"Buyer beware" when it comes to addiction treatment

Substance use disorders affect millions of Americans, and overdose is now the leading cause of accidental death in the United States. The need for treatment and recovery services has never been greater. This increasing demand has led to rapid growth in the number of detox and treatment service providers, which has burgeoned into a $35 billion a year industry. Most of these service providers work hard to provide honest, quality care to save lives.

Yet historically, addiction treatment and recovery services have been largely unmonitored, and remain so. As a result, the field is riddled with its share of corruption that seeks to exploit vulnerable individuals in desperate need of medical care. Because the news is saturated with stories about rehab scams and various patient abuses, it's easy to think that " one bad apple spoils the whole bunch."

Unethical marketing of addiction treatment

Common unscrupulous practices include:

Patient brokering. This can take several forms. Lead selling involves paying brokers a finder's fee or kickback for referring patients to their treatment facility (e.g., financial compensation of $500 to $1000 per patient or special future consideration). This is happening not only with patients new to treatment, but also in agreements made between recovery residences and treatment centers, or between two separate treatment centers. Lead buying is another approach. Call centers generate commission based on the number of placed referrals. Call center agents pose as caregivers, and unbeknownst to the patient, auction him or her off to the highest bidding treatment center. Treatment facilities that appear as separate centers may all route to the same call center. Finally, "addiction tourism" is the practice of sending a patient to a treatment facility in a state other than his or her home state.

Patient enticement. This is providing unethical incentives (money, gifts, free rent, flights, food, or other amenities) to get patients to enter, stay, or switch addiction treatment facilities.

Listinghijacks. Google Business or Google Maps listings can be altered through the suggested edits feature. Unaffiliated individuals can go into an organization's profile and change listed phone numbers to reroute calls and online correspondences to other treatment programs or call centers, and change listed addresses to deceive patients about the actual location.

Misleading language or misrepresentation of services. Treatment facilities may deny their affiliations to other facilities or organizations; inaccurately portray the services they provide, their accreditation status, the types of conditions they treat, the credentials of clinical staff, accepted insurances; or misrepresent facilities, locations, and amenities in various ways.

Patient privacy violations. It isn't unusual for unethical treatment centers to use a patient's personal information — without his or her permission — as part of a sales or marketing pitch. This is in violation of HIPAA and other laws intended to protect sensitive personal health information.

Insurance overbilling and fraud. This is the process of billing insurance companies excessively for unnecessary treatment or services. A common instance is urine drug screens. For example, $10 drug tests are performed every two days and billed at $1,000. Under the guise of free insurance or care, patients may be enrolled in insurance plans utilizing false addresses to take advantage of the "change in address" exception, which allows a person to get coverage outside the open enrollment period. Unethical facilities may also enroll patients, without their knowledge, in premium plans with generous coverage (e.g. out-of-network coverage and low out-of-pocket costs) so that the treatment center gets reimbursed at a higher rate than from other plans or providers.

Fighting unethical addiction treatment marketing practices

Awareness is the first step in combating unethical addiction marketing practices, and has led to new legislation and increased scrutiny of addiction treatment providers by law enforcement, and even for-profit corporations such as Google.

Beyond ongoing criminal investigations led by local and state law enforcement agencies, the National Alliance for Recovery Residences (NARR) officially established a code of ethics for recovery residences in 2016. More recently, in an attempt to thwart aggregate call centers, Google has temporarily ceased the sale of pay-per-click advertisements on thousands of rehab-related search terms that previously generated over $100 per click. And beginning this year, the Joint Commission on Accreditation of Healthcare Organizations will require evidence-based practices in order for treatment facilities to be accredited.

Protecting patients from corrupt addiction marketing practices is necessary in order to provide honest and effective treatment for substance use disorder. While decisions on what treatment facility to enter are often made in states of distress, it is important to emphasize that individuals and families should protect themselves by learning about what constitutes quality addiction treatment, where to find trusted local providers, and how to choose the right option for them.