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A Call To Action!

With a world flooded with those who would seek to take advantage of those in need, the fleecing of private insurance providers by insane overbilling schemes and fraud within the treatment industry doesn’t end there.
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John SFYB Admin/Outreach

When a few ounces of urine are converted into liquid gold by profit mongers using elaborate laboratory schemes promising riches that far exceed any realm of reason, the sincerity of the message literally gets flushed down the toilet. Multi-million-dollar yacht owner James Slattery aptly named his boat “Pissed Away” as almost a means of mocking the federal investigation of his company Millennium Health and the subsequent 256 million dollars fine which was paid the day it was ordered.

This story seems overshadowed by the Chris Bathum scandal by where the self-proclaimed Rehab Mogul is alleged to have perpetrated over $400 Million in fraud, racking up 75 sexual assault charges and earning himself a 35 years sentence. Most recently we watched as the FBI raided Sovereign Health treatment facilities across Southern California to advance their criminal investigations of fraudulent activity within that billion-dollar business. Add to that the Steve Johnson saga in Palm Beach racking up 48 charges of patient brokering and so as the list grows from top to bottom we are forced to stare the corruption down as the epidemic grows.

The opioid epidemic can no longer be swept under the carpet as mainstream America and the world feel its deadly grip grows, grasping increasingly more within its fatal clutch.

The CDC mortality rates may not be the precise statistics some may require in order to raise the red flag yet you simply need a stroll through any impoverished area in order to look this beast in its eyes. That isn’t to say this blight on our species is limited to those poverty stricken by any means as suburbia suffers alongside the ghetto watching its youth die in unimaginable numbers.

Numbers and stats, rates and flow charts can’t compare to the pain we each feel when this brutal onslaught touches down in our lives and we are left baffled as to where we should turn for help. The headline news highlights these two evils almost simultaneously leaving fear for the lives of the addict in our world and doubt that any true help exists.

Power corrupts and great financial means is often confused as such which is what may cause these perpetrators to believe themselves untouchable until some alphabet agency kicks in the door, but what about the addict?

What about the loved seeking help and assistance dealing with the addict? What about the society that will bear the cost of treating the addict?

The solution is transparency and openness in this business which when corrupted is often shrouded and guarded from peering eyes hidden behind HIPAA, a protection intended to aid the client not the facility. HIPAA (Health Insurance Portability and Accountability Act of 1996) is United States legislation that provides data privacy and security provisions for safeguarding medical information. This legislation has been the protective shield for many clients, helping them find recovery without fear of the unfortunate stigma addiction carries.

Being that 91 Americans die every day from opioid overdose and over half those are prescribed by their primary care physician this shadow of darkness must be brought into the light!

When the epidemic more than doubles in deadly force from 2015 and the 33,000 estimated dead from opioid overdose alone, 158,000 estimated total deaths from all drugs that year to shocking numbers this year proves to show, we must rally together for effective means of putting this evil genie back in it’s lantern. 2017 shows so far to be the deadliest year on record where overdose is concerned and it’s only a little more than half over.

Combining the scandal and fraud perpetrated by the very institutions tasked with combatting this disease, the TRILLIONS spent, billed and thrown at it and the headline news airing something about the growing epidemic we must rethink, shift and find a new way. We at Stop Frying Your Brain are a community of over a quarter million addicts joining hands as we do at the end of meetings and shouting for change!

..Revolution in the means we go about treating the addict! Real Progress in the fight against the deadly killer which is not on the streets but the illness within!

Transparent facilities with open doors and legitimate practices! You got nothing to hide you say, SHOW ME! No more will we stand for the same lies and bureaucratic run around, we want to know what you plan to do different! Countless treatment facilities claiming to be evidence based,  well show us the evidence!

The numbers are shocking and I’m not quoting sources because I want you to look them up, I want you informed and not by me, go look and find 90% relapse rates, 85% of all in need receive no help at all, 23 million in need, 4.7 trillion billed…. This disaster must be treated as such, Start asking questions, start taking action!

