KICKBACKS FOR ADDICTION TREATMENT PATIENTS

Art Reflects Life: New Film Body Brokers Explores the Dark Side of Finder’s Fees for Treatment Patients

Unethical treatment providers are exploiting vulnerabilities to take advantage of families and addicts desperately looking for help. The three key ingredients:

  • Infusion of cash (from parents and insurance)
  • Inadequate regulation
  • Vulnerable patients

With 22 million Americans struggling with addiction and alcoholism, and many often seeking help in a crisis with little information as to effective treatment, it is easy to see how this population can be manipulated by providers maximizing profit over service.

A recent article in Counseling Magazine, “Breaking the Body Brokers[i]” discusses California’s reform measures to restrict these predatory practices. Examples include selling addiction placement patients and paying people to relapse to reenter treatment. Other forms include providing housing and transportation to enroll in a center, and referral fees and financial relationships between drug testing labs, outpatient and housing entities.

  • A seamy, sordid business too many families and their loved ones have been caught up in, leading to failed treatments and despair at ever recovering.

These are evil people, by the way – making money while our addicted family members and friends suffer and die.

The Film

A recent film, Body Brokers, captures the reality of this patient exploitation in ways that will turn your stomach and break your heart. Fortunately, California passed legislation restricting these practices. But few other states have acted, meaning that you as the consumer are still subject to the many tactics used to separate you from your money while duping you into believing your loved one is receiving excellent inpatient or sober housing care.

Isolating You From You Addicted Loved One

One problem is separating the addict from his/her family and other support systems. Once that happens, your loved one is open to exploitation because there is no one to be accountable to and the system lacks effective regulatory oversight. People who say, “I’ll take care of everything” or “It’s not your role to tell the addict where to go to treatment,” are to be avoided.

  • Not only is family involvement the key to long-term recovery, but also the key to minimizing exploitation by treatment providers.

Keep this in mind as a first warning sign: Is your helper fully informing and including you in the entire evaluating and treatment selection process?

Common, Less Visible Referral Transactions

Pay Interventionist/Patient Finder (IPF) a Lump Sum for Treatment

In this scenario, the family pays the IPF a lump sum to cover both the intervention and treatment, say $50,000. The IPF then brokers the patient to the treatment center giving the lowest price for treatment and pockets the difference.

Quid Pro Quo

The IPF refers the patient to a treatment center with the treatment center referring the patient back for post-treatment services such as phone counseling and drug testing. Common practice now among high-end centers. 

Client experience: Family member goes to treatment from affluent family with several tricky financial issues. Treatment center sends the family member to their preferred aftercare provider who does not understand or address financial concerns. Plus, the level of service is less than needed to support recovery. End result, relapse with the family member refusing to agree to further help.

IPF Receives Referral Fee

Client experience: I was once called by a family whose adult son was in treatment at a beach resort treatment center that did not consider addiction to be a primary disease and instead were focusing on mental health concerns. He had a previous alcohol dependency diagnosis. How did the son select this center?  On the advice of the IPF.  I strongly suspected a referral fee was paid because there was no clinical reason for selecting this center.

IPF Gets Referrals Based on Patients Delivered

The treatment center gives more referrals to IPFs who provide more patients. Callers to treatment centers are given the names of IPFs who send the most patients to the center.

Web Internet Treatment Center Resources

Searching for addiction treatment on the web often leads the searcher to sites that pay to be promoted on search engines. These sites often are owned or run by the same group who then refer the caller to treatment centers that pay fees for these potential clients.

Remember The Basics

Standard Required Practices for Admission for Treatment

Many IPFs do not follow standard protocols required by regulations and professional standards for admission to inpatient treatment because doing so might likely dictate a less drastic alternative to such care. Plus, many IPFs are not qualified or licensed to apply these protocols. To be blunt, their goal is to send the patient (your loved one) off to treatment without determining if inpatient treatment is needed or the best option.

Diagnosis of Substance Dependence

Use the DSM-V criteria for the substances in question and assess the degree of the disorder, with three levels: mild, moderate and severe. A mild diagnosis usually does not warrant inpatient treatment.

Applying ASAM Placement Criteria

The American Society of Addiction Medicine has developed six criteria for evaluating the level of care, including inpatient:

  • Acute Intoxication and/or Withdrawal Potential
  • Biomedical Conditions and Complications
  • Emotional, Behavioral or Cognitive Conditions and Complications
  • Readiness for Change (Is the patient willing to go in-patient?)
  • Relapse, Continued Use or Continued Problem Potential
  • Recovery/Living Environment

These standards are used in deciding whether or not an addict needs to be treated as an inpatient or in the community.

As noted in a past blog, many treatment centers admit patients without going through any evaluation as to level of care or diagnosis. Avoid these centers. I also wish to remind readers that the authoritarian model prevalent in the addiction field is based on the idea that addicts and alcoholics need to be told what to do and their preferences ignored. Thus, families who only know this model, are vulnerable to sales pitches promoting in-\patient treatment over the objection of their loved ones needing help but wanting to try alternatives.

No Oversight – No Complaint Process – No Accountability

An additional super significant concern about working with patient finder/interventionists is that many are not subject to oversight by any regulatory bodies. This means that when the IPF engages in unethical behavior or provides incompetent services, there is no one to complain to.

What happens is that IPF and AA sponsors/members use their access and interactions to develop a relationship with your family member in early recovery.

