When Gina DeMaria first opened the . opened? Dominic House, a recovery house in Hanover, she was approached by a man who offered her $400 in exchange for every patient she referred to his Florida treatment center.
She said she had declined.
“I want to help people, I want to do good for people … and that’s what they’ll be chasing,” DeMaria said.
That predatory behavior is known as patient brokering. It’s a symptom of the opioid epidemic that state officials fear is plaguing Pennsylvania.
What is patient mediation?
Patient mediation is when someone asks another person to go to a rehabilitation, recovery, or treatment center. Often associated with “recruiters” trying to lure people seeking treatment to an out-of-state facility — often in Florida, Arizona, or California, where there is a dense population of rehab.
Some people lured to out-of-state treatment centers have fallen victim to insurance scams commonly referred to as the “Florida Shuffle”. Recruiters or fraudulent rehabilitation centers near each other will cycle persons in need in and out of each center to pay for insurance claims and cash.
“It probably came to light about a year or a year and a half ago where we heard from some people about some issues where people had gone out of state for treatment and/or recovery and unfortunately ended up in a bad situation,” said David Buono, Pennsylvania. Consumer Contact Insurance Department.
Buono said individuals are often asked by familiar faces or “people they may have met when they used or recovered before.”
On March 25, the Reading Eagle reported on a series of insurance fraud at Liberation Way in Yardley. The Bucks County-based treatment center co-founder and a number of executives were charged with fraud and conspiracy by the Pennsylvania Attorney General. According to a report by the Philadelphia Inquirer, Attorney General Josh Shapiro said insurance company Independence Blue Cross was: over $17 million in claims charged through Liberation Way.
How serious is it?
Patient mediation has become a symptom of the growing opioid crisis. With an increase in addicts, the number of treatment centers has also increased. Not all centers are legit. And once patients are out of state, it can be difficult to track them.
According to a statement from the Pennsylvania Insurance Department and Department of Drug and Alcohol Programs, nearly 17 percent of Pennsylvania residents who received substance abuse treatment did so through an out-of-state treatment facility.
However, there are a number of conforming, state-approved facilities in Pennsylvania.
The appeal of treatment in a warmer climate or outside an area that initially caused addiction can hold promise for someone seeking treatment. But it can also lead to a potentially dangerous, sometimes deadly, situation if a person is caught in a racket of fraudulent centers.
That’s something DeMaria became familiar with after her son was transferred in and out of various treatment centers while he was in Florida. “I found bills for urinalysis that were $8,000,” DeMaria said.
Though she believes her son was caught in the “Florida Shuffle,” her main concern is the recruitment process in treatment centers. Often, facilities hire former or recovering addicts. While she believes there is power in familiarity, that doesn’t necessarily translate to professional care.
“We have these guys in recovery, and two years ago they were stealing from friends and family,” DeMaria said. “Recovering addicts is good for the equation, but you’re not a specialist just because you’ve recovered from an addiction.”
a federal law passed in October 2018 makes it illegal for anyone to receive monetary compensation for rehabilitation or referrals to recovery treatment centers. It is also illegal for a treatment center to pay a person for said referrals. Offenders face a fine of more than $200,000 and/or up to 10 years in prison.
Telling the difference between fraudulent and legitimate centers
Because so many treatment centers are opening in response to the epidemic, the only immediate solution is to do your homework, said Ron Ruman, director of communications for Pennsylvania’s insurance division.
“Before anyone chooses a facility, there are questions to ask and explore when considering a treatment center in or out of state,” Ruman said. “Consumers need to be wary and ask questions.”
There are a number of resources at both the state and national levels for learning whether a treatment center is legit. The Substance Abuse and Mental Health Services Administration offers a: list of certified providers based on each state’s governing body on rehabilitation center lists. It also offers a list of tips for ‘finding a quality treatment’.
In Pennsylvania, interested parties are encouraged to contact the Department of Drug and Alcohol Programs, which approves licensed facilities and maintains updated records of their inspection results. It also maintains referral options for people seeking treatment and relatives or friends seeking treatment for a loved one.
What role does insurance play?
“One of the challenges of being a regulator is that we find out through complaints … people have to tell us,” Ruman said.
A big part of that is understanding what is and isn’t covered by your insurance. Under the Mental Health Parity and Addiction Equity Act of 2008, individuals are covered for substance treatment are entitled to the same reimbursement as physiotherapy.
“If your policy covers those problems, it should cover them against what’s called ‘on par with a medical problem,'” Buono said. In other words, if your insurance covers 30 days of physical treatment for an injury, you qualify for 30 days of insured substance treatment.
Under PA Law 106, the state requires minimum coverage for alcohol and substance abuse treatment, including up to seven days of detox per admission (four admissions per lifetime) — in addition to a minimum of 30 days of residential treatment. These minimums must be met even if the days covered by the parity law are less.
The Pennsylvania Insurance Department can only help with insurance policies and claims. Buono and Ruman noted that if a treatment center or facility is flagged for fraud by an insurance company, that case would be outside their jurisdiction due to criminal law.
Helpful tips and useful links
The Pennsylvania Insurance Department encourages individuals to be wary of:
- Any unsolicited referral to an out-of-state treatment facility.
- Someone who offers to pay for airfare or other travel expenses to an out-of-state facility.
- Someone who offers to pay for the insurance.
- A person who asks for personal information, such as a social security or insurance policy number.
The Pennsylvania Insurance Department also offers an insurance guide on how to: to better understand and analyze your policy and whether it covers substance abuse treatment.
The Substance Abuse and Mental Health Administration also provides: a list of verified and approved facilities based on government agencies. For facilities in Pennsylvania, interested parties should consult the Department of Drug and Alcohol Programs lists for treatment centers.
The York chapter of Not One More too offers a number of resources for outreach and support programs.
The national helpline for treatment referrals is 1-800-662-4357.