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Stop Frying Your Brain song kept rattling around in my head after visiting their website. It was worse than it’s a small world at Disneyland. Eventually… I would hook up with those guys and it’s all because of that one stupid song.

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ADDICTION MARKETING NOT IMMUNE FROM KICKBACK EXPOSURE
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By:
Jeffrey L. Cohen

Many business people involved in some aspect of the recovery business world (e.g. IOPs, PHPs, Detox) are not aware of the punishing laws that apply to their marketing arrangements. Simply paying someone a commission based sales compensation without fully appreciate the applicable laws is dangerous and costly.

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The chief federal law involved in the issue, the Anti Kickback Statute (“AKS”) is found at 42 CFR 1320a-7b(b) and essentially forbids paying anyone for referring patients whose care is compensated in any way by any state or federal healthcare program (e.g. Medicare, Medicaid, CHAMPUS or TriCare).

The law enforcement arm of that law, the Department of Health and Human Services Office of the Inspector General (OIG), has weighed in several times on the issue of how the AKS would apply to situations involving independent contractors whose compensation is commission based. More specifically, the OIG has been clear that such arrangements clearly implicate the AKS and has identified some core suspect indicators, including:

  • Compensation set on a percentage of sales basis
  • Direct billing of any federal healthcare program by the seller for an item sold by the contractor
  • A direct contract between the contractor and a physician in a position to order or refer
  • A direct contract between the contractor and federal healthcare program beneficiaries

The AKS is a statute with both criminal and civil monetary consequences. As such, it is a primary enforcement tool for the government. That said, the AKS is an intent based law, meaning the feds have to prove intent on the part of the offender, namely that the offender intended to pay for referred patients. Though intent can be gleaned from conduct, proving intent (even “one purpose” of the arrangement) is not easy.

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Recovery service providers are well advised to become familiar with not only the AKS, but also the law’s exception, so called “Safe Harbors,” which specify specifically permitted arrangements (42 CFR 1001.952). The “personal services arrangement” Safe Harbor has particular application in the area of marketing, as does the AKS exception for “bona fide employment arrangements,” which apply to W-2 employees, but not independent contractor relationships.

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Many recovery service providers do not interact with federal or state healthcare programs of any kind. For them, the AKS may not seem to be an issue, since the law only applies when services are reimbursable by a state or federal healthcare program. And yet the inquiry cannot stop there since many states have remarkably similar laws that apply even when there is no governmental payer involved.

For instance, Florida’s Patient Brokering Act (“PBA”) (Section 817.505, F.S.) mirrors the AKS in several key r espects. Like the federal AKS, the PBA carries with it criminal consequences and is used by many insurers to deny payment for claims. Like the AKS, the PBA contains an exception for arrangements that comply at the federal level. As such, Safe Harbor compliant arrangements can be expected to survive scrutiny in PBA enforcement activity. This is just one instance where it may appear that federal regulatory compliance is not germane, but in fact is.

Recovery service providers must take care to be familiar with both federal and state laws and to understand how they apply to the risky realm of marketing arrangements

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Lloyd Sokolow

SFYB Facility Consultant Dr. Lloyd Sokolow Author 

Ethical Transparency and Kickbacks.

Beware Addiction Treatment Providers!blue-beware

Does your program engage in any of the these treatment arrangements:
  • Sharing prospect data provided by call centers with and between addiction programs;
  • Guarantying that your program will cure an addiction:
  • Providing substantial gifts to interventionists who refer to a program;
  • Offering to accept insurance even though reimbursement is low;
  • Conducting urinalysis on patients and then sending the samples to labs who bill higher than the community standard;
  • Providing proprietary nutritional supplements to the patient and then billing insurance.
  • Scam marketing on the internet.

