Our rehabilitation industry

Being a recovering addict and having gone through a successful program it pains me so, that for too many the cure is worse than the disease.  When other former addicts would ask me where I was at for treatment I’d always hear “Oh that’s a good one”.  Before I really understood what that meant, I had once pushed really hard for a friend of mine to get help and made a couple calls on his behalf.  He pleaded that those places don’t work and only want your money and he was in no way going.  In the midst of an opioid epidemic and rehabilitation system is in deplorable condition.

It’s hard to measure success when dealing in the treatment of addiction.  It’s not a one size fits all disease and failure is a part of the journey to successful lasting sobriety.  There is also the factor of privacy and anonymity.  One of the major reasons why I can’t understand how AA can boost about such a high rate of recovery, I have my doubts.  Sobriety also needs the patient to do the work and if they are not there on their own accord then they will fail.  What’s so unnerving is the exploitation of the sick for monetary gain.

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Since the passing of the Affordable Care Act the Drug and Alcohol Rehabilitation industry has boomed.  At least 2 million people struggling with opioid addiction, according to most sources, suddenly had access to healthcare that covered treatment for addiction and mental illness for the first time.  It is through the ACA that I was actually able to seek care myself.  With this expansion of coverage did not come oversight.   One of the provisions, including covering preexisting condition, is there is no limitation of benefits for mental health.  A patient can complete treatment and not be denied coverage if he or she needs to return.  Without federal licensing framework in place and the expansion of health coverage a once tiny industry boomed, unbridled.

The predatory practices of the industry seemed to have taken hold in Florida and California first.  In Florida it is known as the ‘Florida Shuffle” and California it’s “Rehab Riviera”.  Cute, right?  In both states the practices work about the same, a patient goes into treatment until they are well enough to take the remainder of this journey on their own, or until they’re insurance is exhausted.  Often the individual is then moved into a “sober living” home, group home ofr other former users.  Here the person will relapse and back to treatment they are sent.  In this new expanding market patients are a commodity.  Business 101, you must keep growing your customer base and keep your existing customers coming back.

This new market has led to all kinds of inventive ways to keep the flow of patients entering clinics through the turnstile door.  Treatment facilities have resorted to using “body broker”.  Brokers scout AA meetings, online chats, even the streets.  Brokers will place false ads online with a phone number that does not reach a caregiver, as the potential patient believes, but a call center where they are bid on by multiple clinics.  The highest bidder gets the patients and the patient gets a bed in a treatment facility where they may or may not get the care they’ve been promised.

 

The most common ways for clinics to fraud insurance companies, purchasers of insurance, and tax payers is done by price gouging.  Now urine is the hot new currency, “liquid gold”.  In this scam rehab facilities will over test patients in order to bill insurance.  Instead of using common strip testing with a cost of around $5-$10 the urine is sent to labs for gas or liquid chromatography testing, more accurate but with a $1000 price tag.  I read an article in the New Yorker written by a brave soul who’d survive a year in the shuffle who’d claimed one patient tested three times a week could be potentially billed $20k for the month.   Billing for urinalysis became so lucrative that in 2011 Fran Cid opened his own lab in the Palm Beach area.  2014 court documents site the labs $32 million sale price.  More small independent labs soon followed.

Following treatment many patients decide to remain in either Florida or California where the weather is nice, and they are close to outpatient facilities.  Sober living homes when done right are actually a really nice resource for people in recovery.  Living amongst one’s peers with a shared common goal of sobriety is healthy and a great segue into eventual sober independence.  As the treatment clinics are loosely regulated, California has only 16 inspectors for all 2000 licensed rehab centers, sober living is entirely in the dark.  This is where former patients often relapse and become patients once again.  Landlords are often employees at a clinic themselves thus merely housing temporarily that clinics patients.  Drug and alcohol use is easily over looked if not facilitated by the landlord themselves.   Relapse and eventual return to treatment isn’t even the worst of the fate of tenants.  I’ve read court cases where the plaintiff, often the landlord, is also being charged with sex trafficking.  This is about the most egregious infraction of trust I can imagine.  Victims in these cases are essentially trapped between their abuser and their drug of choice.  The unlucky looking to get clean find themselves caught up in this peripatetic life style until there death.

Fortunately, it would seem that these abuses have caught the attention advocacy groups, law enforcement, and policy makers.  Florida’s States Attorney, Dave Aronberg, has really made strides to reign in rogue actors in this process.  The Florida Patient Brokering Act has recently passed and prohibits “commissions, bonus, rebate, kickback or bribes, directly or indirectly, in cash or kind”.  And continuation of this practice is charged as a first-degree felony and is punishable up to 30 years in a federal penitentiary.  Sober living homes whom accept referrals from a treatment clinic must be registered opening them up to some regulations.  Aronberg has called for more clarification of Americans with Disabilities Act and the Fair Housing Act so that there may be more broad oversite of sober living establishments.  California too has begun to adopt Florida style regulation of their rehabilitation industry.  This industry is still growing, Arizona has seen a rise in clinics, so federal oversite is a must.

 

And then something like

How important recovery is

These clinics are a great resource done right

We don’t want individuals who need help to be turned off

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