Patient brokering: a festering wound for recovery community


The young addicts flocking to South Florida can be spotted easily. Some just relapsed, walking hangdog down the street with their luggage in tow.

Or they gather smoking cigarettes in front of 12-step meetings, at favored coffee shops or the Western Union at the Walmart — waiting in the parking lot for cash wired from Mom and Dad to arrive.

They often travel in the white unmarked vans of their sober home, stopping en masse for supplies at convenience stores.

For the junkie hunters, they make easy marks.

Each recovering addict with a health insurance policy they can nab for a sober home can net these so-called body brokers up to $500.

They offer addicts free housing, transportation, maybe a Publix gift card, a cell phone or gym membership. If you are lucky an Xbox or cold cash will be offered. For others, there is a promise the addict can keep using drugs.

This is patient brokering. It’s highly illegal. And it is Palm Beach County’s $1 billion recovery industry’s dirty little secret, an infected wound on a growing community of addicts struggling to heal.

Patient brokering starts at that treatment level and that is where State Attorney Dave Aronberg struck last week when he announced the arrest of the CEO and an operations consultant at Whole Life Recovery in Boynton Beach.

The news spread like a shot around the recovery community.

“We are ecstatic,” said John Lehman, president of the Florida Association of Recovery Residences, or FARR, a nonprofit group overseeing the voluntary certification of sober homes for the state.

“Having actually taken definitive action to arrest two guys who were participating in this crap sends a very loud message that law enforcement has arrived.”

Some sober homes supply the people for intense outpatient programs — or IOP — at recovery centers that charge the insurance companies fees for drug urinalysis testing that garners millions of dollars.

To keep the supply of urine coming, the sober homes started paying junkie hunters to find addicts to funnel to outpatient therapy for drug testing at treatment centers.

The Post reported that one addict’s insurance company paid $5,600 for every drug test and $1,075 for every session of intensive outpatient treatment, both of which occurred three times a week. One addict with similar insurance could bring in nearly $120,000 in three months.

Cigna pulled one of its health-care policies favored by addicts because of concerns about fraud tied to excessive and unnecessary drug tests. A spokesman for the insurance company did not return a phone call for comment.

It is a third-degree felony for a Florida health care provider to offer a kickback — be it called a commission or bonus — to induce the referral of patients. Those sober homes and treatment centers engaged in patient-brokering could care less if a young addict uses drugs or not, Lehman said.

“The only thing they want is for that kid to remain in the program so they can bill the insurance company for as many days as the insurance company will pay for services,” he said. “We have that going on systematically throughout Palm Beach County.”

All of this occurs as a backdrop to the growing number of addicts overdosing — sometimes in suspect sober homes — from heroin laced with the powerful opioid painkiller fentanyl.

“That is one of our primary concerns in this whole mess: kids are dying in these so-called sober homes,” Lehman said.

‘Zero Chance’

How low will some of these sober homes go to cash in on addicts?

Justin Kunzelman, who co-founded Rebel Recovery, a nonprofit that reaches out to struggling addicts, said patient brokers infiltrate drug detox units as patients to troll for new residents.

“This poisons the idea of the true treatment center,” he said. “So in this person’s mind, this addict’s mind, the first time they sought help, they were betrayed. Now they have zero chance.”

What is worse is that the struggling addict has just been taught an easy way to make a buck to feed his addiction. “You have just bred another patient broker,” Kunzelman said.

Gene Sullivan, chief financial officer and executive director at A New Start Inc. in Palm Springs — whose sober homes are FARR-accredited — said just Thursday a competitor poached one of his patients by offering her $25-a-week rent if she went to another center. He said patient brokers often dangle co-ed sober homes where rules are lax.

“The client brokers come and say all you have to do is pee in this cup, we will buy you food, buy you cigarettes,” Sullivan said. “The game plan is get these people who are early in recovery, vulnerable and will relapse. Relapse is good business for these flop houses.”

The reason is that insurance companies will often approve a higher level of care if an addict relapses, meaning more money for all involved, he said.

Insurance companies, though, are getting wise, he added, and are refusing to reimburse treatment centers — both the good and the bad.

“Right now this is casting shade over the entire industry,” he said. “It is making it harder for ethical places to provide good treatment.”

‘Everyone is dying’

Emily Isaac knows first-hand how the bad sober homes work.

