What is Patient Brokering?
Patient brokering is a dishonorable and illegal practice where individuals or “brokers” trade clients to a treatment program in exchange for persuasive incentives, such as money, perks, or other forms of compensation. Patient brokering has been known to take many forms. In some cases, a third party broker will reach out to a treatment program regarding a prospective client and solicit a referral bonus or “kickback” in exchange for the client’s information.
Patient brokering has also transpired in the form of treatment programs offering patients a waiver or discount of deductibles, co-insurance, and co-payments or offering to pay for a patients’ travel to the facility. Patient brokers may even infiltrate treatment programs and provide drugs or cash (for the purchase of drugs) to other clients in the program in order to trigger a relapse that starts the treatment cycle over again.
The problem began to surface in 2010, when the ACA (Affordable Care Act), or Obamacare, passed and patient brokering, or “body brokering,” is quickly becoming a growing stain on the addiction treatment industry.
While most substance and behavioral addiction treatment providers see it as a responsibility and a privilege to take part in someone’s recovery, there is, unfortunately, a sector of treatment providers whose quest for profit outweighs trust of people and families in crisis.
After the ACA 2014 passed this sector of treatment providers (as well as third party agents) swiftly discovered the “gold rush” of monetary opportunity awaiting them by engaging in patient brokering and trafficking.
What do brokers look for?
The affordable Care Act (ACA) of 2010 mandates the inclusion of mental healthcare coverage and addiction treatment in insurance plans. Unfortunately, ever since the ACA came in to play, a number of unethical treatment centers have been willing to compensate patient brokers for referrals or “relapse triggers” because a single patient with good insurance can be worth tens of thousands of dollars in insurance claims. Patient brokers are therefore mainly looking for those individual who have insurance that covers behavioral health disorder treatments.
Patient brokers often appear to want to get their targets the help they need and today there are thousands of third-party websites masquerading as a behavioral rehabilitation center. This means they are “fronting” as a rehab center while in reality they do not offer any service themselves, instead they will refer an approaching client to a corrupt treatment center in exchange for money or other goods. These practices can be extremely harmful to individuals who get caught as pawns in the scheme.
Keep in mind, the goal of most brokers is to secure patients for programs that last 30-days or less for maximized turnover. They do their best to enable a patient’s relapse in order to move the patient to another rehab center and secure another trip through the broker’s money-making scheme.
Treating people like cattle is not only dangerously unhealthy for the addict, but also shatters the integrity of the drug treatment industry. Patient brokering harms those who need help most and undermines efforts toward true recovery.
What steps have been taken to prevent Patient Brokering?
To address this issue, President Trump signed into law the support for Patients and Communities Act, also known as H.R. 6. Section 8122 of the Act entitled “Eliminating Kickbacks in Recovery Act of 2018, will prohibit:
- Solicit or receive anything of value in return for referring a patient to a recovery home, clinical treatment facility or laboratory,
- Pay or offer anything of value to induce a referral of an individual to a recovery home, clinical treatment facility, or laboratory, or
- Pay or offer anything of value in exchange for an individual using the services of that recovery home, clinical treatment facility, or laboratory.
Additionally, Governor Jerry Brown signed four new addiction treatment bills on September 26th that further ban patient brokering, strengthen licensure requirements, and increase penalties against addiction treatment facilities in the state of California. Namely, (1) the SB-1228, prohibiting patient brokering. (2) The SB-992, which adds sober living home disclosure requirements. (3) The SB 823, which strengthens licensure standards. And (4) AB 3162, which increases penalties of addiction treatment facilities.
Not only is there a need for the state to hold treatment centers responsible for patient brokering, but the rehab industry must also strive to re-establish trust in clients and the community. This should be done by legitimate facilities holding to a strong model of ethical behavior.
If a center offers bonuses or commissions to a client that signing-up for treatment or a third party that for referring a client anyone signing up, participating in what amounts to a ‘Ponzi scheme,’ they may be involved in patient brokering.
Although California has been taking steps toward regulating body brokering, progress is slow. As so, it is imperative that centers establish guidelines and procedures to protect their patients. While, the wrongful patterns of the past have tarnished the public’s faith, it is important to emphasize that not all treatment centers are guilty of these practices, and there exist many who do focus on patient health.
As these unscrupulous racketeers have cast a shadow on the state of our industry, StepHouse Recovery see it as our duty to educate the public and help treatment seekers navigate the industry. We therefore advice you to keep these questions in mind when searching for a rehab center for yourself or a loved one:
- What is the length of their program? (Legitimate programs often come in many different lengths.)
- What happens to the patient after the program ends?
- How many staff are available at a time?
- How do they treat and prevent relapses?
While researching the treatment center, ask all these questions and more, but be wary of third parties.
How can you avoid Patient Brokering?
First of all, are a treatment center offering a free trip to rehab? Will they give you money to go? Are they selling a rehab ‘scholarship’ or ‘vacation’? If so, these are all red flags indicating potential patient brokering. Rehab is about helping those with addiction and you should therefore examine centers that advertise extravagant amenities with a critical eye.
Secondly be wary of settings where patient brokers tend to find targets. Brokers frequently troll support meetings, locations where drug use is commonly known to take place as well as a detox, sober living and rehab facilities.
Lastly, be aware that a legitimate and reputable center will make sure the individual is a good fit for their particular program. This means, a comprehensive assessment and initial screening should be conducted using ASAM criteria (American Society of Addiction Medicine) before a client is admitted to a program. Also, depending on the type of program, the essential (necessary) standard of addiction treatment should be offered such as withdrawal management or detox services, treatment plans specifically tailored to each individual client’s needs, treatment transitions and multiple levels of care, and comprehensive aftercare.
StepHouse Recovery's Comprehensive Behavioral Health Initiative
Here at StepHouse Recovery we have made extensive efforts to create a more comprehensive behavioral health initiative in our community. This include establishing new strict guidelines and procedures to protect our patients, identifying and addressing risks, realigning existing policies and practices, sharing information and resources, and establishing relationships and mutual goals with partners and affiliates.
We recognize that one institution or behavioral health care center cannot combat the issues of our industry – weather it be access to care, quality of care, or preventing illegal and unethical practices – alone, we therefore emphasize the importance of building partnerships with supporters and other establishments embedded in the behavioral health care setting.
Each addiction treatment agency has a different service delivery model. Services can in some cases be limited by insurance and reimbursement, resources, or may not meet the exact requirements and focuses needed for a particular clients care. Connecting with others thus allows for a wider net of resources, more access, and greater opportunities.
We are therefore working continuously towards a comprehensive network (be it for legal aid, family reassurance, comparable healthcare centers, or services not provided by our program) to assure that each customer/client leaves our care or services knowing how to take the next step. Because we believe there are strengths in working together to strategically advocate for change and a better system of behavioral health care.
The goal of creating a coalition of care providers, advocates, and other stakeholders is to:
- Increase access to quality behavioral health services for anyone seeking treatment or information
- Promote substance and behavioral addiction recovery through a broader spectrum of behavioral health services.
- Build a safe and sustainable behavioral health capacity for all parties involved.
- Achieve higher satisfaction with services offered among all key stakeholders
- Promote systematic changes in behavioral health service delivery.
- Provide legislative advocacy.