  • Then they use that relationship to exploit and take advantage of your loved one: sexual, economic or psychological abuse are not uncommon for our affluent loved ones.

The only recourse is to sue the IPF or sponsor. Few loved ones are in a position to do so and most families are too embarrassed to consider litigation, or they buy into the message that their loved one is at fault. Exploitation is a real danger and another reason to find professional help.

Resources for Professional Help

As emphasized, do not call a treatment center or interventionist or look on the internet for help. You will likely be caught up in this patient brokering, referral fee network that places making money at a much higher priority than patient well-being. And do not call your friend or friend of a friend in AA. Not only are AA recovery rates low, but you need professional help. AA members tend to think their way is the only way to stay clean and reject concepts related to successful recovery management programs.

Professional resources include the following suggestions to find help for your family.

  • Use your Health Care Insurance and Call for a Referral to a Qualified Counselor
  • Network of Independent Interventionists (NII)
  • NAADAC Credentialed Counselors
  • ICRC – International Certification and Reciprocity Consortium
  • American Society of Addiction Medicine (ASAM) providers
  • Physicians Health Programs (PHP)
  • O’Connor Professional Group (OPG)

While I provide a short description and website reference below to most resources, my strong preference for the well off and well known is OPG. Next choice is to find an ASAM physician as they are used to working with a more affluent clientele. Remember the goal is obtaining help for you and your family and to come up with a plan to address your LO’s substance abuse.

1. Use your Health Care Insurance and Call for a Referral to a Qualified Counselor

This is the best option for families that cannot afford specialized help for their families. Use your insurance and find a counselor to help you and your family. For wealthier families there are better alternatives because many counselors do not understand the unique dynamics of affluent families.

2.  Network of Independent Interventionists (NII)

These interventionists are credentialed and independent of treatment centers. For example, the fourth of their policy guidelines for members is:

4th: Being independent of treatment centers means that the interventionist has no financial ties to any residential treatment center through employment, retainers, or through any other arrangement that could render the interventionist partial or biased towards them.

While there are not members in every state, most members will travel to meet you. And their approach to interventions is more oriented towards engaging the person with a problem in the process, rather than the “quickie” type of intervention. Also, note that most members also provide family counseling and can help you manage your loved one’s recovery journey.

3. NAADAC Credentialed Counselors

National Association for Alcoholism and Drug Abuse Counselors has different classes of counselors based on their educational degrees, experience and training.  The various categories are listed on the NAADAC website.  

For example, see the following credentialing criteria for a “Level One Counselor”

National Certified Addiction Counselor, Level I (NCAC I)

  • Copy of GED, High School or higher diploma or transcript.
  • Evidence of current credential or license as a Substance Use Disorders/Addiction Counselor or Professional Counselor (social worker, mental health, marriage & family therapist or LAP-C) issued by a state or credentialing authority.
  • Written verification of competency in all skills groups by a supervisor or other health care professionals who have personally observed the candidate’s Substance Use Disorders/Addiction work for a total of three years full-time or 6,000 hours.
  • Evidence of 270 contact hours of education and training in Substance Use Disorders/Addiction or related counseling subjects.
    • Must include at least six hours of ethics education and training within the last six years.
    • Must include at least six hours of HIV/other pathogens education and training within the last six years.
  • Submission of a signed and dated statement that the candidate has read and adheres to the NAADAC/NCC AP Code of Ethics.

Did the interventionist you were referred to meet these standards? How about that AA friend of a friend? Likely not.

4. International Certification & Reciprocity Consortium

IC&RC is an organization that is made up of state and international boards that approve credentials and oversee examinations to make sure counselors meet minimum standards in their profession. Working with a counselor or other recovery specialist with an IC&RC certificate assures the client that the prospective counselor has been IC&RC standards.  See their website for a list of State Certification Boards.

5. American Society of Addiction Medicine

Find a certified addiction medicine provider. Go to the ASAM website. I like ASAM because the professionals can work with your family on an individual basis.  For example, a family business looking for help for a family member. Our local ASAM certified doctor offers an evaluation for under $500 dollars private pay. No insurance records. No hoops.

6. Physicians’ Health Programs (PHP)

Almost every state has a PHP program for addicted health care professionals. Some state programs sometimes will take on non-physician clients.  If not, they often are good sources for referrals to qualified professionals who are able to assist families. 

  • These programs use the concept of “leverage” – using the license to practice medicine as the incentive for doctors to comply with treatment recommendations.

Therefore, practitioners should be helpful in using access to family resources as leverage to achieve the same end with your loved one.

See https://www.fsphp.org/state-programs for a list of state program offices.

7. O’Connor Professional Group, Inc (OPG)

Founded by Arden O’Connor after her brother had been through 20+ treatments, OPG works with families to develop effective strategies to encourage loved ones to seek help. OPG has a wide variety of recovery resources, including case management and companions for people in early recovery or struggling to quit using. And OPG keeps up to date on treatment centers in order to try and make a good match for clients. Well worth the price for an initial consult. OPG offers services throughout the U.S. and overseas.

Concluding Thoughts

These seven resources for professional, credentialed help for you and your family are credible, viable alternatives to the predominant patient finder/interventionist system with its focus on making money and resultant high relapse rates. You can and must do better. It may take a little more digging on the web for some of the resources, but it is well worth the effort, given the stakes.


[i] Counselor Magazine, June 2021

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