In early May, the Harmony Place leadership team attended the National Association of Addiction Treatment Providers (NAATP) conference in Washington D.C. The conference covered a variety of topics, including the large amount of health care fraud and its implications that harm the addiction treatment industry.
Health Care Fraud within the addiction treatment industry expanded rapidly as the opioid epidemic grew steadily worse. With more Americans using addiction treatment, many unscrupulous and unqualified addiction treatment centers began taking advantage of patients’ needs and participating in misconduct.
At the same time the opioid epidemic was growing, so was the available reimbursement for mental health and substance use disorder treatment. Thanks to the Affordable Care Act and the Mental Health Parity and Addiction Equity Act, more payors, including Medicare and Medicaid, began covering these services, and at better rates than in the past.
The combination of these two factors led to a boom in addiction treatment—and booms always attract people who are only looking to make money.
Types of Health Care Fraud in Addiction Treatment
Treatment centers who participate in unethical practices not only harm their patients, but the experience of others throughout the country. Patients truly looking for help are misled by treatment centers who prioritize profit over quality treatment. This causes damage to the industry’s reputation and affects the patient’s trust in addiction care.
One common practice includes recruiting clients by offering bribes or payment for attending their program. Treatment center will either bribe the clients directly or pay others who refer clients to them. Insurance reimbursement used to be so high that facilities could pay thousands of dollars for a single client admission and were still able to make a large profit.
Another common practice includes treatment centers paying sober living facilities for a bed for their client to stay in so they can charge the client’s insurance company for residential treatment that they aren’t providing. Abuse also occurs through online advertising where corrupt centers spend high amounts on ads which overrides messages from legitimate centers.
Patients who legitimately want help are many times misled by the information they find from these centers. Also, legitimate treatment centers miss out on patients they need to remain financially stable.
In other instances, patients themselves help commit fraud to make a profit. Some insurance companies issue checks directly to the member. Patients are supposed to turn these checks over to treatment centers—but instead keep the money for themselves, sometimes causing treatment centers to lose out on hundreds of thousands of dollars.
In the most terrible instances of health care fraud, some treatment centers are found providing drugs to patients so they will have a positive test—and qualify for more treatment. It’s been reported that some centers keep their patient’s keys or withhold food stamps and other valuables to ensure the patient stays with the center– and they can continue billing their insurance.
How the Government and NAATP is Fighting Health Care Fraud
In the past few years, addiction treatment organizations and the government have stepped in to fight fraud and promote ethical, responsible addiction treatment. Private insurers and government agencies have created their own investigation units to look for health care fraud and abuse. The Department of Justice created the Opioid Fraud and Abuse Detection Unit.
These investigative units are helping identify and prosecute treatment centers for illegal kickbacks, false claims and Medicaid/Medicare fraud. In 2017, the Medicare Fraud Strike Force took down 412 defendants across the U.S. who had participated in a total of $1.3 billion dollars of health care fraud.
States are also passing new kickback laws to prevent bribing patients, doctors, or other centers. These laws help impose higher penalties for kickbacks and narrow legal loopholes. Other states are passing laws to prevent false advertising claims.
Even private companies, such as Google and Facebook, are working with the NAATP to stop false advertising online. To use these advertising services, addiction treatment centers now must pass vigorous certification to ensure they are providing appropriate, evidence-based care.
How You Can Choose the Right Addiction Treatment Center
If you or a loved one need addiction treatment, it’s vital you find an ethical, responsible addiction treatment center that provides evidence-based care. In general, you should avoid any treatment center that:
- Does not employ a team of physicians, licensed social workers, and other certified health professionals
- Relies on only “natural” or “herbal” remedies, not evidence-based medicine
- Offers you any money for using their care
Most legitimate treatment centers offer multiple types of services that can be adjusted to fit your needs. A reputable and reliable treatment center will:
- Offer longer-term care which may include residential care and continuing care after your stay is over
- Be staffed by certified and licensed addiction professionals, including physicians, psychologists, social workers, and more
- Not use recruiters, payments, discounts or other practices to get you to use their care
- Use evidence-based care and personalized treatment plans based on your specific needs
Another way to ensure you have found a legitimate addiction treatment center is to verify that they are accredited by CARF, The Joint Commission or the Commission on Accreditation of Rehabilitation Facilities. Accredited facilities have been vetted by industry professionals and have proven to meet quality care guidelines.
At Harmony Place, we are dedicated to transparent, supportive care for substance abuse disorder. We want to help shed light on issues of fraud and abuse within the addiction treatment community and the impact they have on the industry so patients can find the care they need for a healthier life.
If you have any questions about our care or services, please call us at 1-888-789-4330 at any time, day or night. We are ready to provide you with the answers you need to feel comfortable and confident with your rehabilitation plan. Harmony Place specializes in drug and alcohol addiction and treatment. View our addiction recovery treatment here for more information, contact us if you or a loved one are affected.