May is Mental Health Awareness Month. In recognition, we will be publishing a series of articles about the status of mental health in the United States. Substance abuse and mental health are often intertwined. The opioid crisis is prevalent in the substance abuse treatment world, and patient brokering is a large part of that.
I try to keep up with what’s happening in the behavioral health world by reading what articles I can and paying attention to behavioral health related topics in the news. The opioid crisis has dominated many of the articles I read.
One article mentioned patient brokering and how prevalent it is in Florida. I do a lot of my work in Florida, and wanted to know more about something the people I work with might be struggling with. And the more I learned, the more I thought others might benefit from reading what I learned.
What is patient brokering?
The simple definition of patient brokering is that it’s the exchange of an individual with a substance (typically opioid) addiction for money/perks. There’s a few ways this can happen:
- A third party (known as a broker) collects individuals struggling with a drug addiction and bring them to the treatment facility or sober home in exchange for money or other perks.
- The treatment facility or sober home recruits struggling individuals themselves, without the intention of providing effective treatment.
- Another program will offer patients to the treatment facility or sober home in exchange for a kickback.
Patients are enticed to go to these treatment facilities and sober homes with the promise of material items like money, gym memberships, gifts cards, etc. Often, they’re also promised the ability to continue to freely use their chosen drug.
For families and support systems who don’t know any better, these treatment facilities and sober homes seem like the best option. It offers great incentives for their loved one while helping them get better. However, they quickly realize that the facility is not as helpful as it seemed and often does more harm than good for their loved one’s treatment journey. It will cost them thousands of dollars in insurance payouts and can end fatally.
How is patient brokering lucrative?
When I first started reading about patient brokering, it didn’t make sense that this arrangement is lucrative. Brokers and treatment facilities are spending large sums of money to entice patients to come with them or to pay those who bring patients to them.
Where do they make their money from? From the patients’ insurance.
The Affordable Care Act provided insurance to millions of young people. This means that many individuals who were once uninsured are now insured for a multitude of options.
These facilities and sober homes bill insurances for multiple urine tests a week. In some instances, clinics and labs are charging $4,000 or more per urinalysis test. That’s money that goes directly into the pockets of the treatment facilities and sober homes. But for this to work, the patients need to remain addicted to their drug. These facilities don’t help the individuals beat their addiction because it won’t be beneficial for them if they do. Those in the facility often overdose because there is no concern for their health.
Issues with Patient Brokering
Patient brokering negatively impacts everyone involved – no matter at what level. There are four issues with this practice:
- It’s immoral & illegal
The obvious issue is that it’s wrong. It’s immoral and takes advantage of those who are struggling to begin with. The last thing they need is to be taken advantage of in this state or to continue using under the guise of receiving treatment.
Patient brokering is a type of insurance fraud and considered by many to be a form of human trafficking Florida and California are the states publicly struggling the most with this right now. After the Patient Brokering Act passed in Florida in 2017, patient brokering was declared illegal in the state. California lawmakers are working to tighten their laws and follow in Florida’s footsteps.
- Eradicates trust in treatment relationship
Patient brokering breaks all trust in the client/clinic relationship. When someone with a substance addiction seeks out help, they’ve made a huge step forward and are in an extremely vulnerable position. When they are housed in unsanitary conditions, encouraged to continue using, and essentially used for their urine sample – they don’t get better. And they lose faith in the treatment system. Victims of patient brokering are less likely to seek help from other treatment facilities because they begin to assume that everyone who seems as if they are willing and able to help them is just using them.
- Harms reputation of reputable treatment centers
There are good treatment centers. There are treatment centers that only require urinalysis tests when it’s needed and use the results to aid the patient’s treatment process. There are treatment centers that truly want to help those who walk through their doors beat their addictions and move past it.
But they are getting a bad reputation because of the treatment facilities and sober homes practicing patient brokering. From a monetary perspective, they receive less business because they can’t compete with the, albeit disingenuous, perks and freedom offered by the fake clinics and sober homes. From a mission perspective, they can’t help those who need it because they aren’t coming to their clinic. These individuals are either being swayed by the fake clinics or they’ve lost trust in the system and don’t want to try anymore.
- Takes advantage of families
The financial burden of caring for a loved one with a substance addiction is staggering. The medical bills can total to thousands and thousands of dollars. For most families, this is a crippling number. After paying for multiple rounds of treatment, when someone receives an email promoting a “free” service with multiple advantages for their loved one, many families want to take advantage of it. It seems too good to be true. And it is. Their financial burden will also increase as multiple unnecessary tests are billed to their insurance. One family received a bill for over $86,000 in urinalysis testing.
In addition to the financial burden, families are also subjected to emotional turmoil and guilt as they watch their loved one continue to struggle with their addiction despite being in a “treatment facility.” And their emotional turmoil turns to guilt if the individual dies in the facility their family encouraged them to go to.
What can be done about it?
Patient brokering is a problem – one that may seem without a solution. The first step, as with any issue, is to raise awareness of it. More people, both in and out of the behavioral health world, need to know that this is an issue.
Florida passed the Patient Brokering Act in 2017 that made it a crime for any person, including health care providers and facilities, to offer or receive kickbacks, bonuses, commission or rebates, or engage in any split-fee arrangement, in return for referral of patients or patronage to or from a healthcare provider/facility.
California is taking steps to pass a similar law to ensure that patient brokering is a practice that does not continue.
I work with so many honest and hard-working people in this industry who are trying to make a positive difference for those with substance use disorders. It upsets me to hear that there are people who are taking advantage of vulnerable people who need treatment while undermining the work I see being done by others.
Raising awareness and passing legislation to criminalize patient brokering are the best ways to put a stop to this practice.