“Junkie Hunting:” Everything you Need to Know about Patient Brokering and How to Avoid Scams
There’s a disturbing trend growing in popularity within the rehab industry which involves abusing recovering addicts for their insurance coverage. People are being shuffled in and out of low-quality addiction treatment centers and generating hundreds of thousands of dollars in insurance billing. Recruiting and exploiting recovering addicts for their insurance is a form of fraud. The practice goes by the names junkie hunting, patient brokering and body brokering. Although it starts out as fraud, it quickly escalates to human trafficking. In some rare cases, patient brokering involves violence, abuse and other crimes too.
How does patient brokering work?
Patient brokering is mainly a type of health insurance fraud that’s generating millions of dollars for the people taking part in it. Unfortunately, though, this is not a victimless crime. The people who suffer the consequences are those recovering addicts who get juggled back and forth between low-quality rehabs and half-way houses without ever receiving the proper help they need to get sober.
Sadly, when rehabs participate in body brokering, they’re not just doing financial damage, they’re actually putting their clients’ lives at risk too. Until these recovering addicts receive adequate, honest treatment, they’re at risk for relapsing and dying of an overdose. It’s happening to countless young people including 24 y/o Alison in South Florida. She died from an overdose after being bounced from 1 treatment center to the next for 15 months, generating $1.2 million in insurance billing.
The Affordable Care Act
In 2008, federal law changed, forcing health insurance companies to stop discriminating against their clients with mental health and substance abuse disorders. Fortunately, countless individuals gained access to rehab and the mental health treatment they needed.
Overall, the Affordable Care and Mental Health Parity Acts were major wins for patients’ rights. However, they also opened up the door for patient brokering.
Now that most health insurance plans cover rehabilitation and recovery related charges, people are seeking out ways to cash in. By opening a rehab facility or a sober-living home, people can start to collect large payouts fairly easily.
The Urine Testing Loophole: “Liquid Gold”
The quickest and easiest way to get rich quick in the recovery industry is to open up a halfway house and start doing drug tests. There are currently no restrictions preventing anyone from starting their own transitional home and there’s very little regulation.
Anyone can start renting out apartments to recovering addicts on the condition that they stay clean. By applying for a waiver, which is an easy process, sober home operators can start billing for urine tests. It was about 5 years ago when operators started to realize that this could turn into a highly profitable loophole.
Instead of charging for simple drug test kits which cost as little as $4, sober homes have found ways to bill higher. They’ve started to order high-tech, unnecessary and excessive testing with prices rising into the tens of thousands of dollars. By teaming up with labs, or starting their own labs, sober home operators can end up pocketing large portions of what the insurance companies paid out for these tests. These labs are becoming so common they’ve earned the nickname “pee-farms.”
So far, these pee-farms are mostly being found in Florida, but there are sober homes in Massachusetts and Kentucky are under investigation as well.
How to Spot Patient Brokering
Until regulation in the recovery industry improves, recovering addicts will have to be careful about scams. Unfortunately, that makes choosing a treatment center very difficult. The rehabs offering the best incentives and most affordable treatment may not be very honest. This brings us to our first sign of patient brokering.
Incentives that are too good to be true
Be wary of any treatment center that offers:
- Free travel; did they offer to pay for your plane ticket?
- No Copay / Copay Waivers
- Free or Discounted Rent
- Cash / Spending Money
- Gift Cards and Other Perks
If you’re being paid to go to treatment or receiving these kinds of incentives to choose one center over another, it’s a sign that patient brokering is going on. That’s because a lot of these unscrupulous treatment centers don’t have much to offer beyond these incentives. This means when you show up to rehab, there will be very little in the way of professional counseling or treatment. Then later, your billing will reflect a different story.
The Florida Shuffle
The most alarming and disappointing sign of patient brokering is when treatment providers try to make their patients relapse so they go back into treatment. Cycling patients in and out of rehab is becoming more and more common. So much so that the practice has earned itself a nickname, the Florida Shuffle.
The goal of treatment should be to help recovering addicts detox safely, teach them life and coping skills, and support them as they get on their feet. Unfortunately, with patient brokering, the goal is the exact opposite. These treatment providers can gain much more by recruiting addicts with good insurance coverage and keeping them within their system for as long as possible.
The Florida Shuffle works like this. After treatment, recovering addicts move to a partnered sober home where the staff wil incentivize them to relapse. Some operators gently suggest their clients use again so they can be sent back to rehab (and continue living for free). Others will shamelessly offer drugs, or some cash to buy them, and wait for their clients’ drug screens to come back positive. At that point, they’ll send them back in for treatment, and continue with billing. This can go on and on until a friend or family member steps in, or worse, until the patient dies of an overdose.
The best way to avoid patient brokering scams is to always be wary of any deals that sound too good to be true. We should always be taking the time to thoroughly research every treatment center we’re considering enrolling into, and asking the right questions.
Check out our commitment to the Fair Care Promise, which stands against patient brokering and unfair business practices. If you can’t find the right rehab, you can call us at intervention.com and we’ll help you find the best match.