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Treatment Center CEO Offers Potential Solutions To Drug Rehab Fraud

Aug 17, 2017
Originally published on August 17, 2017 9:35 pm

Widespread incidents of fraud have given the South Florida addiction treatment industry a black eye. Law enforcement has been cracking down — with strong support from the treatment industry’s legitimate providers.

Andrew Burki is CEO of Life of Purpose, an addiction treatment center on the Florida Atlantic University Campus in Boca Raton. He’s been working with the Palm Beach County Sober Home Task Force to increase oversight and close loopholes exploited by unscrupulous operators. Burki spoke with WLRN’s Peter Haden about steps that could clean the abuse.

WLRN: Are drug treatment facilities held accountable in any way for the successful progress of their clients toward recovery?

BURKI:  If you built cars and 90 percent of them broke down, you would go out of business.

In the treatment industry, you get reimbursed for providing services — but facilities don't take responsibility for the outcome the second the client leaves the door.

I have seen charts where a client had been admitted to the same facility nine times. Nine times is insane. That's obviously an ineffective intervention.

[State enforcement agencies] need to go after the licenses. Because if you don’t have the treatment license, then you cannot continue to commit fraud. If you take licenses, the whole thing collapses.

Read more: Sunny Daze, Inside South Florida's Opioid Crisis

What you're seeing is this carve-out of good treatment facilities and good recovery residences and good therapists in private practice. They are all working with people through a legitimate continuum of care.

And then the rest of it is this crazy Wild West horse trading, people being held against their will and windows being screwed shut… It’s this whole seedier human trafficking industry disguised as the treatment industry.

Law enforcement and the state attorney's office has stepped up and said, “We’re going to handle this now.” And they are handling it. And thank God they're handling it.

What role could insurance companies play in curtailing the fraud?

The big thing that has to happen is the insurance providers have to shift to “outcome based reimbursement.” The  fee-for-service model that currently exists is a total disaster. There is a monetary incentive to keep people sick. The second someone actually gets better no one's in their pocket anymore. No one's in their family's pocket. No one's in the insurance company's pocket.

But the second you relapse, your insurance benefits reset. You’re back up at the highest level of care because the higher the level of care the higher the level of reimbursement.

So…the more money you make as a treatment provider.

Right. If they really want to fundamentally change this, the insurance companies need to shift to outcome-based reimbursement models, like,  “We’ll pay you 50 percent of the money up front.” And if the person does not return to treatment for a year, a year and a half, if you actually produce a successful outcome…

...if you actually get this person well…

If you actually help this person get well -- exactly….then we'll give you 150 percent of our billable rate. And if you don't -- then you get nothing.

The insurance companies have the capacity to basically shut the entire thing down -- you know, cut the faucet off.

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Note:  In July, a new Florida law went into effect increasing penalties for patient brokering and giving the Department of Children and Families more authority for regulation and enforcement of addiction treatment centers.

You can read Andrew Burki latest editorial here: Saving Lives And Money In The Fight Against America's Opioid Epidemic

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