Patient brokers know there’s more money in relapse than in getting people sober.
If you think patient brokering, also known as “body brokering,” is just about “professionals” getting kickbacks for referring a client to a certain rehab, you are wrong. It’s much more complicated and sinister than that. I did a deep dive and interviewed the head of a watchdog group, a rehab counselor, a rehab business development guy, and the head of an ethics association to try to get the full picture. And despite patient brokering being officially illegal in California and Florida since January, it’s still terrifyingly prevalent.
I was first prompted to write this piece after an experience with a sponsee. She was in a sober living and was offered money by another client at the house to relapse and then check into an upscale rehab. Because you must test dirty for your insurance to start over and cover treatment, she got loaded and was shipped off to a fancy Malibu rehab for a week. She was ecstatic.
Recovering Addicts Preying on Other Recovering Addicts
Of course, soon she was sent to a shitty sober living which she described as a “flop house.” Thankfully she didn’t die during the relapse, and she didn’t get her money either. The “body brokers” in this case, recovering addicts preying on other recovering addicts, ran off with the kickback money they got from the rehab as well as the money they were supposed to give my sponsee. If this sounds bad, it gets worse.
I spoke with David Skonezny, the admin for the closed Facebook group “It’s Time for Ethics in Addiction Treatment.” As Skonezny moved through the ranks of drug and alcohol counseling, eventually becoming the COO of a treatment center, “body brokering,” an open secret in the business, came to his attention. He started the group to “separate the wheat from the chaff” and to identify the people he wanted to work with to create a solution for the myriad problems plaguing the profession; however, he underestimated how pissed off and hurt people were.
“It quickly ended up being a referendum of sorts on addiction treatment as people started posting snapshots of text messages, naming names… It got really deep really fast.” As a result, one of the moderators of the group set up a site that provided a comprehensive list of agencies for the reporting of illegal and unethical activity, including credentialing and accreditation bodies, law enforcement, state agencies, and insurance investigators. People can now report the facilities as well as the brokers engaging in this illegal and unethical behavior. That site is: Ethics in Treatment (www.EthicsInTreatment.com).
“Body Brokers” Buy and Sell Patients
As Skonezny explained to me, in the referral game it’s about buying clients. Initially a treatment center might pay perhaps $10,000 for a client (that figure has dropped substantially as a result of immense competition), but it was worth it because you could bill the insurance for six figures over the course of a treatment episode. As it became harder to acquire clients this way, body brokers and rehabs started to offer other inducements such as air travel to treatment, clothes, cell phones, and cigarettes. And because people with these premium insurance policies are hard to find, brokers would find a prospect and then buy the policy for them. The rehab pays the first month’s premium, and then once the insurance is active, bingo.
Once the benefits are exhausted, however, the client gets kicked out, usually with nowhere to go and no return ticket home, and ends up homeless and desperate. But now they know the drill. They realize if they get loaded, they’re eligible for treatment again and can go back into rehab. This revolving door, “going on tour,” as Skonezny calls it, became a common strategy for both the brokers and the clients in order to maintain free housing, food, and other perks.
“This has created an artificial recovery community in Southern California, particularly in Orange County where kids are getting flown in and then kicked out. At one point it created a massive homeless population of young addicts, especially in Costa Mesa,” Skonezny told me. Some of those kids die on the streets, some go home, some keep cycling through treatment.
How did we get to this place? I asked. Well, when the Affordable Care Act went into effect, behavioral health issues, including mental health and addiction, became essential medical services.
“This created an unprecedented availability for people to get insurance coverage, and people who wouldn’t have otherwise had an opportunity to go to treatment now could,” Skonezny explained. “This should have been a good thing, except that with addicts flooding addiction centers, the owners and others began to realize that there was a lot of money to be made.”
There are two types of insurance policies: an HMO, where you need a referral from a primary doctor and must go to a place in network, and a PPO, where there’s no referral necessary and because it’s out of network, there are no contracted or set rates. Rehabs want the PPOs. They can charge whatever they want, and they do. They can bill the insurance for ridiculous amounts for daily services ($2,500 for a daily session from a PPO vs. $300 from an HMO) including huge charges for urine tests.
Alumni Get Kickbacks for Bringing in New Patients
Soon insurance companies got wise to the game and began reducing the financial reimbursement to rehabs, as well as the length and level of care they would allow. As a result, the rehabs were making less money and thus needed to up their referral game even more, so they got their alumni involved. Newly sober addicts who have been in a 12-step program have access to a network of possible patients: newcomers in meetings. These newly sober ex-clients start getting kickbacks from rehabs to bring in new clients. And then those clients do the same once they get out of treatment. Now you have a new cycle: predators creating predators.
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