Federal raids on sober homes and addiction treatment centers in Florida in the past six months have resulted in 19 arrests and helped bring to light the prevalence of fraudulent and illegal activities within the state’s profitable treatment industry. In most cases, investigators alleged patient brokering schemes, illegal kickbacks and identity theft.
And what’s happening in Florida is happening in other markets around the country.
It’s exceedingly difficult to quantify the scope of such unethical practices, but experts generally agree that it’s more about criminal enterprise than treatment centers gone bad. For example, one operator arrested in Florida for patient brokering in February had previously served a three-year jail sentence for defrauding the state’s unemployment agency.
At the very least, it’s an issue that has flummoxed the vast majority of programs that operate honestly and aim to put patient care first.
“The industry is not corrupt,” says Marvin Ventrell, executive director of the National Association of Addiction Treatment Providers (NAATP). “There are unethical players but to paint the entire addiction treatment industry with that brush is unfair. And we have to be absolutely clear to the public about that.”
To that end, Behavioral Healthcare Executive surveyed our national audience of behavioral health professionals to get a better feel for their level of awareness regarding unethical practices and their opinions on what should be done to improve matters. More than 650 professionals responded to the first-ever BHE Ethics Survey.
Although not an exhaustive list, the unscrupulous and often illegal activities we identified for the survey focused on egregious examples of profiteering, which include:
- Patient brokering—Generally involves the promise of money, gifts or other valued arrangements in exchange for enticing patients to enter treatment, including enticements given directly to the patients themselves.
- Lab testing kickbacks—Generally involves the promise of money, gifts or other valued arrangements in exchange for lab testing that leads to reimbursement dollars, such as urine drug screenings that may or may not be clinically appropriate.
- Black-hat marketing—Generally involves overstated, intentionally deceptive or false information meant to mislead or entice individuals, especially those with insurance, to seek treatment at a particular facility.
More than meets the eye
An even 11% of BHE Ethics Survey respondents say they are aware of patient brokering in their local area within the past year, and 7.3% say their organization has been approached to enter into a patient brokering scheme. When the results are filtered to only include those identifying their role as “executive or board member”—a total of 83 respondents—the awareness is greater. BHE found that 30.1% of executives are aware of patient brokering, and 15.7% say they have been approached for a deal.
However, there is likely more patient brokering going on than respondents even realize, says Jeffrey Lynne, a Palm Beach, Fla.-based attorney who sits on a committee that is working toward industry reform in the state. Although it’s impossible to confirm, part of the reason for the scant awareness of brokering might be that there were more not-for-profit centers (65.8%) among the respondent pool. Such organizations feel less competitive pressure to fill their beds and therefore might be less likely to notice brokering in the area.
“The pressure to deliver patients appears to be on the private sector and not on the nonprofit sector,” Lynne tells BHE. “The for-profit treatment sector is generally populated by people who are well intentioned but bring a business perspective to drug and alcohol treatment that conflicts with healthcare policy. Your MBA [degree] isn’t going to work in the behavioral health setting because the economics are completely different. The rules of the game in healthcare do not lend themselves by design to traditional capitalism—supply and demand or buy one, get one free. You can’t have three days of treatment and get the fourth one free.”
Lynne says organizations also must consider a longer list of activities that are unethical or illegal in the context of fair business practices. For example, offering potential patients free airfare to encourage them to commit to an intake is enticement. While many treatment professionals might not consider transportation within the definition of patient brokering, Lynne does. And a provider could face legal trouble in some states for doing so.