At a hearing of the House Committee on Oversight and Investigations in Washington, D.C., on Tuesday, behavioral health experts offered critical details about the ethical and legal concerns that have emerged in the addiction treatment industry. Doug Tieman, president and CEO of Caron Treatment Centers, presented the provider perspective.
In a five-minute initial summary, Tieman outlined a few of the common tactics—such as insurance fraud, patient brokering and deceptive marketing—that are hurting consumers and putting ethical providers at a disadvantage.
“It feels more like vacation timeshare marketing than healthcare treatment,” Tieman told lawmakers at the hearing.
Committee Chairman Rep. Gregg Harper (R-Miss.) is troubled by the fact that patients are treated as commodities, and he called for action.
“Sadly, there have been instances where people have died, and I think it’s very important we flush out these schemes,” Harper said.
Speaking to Behavioral Healthcare Executive after the hearing, Tieman said the testimony was undoubtedly an eye-opener for some federal lawmakers who have also been scrambling to understand the opioid crisis. Now they’re beginning to get a glimpse of the regulatory environment as well. It’s been a rapid learning process, but the committee members seemed committed to following through, according to Tieman.
“For many, especially those not in states where fraud and abuse is rampant, it was a stunner,” he said.
Although the hearing had a limited scope, there was some discussion of solutions. For example, Tieman highlighted a comprehensive effort now in progress among trusted treatment centers that are members of the National Association of Addiction Treatment Providers (NAATP) to clearly spell out expected ethical practices so ignorance can no longer be a defense for bad behavior. As NAATP begins its 40th year, the association has gotten serious about delineating business conduct and will refuse membership for organizations when there is evidence that they don’t meet ethical standards.
“I think [committee members] were extremely pleased to hear NAATP is working on a list of ethical providers and is working to police those that aren’t operating ethically,” Tieman said. “So that means the clock is ticking, and we have to get that [list] ready for showtime in 2018.”
Other witnesses discussed the new regulations adopted in Florida that aim to penalize patient brokers and profiteers. State Attorney Dave Aronberg testified that Florida has arrested 41 people and shut down five sober living facilities this year. He believes Florida is the only state to have such stringent laws and suggested that mandatory certification of sober homes would help protect consumers. Certification currently remains voluntary because of established federal laws.
Separate from Tuesday’s hearing, a group of bipartisan House leaders has been actively investigating patient brokering reports for the last several months, sending a letter to the Department of Health and Human Services and to six state governments to gather additional information about state regulations.
Rep. Ryan Costello (R.-Pa.), who invited Tieman to testify, also asked the industry experts about the role of accreditation. Tieman noted that accreditation is a valuable indicator of quality and that Caron is initiating discussions with accreditors to consider measures related to ethical business operations.
However, Alan Johnson, chief assistant state attorney in Florida, cautioned that some profiteers have completed licensing and accreditation yet still remain successful in bilking insurance companies and maintaining operations driven by profits rather than good patient care.
“Clearly accreditation is not the answer,” Johnson said.
Insurers not given a pass
According to Tieman, one thing the hearing didn’t cover in detail was the role of insurers, and he doesn’t want to see payers let off the hook. For example, when insurers deny claims for longer lengths of stay for residential treatment, the natural response from providers has been to build up other billable services. Right or wrong, reimbursement drives delivery, and such payer-provider friction has gone on for decades.
“At some point, we have to address the insurance partnership and what is the appropriate level of care and compensation,” he said.