The Florida Model Becomes a Shuffle, California’s Rehab Riviera, and Liquid Gold

Fraud is an almost foregone conclusion when money is readily available and people are unsure of what they are paying for. The floodgates opened for the addiction treatment industry with mandatory health insurance coverage through PPACA and MHPAEA (Seville,2017). Venture capitalists with no addiction treatment experience but plenty of capital funding wanted in on the payday. They just saw an opportunity and banked on it, offering good to mediocre services.

By far the worst was yet to come, as all manner of frauds, schemes, and patient brokering playing on the desperation and misery of so many looking for help. Con artists and nefarious types saw opportunities when a largely unregulated industry with little accountability was given carte blanche to increase treatment access. Soon Florida (Florida Shuffle, 2018), Arizona (Segal, 2017), and Southern California (Rehab Riviera)(Sforza et al., 2017) became epicenters of disreputable sober treatment centers, rehabs, and sober homes.

These areas were by no means the only ones harboring shady operators but their warm climates beckoned to form communities of addiction treatment providers instantly. Literally anyone could open up a rehab or sober home – and they did (Segal, 2017). Even those with previous criminal records and no professional treatment experience, except perhaps their personal substance use, were owners of rehabs, treatment centers, and sober homes. Blocks full of them sprang up seemingly overnight.

What these “entrepreneurs” lacked in treatment experience, they made up for in ingenious ways to scam money from insurance. Set loose with an unlimited “credit card” of insurance coverage, they recruited current or former patients to bring in new patients off the streets, at bus stations, at AA/NA meetings, anywhere they could find them (Segal, 2017). If the new patient had insurance, it was time to put them through the mill of detox-rehab-sober house and back through again as many times as insurance would pay. If the new patient lacked insurance, that was no obstacle. The cost of a monthly insurance premium paid for a new patient to be covered was peanuts to spend for these “treatment providers” compared to the thousands of dollars in insurance reimbursements available to bill on that newly health insurance covered patient.

As if all this weren’t enough, many of these addiction treatment providers decided to bring in extra cash with unnecessary urine screening (Segal, 2017). Urine drug testing is a valuable tool and is a covered service under insurance. Primary and confirmation urine screenings can help track the progress of a patient and may even be mandated by legal systems as part of tangible proof of adherence to sobriety and program attendance. Some of the biggest offenders were using cheap drug tests and billing at exhorbitant rates multiple times for no reason. This “liquid gold” became another avenue to bring in tens, if not hundreds, of thousands of dollars per patient.

If the substance user seemed to move away from using substances, they were tempted with drugs, often by the very people paid to help them. If they didn’t succumb to temptation, they would be put out on the street until they tested “dirty” again and the billing cycle renewed.

Many of these young patients were lured by patient brokers to travel far from home with the promise of luxury beachfront accommodations during their addiction treatment stay. Being away from home produced two desirable points for the treatment providers: a lack of support and oversight from family and friends and the substance user alone in unfamiliar settings with few resources but to agree to play the treatment game. Trusting parents and vulnerable substance users, perhaps already estranged from the chaos of addiction history between them or used to a lack of communication during previous treatment stays, didn’t have a chance to share the deplorable conditions of their stay and the lack of reputable help. This state of noncommunication led for some to disasterous ends as loved ones overdosed in rehabs, in sober homes, on streets, or on the beach. Morgues in Southern Florida (Clary, 2017) continue to be overwhelmed and some families are left with merely the portion of the bill insurance didn’t cover and no loved one to return home.

As an industry, addiction treatment has been plagued with bad actors for decades. Without excusing their actions in any way, these people are taking advantage of a terminally flawed system. When the standard results immediately after leaving treatment are escalation of the type, frequency, or intensity of substance use, and an increased risk of overdose, it’s clear treatment isn’t improving the situation but is actually worsening the outcomes. When the top predictor of relapse after treatment is the strong belief in treatment principles, there is a critical problem. As a nation, we can’t afford to go on this way.