There’s No Place Like Home: The Importance of Community-Based Recovery Care in Fighting Rehab Fraud

A medical treatment plan that primarily consists of playing bingo and watching Tootsie and Batman sounds like something which is neither medical nor a plan. But if you find yourself in one of the many fraudulent recovery centers in South Florida, your insurance may read that as so-called “restorative rehabilitation.” Thousands of Americans suffering from mental illnesses or addictions are easily scammed every year, because for someone seeking recovery care in this country, uprooting and placing trust in a far off facility in Florida is the only option. Because the US has a weak community mental healthcare system, rehab patients perpetually feed an industry built to capitalize on their isolation and ignorance.

In the Sunshine State, a billion dollar industry has developed in the space of recovery center crime. Private rehab facilities are skimping on actual treatment, actively neglecting patients as a way of scamming private and federal insurance providers. For example, Ohio native Kaitlyn Cruea had high hopes when enrolling in a Florida treatment center to conquer a heroin addiction. But as soon as the facility checked her insurance was in order, they provided no actual treatment, instead taking out hundreds of unnecessary tests and falsifying therapy reports until the mother of two died in a fatal overdose. Tragic stories like these prompted one official’s statement from the Palm Beach County League of Cities: “Stop sending your children and your loved ones to South Florida because we’re sending them back in body bags.”

The US culture around mental health treatment and addiction is part of what has allowed this industry to develop. In 1963, JFK’s Community Mental Health Act planned for a huge increase in localized centers, aiming to bring care back to communities. In the Act’s implementation, however, a mere half of the promised centers in the bill were actually built. Private partial hospitalization programs in Florida, and the rehab fraud that bloomed at the heart of that industry, are a result of that broken promise. People who need medical help for something like Kaitlyn Cruea’s heroin addiction aren’t usually able to find it near home. Instead, they must uproot to get help, which places them at the mercy of being scammed for their insurance credits. Considering the population of people who need recovery care has grown 600% since 1999, there’s no end of needy patients for centers to exploit.

"Stop sending your children and your loved ones to South Florida because we’re sending them back in body bags"

With uplifting names and perfectly curated websites, for the casual researcher, fraudulent facilities are identical to ones that provide actual care. These partial hospitalization programs take out hundreds of tests on their patients, submitting each one as a necessary test for repayment to the patient’s insurer. The fraud here is twofold – centers will first take out endless tests, and then have patients sign off on therapies that they don’t actually receive. Though on an invoice to the federal government or a private insurer, the patient is receiving comprehensive care, in actuality, these rehabilitation centers get away with providing what is, according to the American Journal of Managed Care, “at best recreational adult day care”.

The scheme involves several conspirators. Patient facilities partner with doctors and, crucially, their own testing labs. These labs routinely overcharge the federal government and private insurers for tests that are wholly unnecessary. For instance, in general addiction recovery treatment centers, a  daily urine test is fairly standard. If a patient is exposed to illegal drugs during such an important transition period, it’s vital that centers are aware and can act accordingly. But these facilities often conduct urine tests multiple times a day, and send samples to labs to be screened for a range of drugs that the patient could never have been exposed to, including substances that have been out of circulation for years.

Patients don’t usually leave after their first treatment period, either. Nicknamed the ‘Florida Shuffle’, people are shunted from one community clinic to the next, creating a perpetual rehab cycle that goes until a patient’s insurance benefits run out. Management officials in centers and labs refer to patients as ‘thoroughbreds’, because a lab can make up to $4,000 for each individual test. A Florida clinic-owned lab called A New Start was clearing $188,305 for tests conducted on a single patient over the course of four and a half months.

These centers are making so much money that many of them can afford to fly out of state youth to visit their programs. This exact service helped attract Kaitlyn Cruea all the way from Ohio – her Florida program looked like a free solution to a devastating problem. Again, without care facilities closer to home, thousands who uproot themselves have less information about these centers and are more easily fooled. 75% of the populations of these centers are from outside of Florida, because these places can capitalize on the ignorance of distance.

Several high profile lawsuits have emerged from this illicit industry. In 1999 and 2009, respectively, the Office of the Inspector General (OIG) shut down two major clinic corporations for billing the federal government improperly for care that was not being provided. The OIG maintains that these giant takedowns have sent a message to clinics that mental healthcare and addiction recovery care are closely watched sectors of mental healthcare. Healthcare spending declined 240 million between 2008 and 2012 when OIG started their fraud detection work, which is a positive trend.

More important than shutting down existing scams is preventing patients from ever populating them. With more options within states, people like Cruea don’t have to get caught in a system that takes advantage of people trying to get better. Day programs allow people to remain at home with support systems they know and trust. Not only does it remove the source of exploitation for these centers, but the freedom of rehab seekers is respected, and the quality of care increased. Florida’s lifesucking industry isn’t a byproduct of a working system; It’s a result of the country’s cowardice against this kind of illness. Keeping people at home while they recover is vital, and the more patients a state can help treat at home, the fewer are fed into this pipeline.

Photo: Addiction Treatment Center 

About the Author

Roxanne Barnes '21 is a Staff Writer for the US Section of the Brown Political Review. Roxanne can be reached at roxanne_barnes@brown.edu

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