Brokering Addicts: Covering the treatment profiteers making money off the opioid epidemic

It’s called “the Florida shuffle.”

An opioid addict somewhere in the United States is recruited to a treatment center in South Florida with promises of sunshine, getting clean — and a free plane ticket. But first, they need private insurance that offers generous out-of-state benefits.

After their stay in a treatment center, they’re guided into a “free” sober house, which racks up unnecessary or fraudulent lab tests to drive up insurance payments. There are often drugs on nearby streets, and, if a patient relapses, the cycle continues — until they either leave in an ambulance or body bag.

“There’s no money in sobriety,” said David Aronberg, the state attorney for Palm Beach County, who described how such treatment kickback schemes work in a Center for Health Journalism webinar this week. “It’s really incentivized for them to fail.”

Aronberg, whose Sober Home Task Force has targeted fraud throughout Palm Beach County, joined David Armstrong, a senior enterprise reporter for STAT, reporter Evan Allen of the Boston Globe, and Keith Humphreys, a professor of psychiatry and behavioral sciences at Stanford University. The speakers discussed how to identify and report on the fraudulent schemes as well as how the legal system is trying to stop them.

How patient brokering schemes work

When STAT reporter David Armstrong decided to look into treatment options for opioid addicts, what he found was striking: “a brisk business in the trading and brokering of people who are seeking addiction.”

Armstrong detailed a characteristic example: A Boston-area man was contacted by a broker and offered the chance to receive treatment in locales ranging from California to Florida. First, though, he needed to swap his Medicaid plan for one preferred by the treatment center: a private insurance Blue Cross plan in Pennsylvania. The man was fraudulently enrolled using a fake address, something that is “shockingly easy to do.”

Brokers often will identify people by attending addiction or advocacy meetings, and have call centers and web sites advertising their services.

Brokers make money from the payments eventually collected by treatment centers from insurance companies — sometimes up to $30,000 a month for a stay in a treatment center. The center’s kickback to the broker — $500 to $5,000 a head — is minimal in comparison, he said.

“It’s a small price of doing business when you’re able to bill at the rates that a lot of these unscrupulous treatment centers do,” Armstrong said.

The red flags reporters should look for

The Boston Globe’s Evan Allen offered several tips for journalists interested in investigating similar schemes in their own communities. One red flag is a treatment center that promises luxury accommodations, such as spray tanning or ice cream machines. Reporters can also track ads that tout free treatment in other states, another sign of possible patient brokering.  

Other ways to follow the story include tracing overdose deaths backward. Look for people who aren’t from Florida but died there because of their addiction, she said. Ask family members if their loved one received a free flight and signed up for new insurance just before traveling.

Social media is useful for not only finding these ads, but also for tracking complaints. Even if someone’s last name is not listed in a Yelp review, reverse image searches of the reviewer’s profile photo can help find them on other platforms. Once you connect with one victim, you can often tap into the whole network.

“It’s pretty well known who is brokering and who is trying to help,” Allen said.

Cell phone texts or Facebook messages can help reporters figure out the timeline and breakdown of how the schemes unfold. Other useful documents include the state departments of public health, where you can search for complaints and investigations into treatment centers. Allen also recommended looking into physicians involved in treatment centers, who “might have checkered pasts.”

When looking at death certificates, check the actual place of injury not just the place of death, which may be the hospital. The Joint Commission and CARF (Commission on Accreditation of Rehabilitation Facilities) are useful resources to find the addresses of treatment centers.

Government struggles to catch up

Aronberg, the state attorney, offered insight into what factors allow theses scams to proliferate, and what can be done to stop them.

As Florida cracked down on prescription drug abuses, some of the same people who set up fraudulent pain clinics and pill mills moved to fraudulent treatment centers, he said.  The laws haven’t quite caught up to them yet.

“Government does a better job of reacting after a crisis has occurred,” Aronberg said.

Well-intended laws such as the Fair Housing Act and the Americans with Disabilities Act  make it harder to regulate so-called sober homes, where recovering addicts live together communally after their in-patient treatment stays. Another inadvertent challenge comes via the Affordable Care Act, which extended parents’ insurance to children until age 26, banned insurers from refusing people for pre-existing conditions, and expanded benefits for mental health and substance use disorders.

“These generous benefits are exploited by profiteers for money,” he said.

Aronberg detailed strategies that are helping law enforcement tackle the problem in Florida, such as cracking down on deceptive advertising, strengthening penalties for patient brokering and statewide training sessions for prosecutors and law enforcement on how to stop the fraud.

All of that means these scammers may go elsewhere, he said, adding that “the rest of the country needs to be prepared.”

The big challenges in treating addiction

Humphreys discussed some of the reasons why such problems persist with addiction treatment. Before the Mental Health Parity Act, addiction treatment was underfunded, leading to poor quality and low standards.  

Another challenge is the widely held perception that people can go into rehab and be cured of their addiction forever. Addition is better viewed as a chronic health condition like diabetes, not something acute like influenza that can be fixed, Humphreys said.

Too often, patients are blamed for bad outcomes such as failing at their addiction treatments.

“You don’t say cancer patients failed at chemo,” Humphreys said.

Addiction treatment is in a transitional moment, he said: It’s just starting to get the financial resources from insurance. At the same time, it still hasn’t been integrated very well into the medical field.

Ultimately, that integration will lead to more consistent standards, better staff, increased regulation and improved access and informed consumers, Humphreys said. 

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Watch the full presentation here: