There are even cases of addiction centers applying for insurance for a patient who is unaware the center is doing so. Despite these laws, drug rehab fraud is still occurring, and health insurance companies are spending additional time and resources sifting through legitimate and illegitimate claims.
Full Answer
Are drug rehab centers losing millions due to fraud?
Health Net reports that due to widespread fraud at drug rehab centers in California and Arizona, they have lost tens of millions of dollars and have had to pass the costs on to individuals in the way of higher premiums.
Will drug rehab fraud affect your insurance premiums?
Health Net reports that due to widespread fraud at drug rehab centers in California and Arizona, they have lost tens of millions of dollars and have had to pass the costs on to individuals in the way of higher premiums. If it hasn’t already affected your insurance premium, it may be coming.
How do addiction treatment centers take advantage of insurers?
Another way disreputable addiction treatment centers have skirted the laws and taken advantage of insurers is by patient brokering. Patient brokering involves hiring sales agents to convince prospective clients into traveling to a certain rehab facility. The sales agents get a kickback for each client referred.
Why was Health Net sued by drug and alcohol treatment centers?
Health Net was sued by nine drug and alcohol treatment centers last year for delayed or incomplete payments for policyholders’ addiction treatment. The nine treatment centers claim Health Net improperly withheld funds from virtually all drug addiction rehab facilities in Arizona and California.
As seen in a Roman epigram: A case of fraud?
Surprisingly, insurance fraud is not a new thing–in fact, it may even be as old as the stone statues built by the previous civilization. As seen in an epigram by the Roman poet Martial, there is a clear evidence that insurance fraud dates back to the old ages of the Roman Empire:
What about fraud in addiction centers?
Although the schemes are different, the crimes are identical. Now, many “treatment centers” are under the fire after reports of issues on patient brokerage. Susceptible individuals who have insurance polices may be encouraged by fake treatment centers to seek their rehab services, often receiving nothing in return.
Government crackdown on rehabilitation insurance fraud
In 2017, the US House Committee on Energy and Commerce held a meeting regarding substance abuse patient brokerage. The meeting was aimed to stop the profit-focused status of many rehabilitation centers and bring awareness to insurance fraud.
Understanding the signs of fraudulent treatment centers
With the increased offense toward insurance fraud in the drug rehabilitation business, CAIF and other non-profit organizations are partnering with each other to promote awareness among patients considering treatment.
Who is the defendant in the sober homes case?
Defendants Kenneth Chatman, Bonds, and Davis referred the sober homes’ residents who had insurance to treatment centers owned by Kenneth Chatman but titled in the name of Laura Chatman. These treatment centers purportedly offered clinical treatment services for persons suffering from alcohol and drug addiction.
How long was Stefan Gatt in jail?
Stefan Gatt, 27, of Deerfield Beach, was sentenced to 18 months in prison, to be followed by three years of supervised release. The defendants previously pled guilty to one count of conspiracy to commit health care fraud, in violation of Title 18, United States Code, Section 1349. Davis also pled guilty to one count of managing, leasing, ...
What are the problems with federal hand out programs?
One of the problems with federal hand-out programs is that individuals take advantage of them and scam artists outright loot them. Monday, June 3, 2019. Politics Obamacare Health Care Fraud Drugs Addiction. One of the problems with federal hand-out programs is that individuals take advantage of them and scam artists outright loot them.
Who looted the Obamacare?
Daily Beast writer Evan Wright has the appalling story of Christopher Bathum, who looted addiction-treatment funds made available by the Obamacare law. The law required addiction-treatment funding by Medicare, Medicaid, and private insurance companies. Addiction is, of course, a huge problem, but to me, Wright’s article indicates ...
When did the Affordable Care Act go into effect?
The Affordable Care Act made sweeping changes to the recovery industry, which went into effect in 2012. After decades of denying coverage, insurance companies were required to pay for treatment, and at rates comparable to coverage for major illnesses.
Did Bathum overdose?
There was a photograph of Bathum being loaded into an ambulance during his overdose. Aron unearthed a lawsuit filed by a former patient from Seasons in Malibu who claimed Bathum offered her drugs in exchange for sex. Patients from Community Recovery stepped forward to say Bathum had sexually assaulted them.
What states are Blue Cross billed for fraudulent enrollment?
Among the Blue Cross plans hit hardest by the fraudulent enrollments are ones in Pennsylvania, Delaware, and West Virginia.
Who was homeless after a decade of heroin use?
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.
How many people did Hislop say achieved sobriety?
Of the 55 or so people Hislop sent to Florida treatment centers, he said only about 10 achieved sobriety. T he story of Peter SanAngelo, documented in text messages found on his cellphone, illustrates how the insurance scheme works.
Why did Kagiwada pay his insurance premium?
The treatment center, Kagiwada surmised, had paid his premium because it was a drop in the bucket compared with what they could bill his insurance provider. He was getting drug-tested three to five days a week, at hundreds of dollars a sample, he said. He declined to name the center or the broker.
What is a patient broker?
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.
Is it legal to sign up for insurance with fake addresses?
Hislop said it was the marketers and brokers in Florida who advised him that signing people up for insurance with fake addresses was legal, and brokered patients said that treatment center staff either ignored obvious signs of fraud or helped perpetuate it.
Is Highmark Blue Cross Blue Cross out of state?
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.
How much did John Chatman defraud insurance companies?
Chatman and his associates defrauded insurance companies of an estimated $24 million between 2013 and 2016. Chatman and his wife, Laura, lived a luxurious life thanks to their fraud proceeds, living in a $1 million home and driving high-end cars.
Why was John Chatman not allowed to own a treatment facility?
Chatman was legally able to have the several sober homes that he owned and operated, but he was not allowed to own a treatment facility because he was a previously convicted felon, having served time for credit card fraud.
How long was John Chatman in jail?
Last year, Chatman pleaded guilty to conspiracy to commit health care fraud, money laundering, and sex trafficking and was sentenced to 27 and a half years in prison.
How many people died in Chatman's sober home?
Yet the toll on the sober home residents was even worse than the financial crime. Some of the more than 2,000 residents who lived in Chatman’s facilities died of overdoses. He also forced some of the women into prostitution, giving the addicted women drugs and then withholding those drugs if they would not comply.
Do sober homes have to be licensed?
The resident pays rent, and the landlord provides a place to live—but not actual treatment. In general, sober homes consist of communities of people who agree to live together in a drug-free environment. A drug treatment facility, however, is much more proactive and offers medical treatment, so it must be licensed.
How much did Cesario and Cooper pay for Tricare?
The foundation, however, was funded entirely by payments from Cesario and Cooper, or business accounts they controlled, and from November 2014 to June 2015, they paid approximately $2.8 million to the foundation, the majority of which was used to pay TRICARE beneficiaries and doctors.
Who owns FW Medical Supplies?
Defendant Kuper owned and operated FW Medical Supplies LLC, a compounding pharmacy in the TRICARE network that was located in Burleson, Texas, that did business under the name Dandy Drug. Dandy Drug paid kickbacks to Cesario and Cooper in exchange for referring prescriptions to them.
as Seen in A Roman Epigram: A Case of Fraud?
What About Fraud in Addiction Centers?
- Although the schemes are different, the crimes are identical. Now, many “treatment centers” are under the fire after reports of issues on patient brokerage. Susceptible individuals who have insurance polices may be encouraged by fake treatment centers to seek their rehab services, often receiving nothing in return. These fraudulent centers collect the money from the insurance…
Government Crackdown on Rehabilitation Insurance Fraud
- In 2017, the US House Committee on Energy and Commerce held a meetingregarding substance abuse patient brokerage. The meeting was aimed to stop the profit-focused status of many rehabilitation centers and bring awareness to insurance fraud. According to CEO and President of Caron Treatment Centers Douglas Teiman, he was “deeply troubled by the unethical practices in …
Understanding The Signs of Fraudulent Treatment Centers
- With the increased offense toward insurance fraud in the drug rehabilitation business, CAIF and other non-profit organizations are partnering with each other to promote awareness among patients considering treatment. Some of the most common signsto look out for suspicious rehab centers are: 1. Unsolicited messages in text or social media by recruit...