(Understanding and Avoiding “Patient Brokering”)
Patient brokering is an illegal practice used by some rehab facilities to pay a third party to procure patients for them. When at their most vulnerable, addicted people and their families are talked into believing the facility is acting in their best interests, when in reality, they’re in it for financial gain.
Patient brokers are paid to seek out patients whose insurance will cover drug testing and other services, then refer them to specific facilities and receive a commission for each referral. Some of these facilities often focus on collecting substantial fees for drug testing without providing any follow-up treatment.
How do people fall prey to patient brokers?
Often, the act of seeking out a treatment facility is a new and uncertain experience for addicted individuals and their loved ones. The urgency of the situation often adds to their vulnerability. When they call a “treatment center” they located online and find a sympathetic, compassionate voice on the other end, it’s comforting to believe that person wants to help. As a result, people struggling with addiction, as well as family members seeking to help, can be easily manipulated into agreeing with suggestions from a supposedly credible source. In reality, they’ve just fallen prey to a third-party patient broker.
Some patient brokers even loiter around sober halfway houses, detox centers, and recovery meetings, attempting to recruit patients by telling them insurance won’t pay unless they fail their drug test. An episode of the Dr. Oz show highlighted these and other disturbing tactics used by “body brokers,” and the substantial amount of money, these brokers are paid for their services.
Sober home facilities must also be carefully vetted, as several unscrupulous sober home operators have been arrested on patient brokering charges. A 2017 story in the Palm Beach Post reported that six such operators had been recently arrested by the Palm Beach County Sober Home Task Force, bringing the total number arrested at that time to 40.
One tactic used by sober halfway houses and other dubious treatment or recovery centers to lure patients is to offer free or reduced rent, free cigarettes, pre-paid debit cards, or other incentives. If this happens to you when you’re searching for a treatment program, it should send up a red flag. Legitimate rehab facilities offer licensed treatment services with credentialed staff, not gimmicks.
Treatment centers can also be unwittingly drawn into patient brokering, especially if they are new or struggling to become profitable. Third-party call centers may offer to verify the benefits of potential patients and then refer qualified patients to the treatment center chosen by that third party. It is up to treatment centers to research and understand the laws in their state regarding such an arrangement.
Fortunately, there are many legitimate, highly credentialed drug and alcohol treatment centers that can also be found online or by referral from a trusted source. These are facilities employing highly trained, truly compassionate, credentialed staff, utilizing proven therapeutic protocols with successful track records.
Severe penalties for patient brokering in Florida
Florida’s Patient Brokering Act (PBA), statute § 817.505, was originally enacted to prohibit patient brokering and split-fee arrangements with health care providers or facilities. The PBA makes it illegal for providers or facilities to “offer or pay a commission, benefit, bonus, rebate, kickback, or bribe…or engage in any split-fee arrangement…to induce the referral of a patient or patronage to or from a health care provider or health care facility.” Violators may be convicted of a first, second, or third-degree felony, and fined from $50,000 to $500,000 per violation.
To clarify coverage and ensure the PBA applies to both private insurance and federal health care programs, HB369 was approved by Governor Ron DeSantis this year. The bill also broadens criminalization of practices that were previously unclear or considered exempt.
How to avoid the patient brokering trap
There are many ways those seeking addiction treatment services can ensure a facility is reputable. If the answer to some or all of the following is “no”, it’s best to search for other facilities that fit the criteria. Ask or research the following:
- Are they licensed? Call the State’s licensing office to see if the facility is licensed, registered and certified by your local health department. The license should be on display at each facility.
- Are they accredited by the Joint Commission? The Commission is an independent, not-for-profit organization that accredits and certifies health care businesses and programs nationwide to ensure they meet quality and performance standards.
- Is the company name listed with the state? For Florida businesses, check the Florida Department of State Sunbiz.org website to search Florida business names.
- Does the website list staff names, bios, and credentials? If yes, perform a Google search on staff names for additional information.
- Always ask for a site visit/tour of the facility, prior to admission.
Sara Howe, the public policy chair of the National Council for Behavioral Health, adds some additional questions to ask when seeking a local addiction treatment center that will best meet the addicted person’s needs. In her video, “How to Find a Reputable Addiction Treatment Provider,” she gives some great tips on what to ask any treatment provider you’re considering.
She highly recommends talking directly to the potential treatment provider to get the following answers and information:
- What services and programs are offered?
- Do you have outcomes? What do they mean?
- What evidence-based programs and approaches do you use?
If you or a loved one needs treatment, start by talking to your doctor or another health care professional you trust. They can provide resources or referrals to give you some direction. Check legitimate sources like the Substance Abuse and Mental Health Services Administration (SAMHSA), a division of the U.S. Department of Health and Human Services, to find the best and closest treatment center to fit your needs.
Turning Point of Tampa’s goal is to always provide a safe environment and a solid foundation in 12-Step recovery, in tandem with quality individual therapy and groups. We have been offering Licensed Residential Treatment for Addiction, Eating Disorders and Dual Diagnosis in Tampa since 1987.