Federal and State laws may not apply to these type of arrangements. Private providers are more like to have these arrangements because reimbursement is more likely in the for-profit sector. The for-profit sector is not immune from Federal oversight. The Affordable care Act (ACA) covers many alcohol and substance abusers through Medicaid. This law has increased the number of individuals eligible for addiction treatment. However, though a program may not be engage in a illegal practice than it still may be unethical.

anti-kickback-statuteThe Federal Anti-Kick Back Statues (“AKS”) What is a Kickback?

Under federal law, a kickback is an offering of money or remuneration of any sort to influence the referral of Medicaid and Medicare patients. Addiction treatment professional have to be wary of any arrangement involves payment for patient referrals. The law was designed to protect patients from fraud and abuse by inhibiting the use of money to influence healthcare decisions.  It applies to an individual who knowingly and willfully accepts or offers remuneration of any sort and in any manner.  The person must intentionally make those payments for referrals. The persons involved can be prosecuting for a felony.

What are the sanctions under the anti-kickback? The penalties If found guilty for violation of the AKS criminal fines up to $25,000, and imprisonment up to five years. Administrative civil money penalties reaching as much as $50,000 can be imposed. Additionally, the Department of Health and Human Services’ Office of Inspector General may prohibit participation from Medicare or Medicaid programs of anyone convicted of an Anti-Kickback violations from participation in federal and state health care programs.  Civil monetary penalties for fraud, and kickbacks may be levied.

publication_photo_4361Does the Anti-Kickback Law have any exceptions?

There are exceptions to the Anti-Kickback law called “safe harbors”. It is best to consult with an attorney to determine whether the “safe “harbor” is applicable to a specific situation.

What are some of the arrangements alcohol and substance abuse providers that raise concerns?

Luxury “treatments” like equine therapy, yoga, SPECT brain scans and other treatments that are not typically covered by insurance.

The true cost of treatment may not be transparent. The patient, or the patient’s family is told that the bill will be covered by insurance, only to discover that the responsible party has to pay a large chunk of the bill. Ethical programs provide partial scholarships for this portion of care.

Kickbacks for referrals are unethical, and clearly illegal under Federal and Florida law. Programs sometimes treat patients like commodities. A price for a referral, whether it’s pay by click, direct or indirect payments are unethical in the U. S. This is not the case in Europe. Quid pro quo (“this for that”) must be proven.  Substantiating that the provider paid or received something of value in return for referrals is key and not very easy to prove. Kickbacks or bribes are sometimes disguised in the form of vacations or gifts as compared to just giving a cash at night in a parking lot.

Pay per click. Treatment programs invest large sums of money in Internet marketing.  If you want Search Engine Optimization (SEO) of your program to come on first it will cost you, gut once referrals come into the facility you will make it back. This may not necessarily be a kickback but may be unethical.

Depending on what search term is used, Internet marketing can be very expensive. According to a story published in Wired magazine in 2011, “rehab” cost $33.59 per click, and “recovery” was even more expensive at $42.03 per click. “Treatment” was $37.18 per click. Number one was “insurance” ($54.91 per click), with other costly terms including “loans” ($44.28 per click), “mortgage” ($47.12), and “attorney” ($47.07 per click).

call-centerCall centers

Call centers operating, as referral centers are particularly likely to be guilty of ethical lapses. Licensed treatment personnel aren’t staffing the call centers. The standards would be higher, he says, just as if a treatment program professional is on the talking with another substance abuse professional marketing a program would likely have an ethical standard.

Excessive and unnecessary procedures. A area of current concern in is urinalysis testing. There is special waiver from the federal government allows reimbursement for Medicaid patients of sober houses and treatment programs for this laboratory service. This has increased the frequency of urine analysis.in some treatment programs. Financial disclosures or background checks are not required for these waivers. But they must be medically necessary.

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The addiction treatment profession is filled with honest, ethical, dedicated and committed individuals. However, like all industries, there are those who betray their colleagues and society.  Forewarned is forearmed.

The author has adapted from Knopf, Alison. “Special Report: Addiction Treatment at an Ethics Crossroads”, Addiction Professional, Web,

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