The high cost of insurance fraud in drug rehab
Health insurance fraud in drug rehab is not just about money. It can be an issue of life and death. But the money involved is enormous, too.
Read this article and weep. An excerpt:
When she enrolled in a South Florida drug treatment program in 2015, Alison Flory had high hopes of getting her life in order and starting anew.
But instead of receiving life-saving health care, the 23-year-old from a Chicago suburb found herself being recruited from one recovery residence to another as a string of shady drug treatment facilities systematically overcharged her mother’s health insurance policy for expensive, unnecessary procedures and tests.
By October 2016, Alison was dead…
Experts estimate that the government and private insurance companies lose $100 billion each year to health care scams and fraudulent claims…
Over a 15-month period in 2015 and 2016, Alison moved nine times to different drug treatment centers. It was largely the work of fellow addicts ”“ young men ”“ who were paid to lure her and others away from their current treatment program. They did so with the promise of free rent, free use of a scooter, and other benefits ”“ including possible romance ”“ if the patient agreed to enroll in a particular treatment program and live in a recovery residence or sober home associated with that treatment program.
Sobriety had nothing to do with it. It is an open secret among addicts enrolled in South Florida treatment facilities that hundreds of suburban homes posing as drug-free recovery residences are little more than co-ed flop houses where the use of drugs is permitted and sometimes encouraged.
The situation is an outrageous disgrace. And why is there no effective algorithm at insurance companies to catch this sort of thing? It wouldn’t seem all that difficult to do; and surely they are losing a lot of money in this way and one would think they’d be motivated to spot it and stop it. Are they afraid they’ll be accused of being meanies if they flag the behavior?
The situation is also a result—an unintended consequence—of Obamacare’s covering “children” up to 26. They are adults, and their parents don’t necessarily know what’s going on even though the payments and statements are on their insurance and come to them. Or perhaps they are just too trusting, but that’s what the perps depend on.
And why on earth was a new license given by the state of Florida? Was someone on the take?
[Hat tip Althouse.]
This is why mental health was excluded from health insurance until the Socialists got hold of it. Years ago I was on a committee that reviewed mental health referrals for military dependents who had Champus. They were larded with fraud. Parents with unruly teenagers would get them sent back to San Diego from Guam for inpatient treatment. It was just a way to get rid of them at government expense which was enormous.
I am not surprised at the fraud, but am at the gargantuan scope. My clue was simply the large amount of expensive advertising I see on mainstream TV offering drug treatment AND my skepticism that any treatment programs yet developed are that effective. I imagine that those drug users who are enticed into the program are not yet ready (if they ever will be) to change.
One more example of a society devolving into ever deepening levels of corruption.
Here in FL, the local news regularly features stories on restaurants that have failed multiple health inspections, some with a number of serious violations, yet remain open for business. Graft and corruption, extending into the legislature and executive branch, must be a factor in why state health inspectors haven’t closed them down…
It’s also noteworthy that the news never explores or follows up as to why this state of affairs exists.
When state officials turn a blind eye to serious health and basic hygiene violations in food service businesses, why would they be concerned with graft and corruption in rehabilitation programs for drug users?
John Adams had the right of it; the elected representatives in a republic will reflect the moral and religious character of the society from which they are selected.
This is why we have many more Chuck Schumers than Tom Cottons.
South Florida in particular has been a star in the health-care fraud arena, for decades.
Data that I recall from the 1980s showed median costs of having a stroke in Miami were double what they were in other Gulf South areas.
Young adults are particularly vulnerable to addiction, be it tobacco or alcohol or opioids. Has something to do with brain maturity.
It is clear that AA is the best program for alcoholism, costs nothing, as long as the alcoholic is willing to do what it takes. I’m not sure of the Narcotics Anonymous data but its principles are the same.
The failure, as shown in this article, is by multiple actors: 1) the Bleeding Heart State 2) the failure of the Federal State to interdict drug cartel deliveries-see Obama and Holder on that. Most Fentanyl is made in China, our good trading buddy. China has a vile record on many drug fronts- see the history of heparin. 3) Insurance coverage, plus the 26 year-old coverage deal- more Obama 4)Societal- Libertarians and others consider these events victimless crimes and oppose drug laws 5) The massive #s of drug dealers pardoned from Federal prisons by Obama-
what will they do but return to dealing? 6) More Societal: Passivity of parents, “too busy”, as Allison’s mother claimed to be, shoving unopened insurance coverage statements into a drawer, ‘estimating’ that $750K was spent on Allison. 7) Individual: Allison herself; what she did was voluntary.
Acute withdrawal from alcohol causes the DTs, which can be fatal if not adequately treated. Withdrawal from opioids without legal narcotic coverage like Methadone causes several days of restlessness, irritability, other discomforts, but not cognitive impairment, seizures, aspiration and death.
Of course there is huge fraud in treatment (ahem) centers, which are boarding houses with a few “counselors” that require 30, 60 or 90 day stays. Drugs and booze are smuggled in. They are a gold mine for the unethical. The “halfway houses” for those released from the centers are self-policing and also profit-driven, and we know how well that works. So be not surprised.
This is not going to get fixed anytime soon. In the meantime, we’ll just blame the convenient scapegoats, physicians prescribing opioids for patients in need whose relatives steal and use/sell the drugs.
I prescribed a lot of Fentanyl patches for cancer pain; it was great for patients. But illegal Fentanyl is made in pill form, with uncertain amounts of drug…so, overdoses.
OT: A post of yours entitled Starting to Leave the Left appears in my newsfeed but when I click the link I get Page Not Found.
“And why on earth was a new license given by the state of Florida? Was someone on the take?”
The second question answers the first.
At my brother’s highly regarded, state subsidized, half-way house the mortality rate was only 60% after two-years.
That figure is low since it does not adjust for the most recent arrivals.
Booze, meth or morphine, the boyz just could not stop reverting to habit.
That’s the nature of intense addiction.
The more obscure regulatory bodies have more influence than we generally see.
Still, it’s there, in the licensing and permits and inspections.
The question about “take” is obvious
The situation is an outrageous disgrace. And why is there no effective algorithm at insurance companies to catch this sort of thing?
Such as on-the-spot drug testing, bearing in mind how long a client has been at a treatment center versus how many days after use a drug can be detected. After all, if the insurance company is paying hundreds of dollars a day, it has some skin in the game.
For that matter, simply having an insurance company rep show up at the place to do a quick look-see. If the place looks like a crash pad/flophouse, it goes off the insurance company’s approved list.
The situation is an outrageous disgrace. And why is there no effective algorithm at insurance companies to catch this sort of thing?
Consider the following statement from the link:
That should be EASY for insurance companies to catch. EASY. I wonder if the insurance companies aren’t catching this because they figure the government will reimburse whatever they pay for.
Gringo:
That’s exactly why I asked the question. It would seem very easy to flag that as unusual, and to investigate.
Humans fall for the con again, as usual and as expected. The sheep think to rule themselves… pretty ridiculous.
I wonder if the insurance companies aren’t catching this because they figure the government will reimburse whatever they pay for.
It is more likely the nurses union and the doctor associations are getting kickbacks. It’s corrupt to the turtles and beyond.
Not just Florida. From Instapundit: GOLDEN STATE BLUES: How some Southern California drug rehab centers exploit addiction.
More at the link. Unfortunately, government-funded “compassion” often leads to chicanery like this. Not just in sunny Florida and sunny California.