By: Maria Williams
Today, addiction plagues millions; 1 in 7 Americans 12 and older admit to having an addiction to drugs or alcohol. For many of those suffering from substance abuse disorders, hope can feel downright elusive. To make matters worse, many of the 17,000-plus addiction treatment centers that were once perceived as sanctuaries have, in many cases, become exploitative profit-driven enterprises prioritizing financial gain instead of recovery and support.
The fraud and corruption that have become commonplace in the industry perpetuate a cycle of relapse and despair for individuals finally ready to reach out for help. No one knows that better than founder Chris Thompson. His experiences of wanting and needing help but not knowing where to turn inspired his development of Sober Sidekick, a mobile application and social platform designed to support individuals in their journey towards sobriety.
Fraud’s many faces in the rehab sector
In recent years, the U.S. government has passed several laws (the Mental Health Parity and Addiction Equity Act, American Cares Act, 21st Century Cures Act, CARA, and Support for Patients and Communities Act) to help people access treatment and provide support for those struggling with addiction. They ensure fair and additional insurance coverage for addiction treatment and provide funds to fight the opioid crisis. While these laws aim to improve access to treatment and increase support for those struggling with addiction, fraud and corruption have followed the money.
The fraud impacting addiction treatment facilities involves a range of deceptive practices aimed at exploiting vulnerable individuals. Many schemes center around targeting Medicaid billing systems which ultimately increase the financial burden on both patients and the healthcare system.
They undermine the important efforts to address substance use disorders effectively while eroding people’s trust in essential services. Thompson shares, “In my own experience, both in seeking help and helping others, I have been more surprised when a treatment center is doing everything above board than those that aren’t. The fraud and corruption are incredibly common. There are many different variations, and it is very common, way too common.”
Inadequate supervision, therapies and care
One scheme being perpetuated is sham treatment centers that offer comprehensive care but fail to deliver evidence-based therapies or adequate medical supervision. They have popped up across the United States. “These facilities prioritize profit over patient well-being and employ aggressive marketing tactics to attract clients and maximize insurance reimbursements,” Thompson explains.
A study shared by NPR and conducted by Tamara Beetham, a health policy researcher at Yale University, confirms these practices. Using a fictional persona of a 26-year-old heroin user, her team called over 600 residential treatment centers across the country. The findings, published in Health Affairs, revealed troubling practices in many for-profit rehab programs. Despite the evidence supporting the importance of high-quality medical care in achieving long-term recovery, they discovered inflated fees, misleading sales tactics and a lack of evidence-based care in a majority of the programs. Beethaum was also very surprised that sales personnel, not medical professionals, often handled inquiries by interested individuals seeking help. And rather than a focus on potential medical treatments, they focused on luxurious amenities.
Body brokering
Another prevalent form of fraud in the addiction treatment sector is body brokering, where individuals or organizations receive kickbacks for referring patients to specific treatment centers. Thompson shares, “Essentially, there are sober living directors, sobriety coaches, providers and others who are supposed to be supporting patients in overcoming their addictions but instead are getting a kick-back for referring patients back into a treatment facility thereby perpetuating and almost encouraging a cycle of relapse instead of healing.”
“These referrals are often made without regard for the patient’s clinical needs or the quality of care provided which often results in substandard treatment outcomes,” he notes. Sadly, the financial incentives provided by insurance coverage for addiction treatment have contributed to this rise in body brokering. “It has become such a big problem that brokering has now been classified under federal law as human trafficking,” Thompson shares.
The Affordable Care Act has been essential to helping individuals get the help they need. It mandated insurance coverage for substance use disorder treatment which led to an influx of individuals seeking treatment, and with it, a corresponding increase in insurance reimbursements for treatment providers. This financial incentive has led to many treatment centers prioritizing profits over patient care and engaging in unethical practices such as body brokering to maximize revenue.
“There are facilities right now that, because of the monetary incentives, are gladly hosting the same patients 5, 10, 15 times, so they have no reason to want to see that person stop that cycle of completing treatment,” Thompson explains. “I have seen it first hand. It’s that ‘heads in beds’ business model that totally counters the support, therapy, care and help that individuals with substance abuse disorders are desperately in need of and reaching out for.”
Preying on the vulnerable in Arizona
Another prime example of rampant fraud took place in Arizona. Navajo activists raised the alarm over the number of ‘white vans’ that had emerged near tribal reservations in the Southwest a few years ago. Seen scouring alleys and parking lots in search of new clients, they targeted individuals who appeared homeless or under the influence, enticing them with persuasive offers of shelter, sobriety and a better life.
Monica Antonio, a 21-year-old from the San Carlos Apache Reservation, took them up on their offer. She was desperate to quit drinking for her children’s sake. Unfortunately, she, along with thousands of others, fell victim to that exploitative system. Antonio didn’t receive treatment and was even allowed to drink at a sober living facility, according to a New York Times report.
To date, over 40 individuals lured by those fraudulent claims have even died, some from overdosing in facilities, some in the streets, and some because they were kicked out and left in Arizona’s heat without any resources.
The need for regulation
A lack of regulations and oversight within the addiction treatment sector has created these opportunities for individuals to exploit vulnerable people and the Medicare system for financial gain. Thompson explains that it is essential, “Without proper regulations in place, there is very little accountability for unethical practices; it allows the body brokers to operate with impunity. It allows the facilities to overcharge, underserve and cheat people out of the care they desperately need and deserve.”
While efforts to reform the industry are underway, including initiatives to standardize addiction programs, progress has been slow. Many programs continue to prioritize profit over proper medical care, perpetuating the culture of deception and exploitation. Despite advancements in research-based treatments and improved insurance coverage, the stigma surrounding addiction persists, hindering integration into mainstream healthcare systems. As a result, individuals seeking help often find themselves navigating a flawed rehab system that prioritizes profit over healing. Thompson stresses, “People have to do their due diligence before entering a treatment center. It can be difficult when they are desperate, but they have to get referrals from patients who have experienced success and been given effective treatment.”
Once perceived as sanctuaries for those desperate for help with addiction, treatment centers have become breeding grounds for corruption and fraud. Schemes, including body brokering, prey upon a vulnerable population seeking help, thereby perpetuating a cycle of deceit and harm instead of fostering long-term recovery and wellness. Without widespread oversight, these stories are sure to become even more prevalent, with the vulnerable being caught in the middle.
Get the support you need, download Sober Sidekick today.
Published by: Holy Minoza
