility.
- Someone offering to pay for insurance coverage.
- An individual asking for personal information, such as a Social Security or insurance policy number.
The Pennsylvania Insurance Department also provides an insurance guide on how to better understand and analyze your policy and if it covers substance abuse treatment.
The Substance Abuse and Mental Health Services Administration also provides a list of verified and approved facilities based on governing state bodies. For Pennsylvania facilities, interested parties can check the Department of Drug and Alcohol Programs listings for treatment centers.
The York Chapter of Not One More also provides a number of resources for outreach and support programs.
The national helpline for treatment referrals is 1-800-662-4357.