Addiction treatment initiatives won't succeed without a closer eye on fraud

The addiction treatment industry is at a crossroads.

A major spike in opioid addiction has pushed the industry into the eye of a storm that appears to be getting larger and more unmanageable by the day. More than 47,000 people died of drug overdoses in 2014, according to the Centers for Disease Control and Preventino. Nearly 30,000 of those deaths were linked to opioid analgesics or heroin. Deaths tied to prescription pain medication have doubled over the last decade, reaching a rate of 5.9 deaths per 100,000 people.

In February, President Barack Obama's 2017 proposed budget included $1.1 billion in new mandatory funding to expand access to drug addiction treatment. On Tuesday, the President traveled to National Rx Drug Abuse & Heroin Summit in Atlanta to unveil new plans to combat the opioid addiction epidemic. 

The president's landmark healthcare legislation has already addressed substance abuse treatment. Since 2014, the Affordable Care Act requires plans sold on health insurance exchanges to include services for substance abuse disorders. Federal law requires insurers to cover drug and alcohol addiction like any other medical condition, although insurers have occasionally found ways around that law.

On the other hand, corruption and fraud appears to be firmly rooted in the foundation of the industry. Although providers are actively fighting this growing perception, evidence is mounting that the industry is overrun with kickbacks, marketers and bribery.

Last week's investigative piece by Buzzfeed News outlined some of the issues that plague addiction treatment providers in Florida, including reports that marketers routinely provide recovering addicts with money to purchase drugs in an effort to get them re-enrolled in treatment programs.

Sadly, this is not the first time this issue has surfaced. The article echoed issues raise in a New York Times investigation into "three-quarter" houses, where recovering addicts were provided free housing as long as they attended certain outpatient treatment programs and often persuaded to relapse. Last year, the government filed claims against New York City-based Narco Freedom for a similar scheme. In October, the nation's largest drug testing lab paid $256 million to settle claims it billed Medicare for unnecessary testing.  

Two overarching themes appear throughout all of these stories. First, it's clear that the substance abuse industry is largely unregulated, and fraud enforcement seems low on everyone's list of priorities. That's likely to change with more than a billion dollars poised to infiltrate the industry, as proposed in Obama's budget.

Second, although the addiction treatment industry is positioned to help an extremely vulnerable patient population, it appears that vulnerability is also at the heart of these fraud schemes.

This is an age-old approach to healthcare fraud, and an easy one since most people in the healthcare system are vulnerable in one way or another. Look back at any of the major fraud schemes and you'll see a similar theme. Power wheelchair fraud schemes targeted the elderly, enticing patients with blenders and other free gifts. A Detroit oncologist preyed on patients who thought they had been diagnosed with cancer, using his medical credentials to pump people full of chemotherapy drugs they didn't need. A California hospital owner orchestrated a massive spinal surgery scheme directed at residents with debilitating back injuries.

Now, fraudsters use addiction as a convenient tool. Fueled by greed, marketers see a recovering addict as an ATM just waiting to spit out money. Fighting a powerful disease and the stigma that accompanies that, addicts are repeatedly chewed up and spit out by corruption that has infiltrated the system.

Expanding addiction treatment services is long overdue. Now that the opioid addiction epidemic is frighteningly large, payers, providers and the government are coming together in search of solutions. Often, those solutions lead to notable progress. As is often the case, more money will lead to more success stories.

But as the government makes addiction treatment more accessible, and injects the industry with an influx of cash, it better be prepared to at least take a look at the industry's corrosive underbelly. Failure to address these fraudulent practices will negate the impact of any new approaches to addiction treatment, offering a larger cash grab for fraudsters and making an already defenseless patient population even more vulnerable. - Evan (@HealthPayer)