In my last article, Time To Up the Standards( January 2017), I wrote about the state the addiction treatment milieu is presently in and emphasized the necessity for increasing standards in the fields. I am a member of the 15th Circuit Sober Homes Task Force which was formed in July of last year and has made great progress under the leadership of State Attorney, Dave Aronberg, and Chief Asst. Al Johnson. We have made over 20 arrests so far with many more to come. A grand jury was convened, which was the first of its kind in Florida to examine the state’s billion-dollar substance abuse treatment industry and offer recommendations on how to improve it. The report cites deceptive marketing as a common practice that threatens to exploit a vulnerable class.
To illustrate, people looking for treatment call an 800 number thinking they are calling a legitimate treatment center and speaking to a professional. The fact is they are usually talking to a telemarketer in a boiler room where the call has been routed. This person is going to tell the prospective client whatever they want to hear to ensure that they come to that facility. Some will even go as far as sending the client a plane ticket to reel them in. These marketers are usually rewarded with some type of bonus for the number of clients they bring into the facility – as a straight per client commission would be a more obvious violation of the Stark Act, a federal law that prohibits patient brokering. The State of Florida also has laws in the book against patient-brokering, which have gone largely unenforced in this industry due to the lack of regulation and the general culture of acceptance within the field.
The grand jury report recommends the state certify marketers, force them to provide disclaimers and criminalize deceptive marketing practices and providers. This is a start. However, we need to penetrate much deeper than just the unethical marketing which is going on at the admission level. We need to look at the actual treatment being provided to the clients once they are enrolled, as well as the Case Management services provided, which should include discharge planning. I reiterate from the last article, the need to hire qualified clinicians with educational degrees as well as clinical field experience.
I have watched every episode of Law & Order on TV and thought I had a pretty good knowledge of the law; yet, I still had to go through all those years of college and law school and then pass the Bar Exam. It should be even more stringent to become an Addiction Professional considering we are treating people with a medical disease.
I believe that treatment centers should only be owned and operated by people with a medical background or who are licensed/certified personally under the appropriate state statute. If they are going to bill insurance as medical providers, they should be required to have all the proper credentials as such. Sober Homes can be owned and operated by anyone. Up until now the municipalities have had little success with any regulation of these homes because they used the ADA (American Disabilities Act) and The Fair Housing Act as their shield. However, we have now found other ways to hold them accountable, such as requiring accreditation in order for them to receive any referrals from state-licensed treatment facilities. More regulation is better, as these facilities have been operating like the Wild West for much too long.
The Task Force is also recommending raising industry fees to hire more regulators, making it easier for investigators to access patient records, toughening penalties for illegal patient referrals and requiring commercial sober homes to be licensed. They have recommended fines be increased for multiple violations of the patient-brokering statute. (Violating the patient-brokering statute is a third-degree felony, punishable by a maximum of five years in prison – for each count).
The funding which will be necessary for cleaning up this industry will come from the appropriate place – the treatment industry itself. Some may try to pass these costs on to their clients – but we will be watching carefully. The grand jury report concludes that the “proliferation of fraud and abuse within the substance abuse treatment and recovery residence industries requires immediate attention by the Legislature.”
Parents should be very wary of treatment centers that employ the marketing tactics I have described. These marketers know that the parents are desperate to get help for their loved ones and will use that desperation along with the parent’s understandable desire to believe they are being steered in the right direction. I urge the families to speak with an independent Addiction Professional prior to making any decisions about where to place their child.
Parents should also examine all Explanation of Benefits (EOBs) they receive from the insurance companies. Look for things like excessive UA testing, and make sure they have not billed for a level of care that was not received. For example, if the patient was in IOP (Intensive Outpatient) but was being billed for PHP (Partial Hospitalization) that would be a problem.
Many facilities have a Medical Director on paper only. In other words, they have contracted with a Psychiatrist who may be present once a week to make rounds, but most of the “treatment” is handled by a nurse practitioner. Make sure that the therapists at the center are all qualified addiction professionals, not only the clinical director.
You are literally putting the life and safety of your loved ones into their hands – Please do your homework and be sure that they are in qualified and competent hands! There is a myriad of other things to be aware of when placing your loved one in treatment and again I suggest you do your homework and ask questions. If you need help navigating through the perfidious sea of treatment centers, feel free to contact me and I will assist you and your family in any way I can.
Myles B. Schlam, JD, CAP/CCJAP
Advocare Solutions, Inc. – CEO