Senators Take Aim at ‘Sober Home’ Scams

On the SUPPORT Act’s one-year anniversary, members of the Senate Finance Committee sought advice from government officials and advocacy groups in preventing “unscrupulous” recovery clinics from exploiting patients with substance use disorders and cheating insurers including government payers out of millions of dollars.
Currently, there is no federal agency responsible for oversight of recovery homes, the committee was told.
The SUPPORT for Patient and Communities Act was a bipartisan bill that sought to curb the opioid epidemic by increasing access to behavioral and mental health providers, expanding resources for neonatal abstinence syndrome treatment and improving state prescription drug monitoring programs.
Yet, 20 million Americans still suffer with substance use disorders, said Finance Committee Chairman Chuck Grassley (R-Iowa).
Some are tricked into treatment at “sober homes” where they’re exploited and not given proper care, Grassley said.
“The last thing you need when you’re suffering from this disease is yet more obstacles — rip-off artists, empty promises, or just out and out abuse… when all you want to do is get better,” said ranking member Ron Wyden (D-Ore.).
He described examples of “unscrupulous operators” who dangle hard-to-resist incentives in front of patients, such as travel and living expenses.
“Once the patients arrive, what they end up getting is lousy care or no care at all,” he said.
Perpetrators of these scams bill payers for services they never deliver or for services that are medically unnecessary and cost Medicare, Medicaid, and private insurers hundreds of millions ever year, Wyden said.
And the schemes and scams continue because there isn’t a way for patients and families to distinguish good treatment providers from bad ones, noted Grassley.
At a hearing Thursday, the committee asked expert witnesses to help identify ways to ensure that patients who need treatment for substance use disorders receive quality care.
Wyden stressed the urgency of the problem given that lawsuits against drug companies and distributors are beginning to play out — and pay out.
Between the current lack of oversight and the potential for giant fines and settlements from opioid sellers, “we’re creating a perfect storm for more fraud,” he said.
GAO Investigates
Mary Denigan-Macauley, PhD, director for health care at the Government Accountability Office, highlighted a March 2018 report that reviewed five states — Florida, Massachusetts, Ohio, Utah, and Texas — all of which had seen complaints of potential fraud related to “recovery homes.”
In southeastern Florida, a task force found recovery home operators tricked vulnerable patients by promising free airfare and rent. Recruiters then linked patients to providers who billed insurers for hundreds of thousands of dollars, she said.
“Home operators were paid three to five hundred [dollars] per week for every patient they referred,” Denigan-Macauley said.
In Massachusetts, labs that performed drug tests also owned recovery homes. Other labs paid kickbacks to recovery homes for testing that wasn’t medically necessary.
After 2010, as the opioid crisis took hold and the Affordable Care Act provided insurance to more young people, charging $4,000 per urine test and testing clients two and three times a week was commonplace, The New York Times reported in a 2017 investigation.
From 2007 to 2015, Massachusetts settled with nine labs for over $40 million in restitution.
In October, the Attorney’s office in Ohio reported that six people from the Breaking Point Recovery Center pleaded guilty to fraud for billing Medicaid more than $48 million for drug and alcohol recovery services that were never delivered or weren’t medically necessary, Denigan-Macauley said.
In response, Florida, Massachusetts, and Utah established either mandatory licensing or voluntary certification programs for recovery homes. Ohio and Texas provide training to recovery home operators, but have not instituted more formal oversight, Denigan-Macauley said.
Some state officials the GAO spoke with opposed licensing and certification, because they said it would “suppress the grass roots [efforts] … and it could actually put some good operators out of service, because they just don’t have the resources to be able to meet” the requirements, Denigan-Macauley told MedPage Today after the hearing.
Similarly, Gary Cantrell, deputy inspector general for investigations at the HHS Office of Inspector General (OIG), stressed his concern for law enforcement activities unintentionally creating gaps in care for patients.
He emphasized the importance of OIG working “hand-in-hand” with public health partners such as the CDC to make sure patients have uninterrupted access to treatment and continuous care.
Developing Standards, Licensing Requirements
One of the biggest problems for patients and families is locating appropriate evidence-based care.
Gary Mendell, a witness at the hearing and founder and CEO of the nonprofit Shatterproof, said his son Brian died because of a substance use disorder in October 2011 after visiting multiple treatment centers.
In the months after his son’s death, Mendell said, “I was destroyed all over again when I learned that research existed proving the types of interventions that would have significantly improved the outcomes for Brian and millions of others who were in treatment for addiction.”
He noted that some facilities still use services rooted in “outdated” and “ineffective” methodologies and highlighted a 2006 Institute of Medicine report (now called the National Academy of Medicine) which recommended establishing a common and “continuously improving” set of measures for treating substance disorder to “drive quality improvement.”
Shatterproof is currently developing a public platform, “Atlas,” to help patients and families by providing information about evidence-based treatment; offer providers data to help them advance evidence-based practice; and make sure policy and payment decisions are driven by data.
The program is in its first phase and Mendell is working with treatment facilities, payers, and other stakeholders in six cities on its development, he said.
U.S. Surgeon General Jerome Adams, MD, MPH, told senators that his office worked with Shatterproof in developing a recent report, “Spotlight on Opioids,” which he encouraged members of Congress to promote.
Adams also stressed the importance of better data. CMS has developed a substance use disorder “data book” which will help states make decisions about which recovery centers to “lift up” and which ones to investigate. Also, helping consumers understand what to look for in a good treatment center is important. (According to Adams’ written testimony, release of the “data book” is expected this fall.)
In his report, Adams highlights what to look for in a substance use disorder treatment center: a personalized diagnosis, assessment, and treatment plan; long-term disease management (including for related diseases such as HIV, Hepatitis, other sexually transmitted diseases and co-occurring mental illnesses); access to FDA-approved medications; effective behavioral interventions; coordinated care for other co-occurring diseases and diagnoses; and recovery support services.
“Look at what Shatterproof has put out, look at what we’ve put out and use your bully pulpit as senators to push that information out to individuals” who need help distinguishing good treatment centers from bad, Adams urged. “We have a checklist available — we need your help to push those out,” Adams said.
Who’ll Take the Reins?
When Wyden asked who should be responsible for oversight at the federal level, Denigan-Macauley declined to say, but noted that CMS and the Substance Abuse and Mental Health Services Administration have had strong involvement in this area.
Asked after the hearing how clinicians can avoid directing their patients to these unscrupulous recovery clinics, Denigan-Macauley suggested that one red flag is the sober home that is aggressively pushing drug tests.
“It’s been shown that for the purpose of recovery homes, just using a simple over-the-counter test on a regular basis is sufficient,” she said.
Denigan-Macauley also recommended looking at recidivism rates: “If they’re continually seeing someone coming back and back again, that should be a red flag as well.”
https://www.medpagetoday.com/publichealthpolicy/opioids/82936