Drug Treatment industry deserves public scrutiny
With the siting of drug treatment facilities being discussed in Sussex County, the experiences of other communities, individuals, and government agencies should be closely examined and considered. The Boston Globe, one of the nation's foremost newspapers, recently (July 8, 2017) published an article on the subject, which raises a number of interesting points:
Some seeking help for opioid abuse are lost in a circle of lies
By Evan Allen and David Armstrong
JULY 08, 2017
Drug users, desperate to break addictions to heroin or pain pills, are pawns in a sprawling national network of insurance fraud, an investigation by The Boston Globe and STAT has found.
They are being sent to treatment centers hundreds of miles from home for expensive, but often shoddy, care that is paid for by premium health insurance benefits procured with fake addresses.
Patient brokers are paid a fee to place insured people in treatment centers, which pocket thousands of dollars in claims for each patient. They often target certain Blue Cross Blue Shield plans, because of their generous benefits and few restrictions on seeking care from out-of-network treatment programs.
The fraud is now so commonplace that brokers use a simple play on words to describe how it works: “Do you want to Blue Cross the country?”
Patients from across the United States have been taken in by these profiteers capitalizing on the surge in opioid addiction. For Peter SanAngelo, hopeless and homeless after a decade of heroin use, the promise of free insurance and luxury rehab in another state was a lifeline. A patient broker used a phony address to enroll the Massachusetts man in a Pennsylvania Blue Cross plan and bought him a plane ticket to Florida. He was even promised money for cigarettes.
Three months later, the 33-year-old died of a drug overdose.
“This whole thing began from a place of deception,” said SanAngelo’s cousin Samantha Herring. “Peter had an honest desire to get better, and they had an honest desire to make money.”
Patient brokers, some of whom are themselves in recovery from drug addiction, are paid by marketers working for treatment centers eager to sign up patients with private insurance plans. For them, the most attractive plans to exploit are PPOs — which stands for preferred provider organizations. These plans often impose few limits on where people with addiction can seek treatment and often actually pay more for rehab provided out of their coverage area.
HMOs and government insurance plans like Medicaid are shunned by treatment centers engaged in patient brokering because they either limit where treatment can be provided or pay much less than PPOs.
The patients are often enrolled through Heathcare.gov, the online insurance marketplace created by the Affordable Care Act that connects patients to insurers in dozens of states.
The brokers use phony addresses to sign up people immediately — a change of address is an exception to the usual limitation that customers can sign up only during the end-of-year open enrollment period — and to take advantage of the best-paying PPO plans in states in which they don’t live.
The brokers, patients’ families, or marketers for the treatment centers pay the insurance premium. Within a few weeks, the insurer is billed tens of thousands of dollars for what is often subpar care.
Among the Blue Cross plans hit hardest by the fraudulent enrollments are ones in Pennsylvania, Delaware, and West Virginia. They include Pittsburgh-based Highmark Inc., the fourth-largest Blue Cross company in the country. Brokers have signed up out-of-state patients with the company using addresses of treatment centers in Erie, Pa., and Pittsburgh, according to information obtained by STAT and the Globe.
“We can confirm we are definitely seeing the issues you are identifying,” said Rachel Jones, the director of Highmark’s Financial Investigations and Provider Review unit.
People from across the country are being enrolled with fake addresses and some individual brokers are enrolling multiple people at once, said Latrisha Oswald, a manager in the insurer’s fraud unit.
Many are signing up for premium plans that provide out-of-network benefits with low out-of-pocket costs, she said. Highmark said it began investigating the enrollments with phony addresses last year and recently expanded its efforts to identify those bogus signups.
Many patients have no idea how their insurance coverage was obtained or that they are part of a scam. They are often told they are receiving free care — or that their insurance is being taken care of by the patient broker. Some find out their coverage is from a company in a state where they have never lived only when a billing problem arises or when the broker stops paying the premium. By then, they’re far from home, stranded without any insurance.
A broker who knew the streets
Michael “Hiss” Hislop grew up in Boston’s Savin Hill neighborhood, and once counseled gang members as a street worker for the city. He spent a decade mentoring people through Alcoholics Anonymous, after beating his own addiction to heroin and alcohol. He knew the ins and outs of the Massachusetts treatment world, and built a reputation as an ally on whom struggling young addicts could rely.
Then, at the beginning of 2016, he got involved in the brokering business. As he saw it, he said, he could make good money while also helping people.
In a series of interviews, Hislop said he had been naive about the legality of patient brokering when he founded his company, Barnowl Treatment Options LLC, which arranged for 55 to 60 Massachusetts residents to travel to Florida last year for drug addiction treatment.
He admitted to receiving payments to place patients in centers in Florida, as well as enrolling some of them in Blue Cross plans in other states where they didn’t live.
He said he sometimes paid their premiums, and also paid for airfare for people he sent to Florida, which in some cases can be considered an illegal inducement under state and federal health care law.
“We were blind to a lot of things when we were doing it, and then we stopped,” said Hislop, 51. “That’s all I can do; what else can I do? If I have to accept responsibility for something, then I would have to do that as an adult, as a sober adult.”
Michael Hislop said marketers for Florida-based treatment centers paid him $500 to $1,000 for each patient he sent their way.
Hislop said marketers for Florida-based treatment centers paid him $500 to $1,000 for each patient he sent their way, and he could make even more by sending groups of patients — $3,500 for three, for example. Hislop recruited patients that he or two people working with him knew, or people who were referred to him.
One referral source, Hislop said, was Daniel Cleggett. In May, STAT and the Globe published an article about widespread patient trafficking that detailed allegations that Cleggett, a high-profile recovered addict who runs treatment centers in Massachusetts, had helped broker addicted people to out-of-state treatment centers.
Cleggett has previously denied any involvement in brokering. He did not respond to requests to comment on Hislop’s allegations.
Hislop said Cleggett referred between 15 and 25 patients who were flown to Florida, and he paid Cleggett up to $1,500 a patient.
Hislop said he mostly delegated the insurance end of his brokering business to Elizabeth Mooney, a Boston woman who had worked at a Florida treatment facility. Mooney acknowledged working for Hislop.
She said patients were actually enrolled in Blue Cross plans by licensed insurance brokers who worked with the Hislop organization, and she would find fake Pennsylvania addresses for patients by searching the Web for sober homes and treatment centers in that state. Patients were also signed up using their out-of-state relatives’ addresses, she said.
Mooney said she made $600 every other week working for Hislop, and at the time she didn’t think she was doing anything illegal. Hislop also said he didn’t think it was illegal to use fake addresses.
Both Hislop and Mooney said they left the broker business in late 2016 after realizing that much of what was happening — the out-of-state insurance signups, the flights they were paying for, the per-patient payments from marketers — might be illegal.
“I quit, I quit with no job and nothing, no notice,” Mooney said. “I was four months with no job.” She now works as a regional coordinator for the state-funded Massachusetts Organization for Addiction Recovery, a nonprofit advocacy group.
Of the 55 or so people Hislop sent to Florida treatment centers, he said only about 10 achieved sobriety.
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