Insurance Fraud NEWS
Coalition: Patient brokers gaming drug rehab system
February 07, 2019, Cleveland, OH
Cleveland 19 discovered recovery is worth something, and not just to the families of addicts.
We uncovered a practice called “addict brokering.”
It’s when treatment facilities pay incentives to sales people who recruit patients, even if they are not clinically appropriate for the program. Insurance industry professionals say it’s not only unethical, but also illegal.
It works like this:
An addict wants to end their addiction.
A for-profit broker reaches out.
The broker offers a free flight to a treatment facility, and sometimes even a cash kickback to take the deal.
But, if the addict has already taken some steps to get clean, they’ll have to get their insurance to believe they need more help.
It’s how one Ohio man’s son lost his life.
Heroin addiction gripped Rich Strickling’s son, Alex, for years.
His family had effective insurance, so Alex got chance after chance to get clean.
But each time, it got more and more complicated.
“Basically, the industry is leading us to believe that if we put our kids on an airplane, we send them to Florida, we send them to Arizona or even Southern California, that they’re going to come back fixed,” he said. “Well the way things are happening now, they might not even come back alive.”
Last summer, a friend called to tell Rick police found Alex dead in a hotel room.
“She called me and she told me that it was confirmed. They had found my boy,” he said. “For two years I’d braced myself for that phone call, but you’re never prepared for it.”
Within 24 hours, Alex’s sister found suspicious messages on Alex’s Facebook account.
Rick says the messages are between Alex and another patient he’d met at rehab in Florida.
He was trying to convince him to transfer to a facility in California.
He offered to pay for Alex’s flight. Then he said, “You gotta do detox though for 14 days and I’ll send you like 200 for going.”
In other words, Alex’s insurance would pay the rehab facility. The rehab facility would give a cut of it to Alex’s friend acting as a broker. And, in return for signing up, Alex’s broker would give him part of his kickback.
Rick says Alex should have known better, but he was still operating like almost any addict would.
In order to get insurance to pay for detox, Cleveland 19 discovered an addict has to have drugs in his system.
Rich says Alex was six weeks clean at the time--long enough to lose his tolerance, but not long enough to make a good decision.
“The real enemy here is the treatment centers that are paying these kids in short term recovery telling them ‘you’re helping these kids get clean,’” Rick said.
Cleveland 19 discovered Alex isn’t the only addict who’s lost his life that way.
In a Skype interview, James Quiggle with the Coalition Against Insurance Fraud, says Fraud in addiction treatment is a large and tragic problem in this country.
“Right now, the rehab system is being gamed by predators who keep addicts relapsing and hooked in order to keep insurance money flooding in,” he said. “Brokers will troll AA meetings, jails, homeless shelters and even the street corners to try and recruit addicts and bid them out to the highest bidder.”
Rick knows the world of addiction all too well.
He’s actually in recovery too, and says Alex was home four years ago when his uncle died of an overdose.
“Honestly, Alex was never the same after that,” he said. “I think that was one of the things that he was trying to numb inside.”
Now, Rick just wants other parents to know the risk that comes with sending your kid out of state.
“The one message that i would give any parent is: Don’t put your child on an airplane and send them a thousand miles away and then expect them to be fixed,” he said.
Coalition Against Insurance Fraud says there’s of course no way to prevent addicts from seeking help out of state.
However, the organization says the best way to prevent addicts from falling into these brokering schemes, is to make treatment right here at home appealing and effective.
There’s one family in Northeast Ohio trying to make the process of finding local treatment less confusing.
They started a non-profit after one of their loved ones died of an overdose.
Source: Cleveland 19