While a resident at a sober home in Delray Beach, she said she was subject to unnecessary drug tests and put on the street the minute her insurance policy ran out, she said. The sober home was raided by the FBI in 2014 and closed down.

Isaac — who works a 12-step program to remain clean and sober — tried to draw attention to the issue last Halloween, dressing up as a patient broker, mocking the junkie hunters she had seen lingering outside of meetings. “It had to become a joke because nobody knows what to do about it,” Isaac said.

Patient-brokers preying on addicts got so bad on Atlantic Avenue in Delray Beach this year that Starbucks near Federal Highway removed its outdoor seating. Isaac said the junkie hunters seemed to have moved on from bustling Atlantic to target addicts in other ways, such as on Facebook or in big box store parking lots.

Even good treatment centers may fall prey to patient brokering to survive in a sea of competing recovery centers and sober homes.

“After a few years of watching kids use their insurance cards like credit cards while the rest of Delray Beach kicks back and jokes about the level of chronic relapse, I’m seriously open to suggestions,” she said.

“These two things are kind of going in parallel and everyone is dying,” Isaac said.

Inevitable relapse

Those on the front lines battling the illness that is addiction say patient brokering is a cancer that threatens the very nature of recovery. Young adults trying to stay sober end up in the hands of patient brokers who shuffle them off to flop houses where their health — their lives — are not as important as the insurance money. Inevitably, relapse occurs.

Jennifer Flory told State Attorney Aronberg’s Sober Homes Task Force this month that her 24-year-old daughter Allison was getting paid $350 a week in exchange for going to a specific treatment center that provided a sober home. She died there from an overdose.

“She said she was lucky to find a home where she could go, and she didn’t have to pay rent so long as she went to IOP,” Flory said.

Lehman said legitimate sober homes and intensive out-patient programs are expensive, but parents of addicts ask why should they spend big money when they are being bombarded with e-mails offering free room and board and other perks if they send their kid to a particular program or sober home.

“The answer is: It’s illegal,” he said. “That is why what Aronberg did on Tuesday is so incredibly important.”

Lehman banged the drum loudly about this dance between unethical sober homes and recovery centers. There were two FBI raids and programs shut down, but no arrests. Those in the recovery community took to facebook and blogs to excoriate suspected bad actors.

The Palm Beach Post, in its ongoing series Addiction Treatment: Inside the Gold Rush, exposed how urine tests rake in millions.

Case management

Patient brokering is not common in the medical field except when it comes to alcohol and drug recovery.

In 2003, state officials arrested five Miami residents who operated a dental clinic in Orlando for receiving more than $715,000 in a Medicaid scam involving poor children. Patient brokering was among the numerous charges.

The police reports on the arrests last week show how the inducements work on the business side. While CEO James Kigar signed the checks for the so-called patient broker, the point man was operations consultant Christopher Hutson.

Hutson tried to disguise the alleged patient brokering as case management fees, the reports said.

Hutson had been sentenced in 2011 to five years for his role in a $40 million pill mill operation. Now documents show he was working the other end of the epidemic he helped start: recovery.

Lehman said he is not surprised. Scamsters who made a mint on pain clinics trafficking in pills, sub-zero mortgage loans and even time shares have found a home scamming insurance companies and addicts in the recovery industry.

Investigators set up a confidential informant who ran a sober home with a wire. Hutson, who paid the informant $400 apiece for sending sober home tenants to Whole Recovery, asked how much the informant got paid elsewhere, according to the police reports.

Wire taps caught Hutson, according to the police reports, balking at paying the going rate for patient brokers of $500 a head.

What may concern unethical sober homes and recovery centers is not so much the arrests, but the fact that a confidential informant was used. Lehman said law enforcement won’t have any problems leveraging others to wear wire taps.

Kunzelman, though, worries about how patient brokering has added another barrier to get clean for the new generation of heroin addicts whose next relapse may kill them.

He recalls receiving a phone call recently at 3 a.m. The young addict on the phone was desperate. He needed to be picked up in the parking lot of a McDonald’s restaurant. He needed to go to detox.

So after leaving his wife and young child at home, Kunzelman picks up his caller and the first thing the addict asks as he climbs into the front seat: “How much are you getting paid to be here right now?”

“The worst part of it is that they feel nobody has altruistic motives,” Kunzelman said. “How can you accept help if you can’t develop a trusting relationship?”



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