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'Body Brokers' Get Kickbacks to Lure People with Addictions to Bad Rehab

167 points by Mz 9y ago

javajosh 9y ago
Glad to see this problem getting visibility. I worked briefly for a rebilling company that specialized in rehab centers in SoCal. With the right billing codes, those places could pull incredible incomes.
- deleted 9y ago
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hn_throwaway_99 9y ago
I'm not particularly religious, or superstitious, but I have to believe there is a special place in hell for those that would prey on the sick like this.
- alexanderstears 9y ago
  There's a special place on Earth too: private beaches.
chefandy 9y ago
Been going on in Boston for a few years.
- eropple 9y ago
  Can you substantiate this? I have some friends who would be interested in this if you can.
Mtinie 9y ago
In theory, it should be straightforward to validate if a halfway house is legit or not. Professional help offered generates fees through insurance charges which means income for the businesses that can be traced... ...so why am I so cynical about being optimistic for an actual consumer-beneficial outcome in cases like these?
- ingenuous2 9y ago
  It turns out, it's very hard to determine "legit" or not. Standard of care has not permeated much of the AA/NA [edit: treatment] culture. This is a heavily stigmatized group of people who frequently do not have the response reactions you or I might. Insurance companies like scans from MRI tests, not reports written from mental health consultants. These are some of our most vulnerable people. We need to take care of them. It's less competitive as a business to do so. [edit - like much of mental health issues, 'success' is difficult to define, so outcome based measurement is difficult.]
  - honestoHeminway 9y ago
    It actually is. Request treatment documentation. If they screw that up, they will screw up treatment.
  - Mtinie 9y ago
    Thank you for the response. In your opinion, in the facilities such as those discussed in the article and ones like them, would physical inspections address the more egregious cases? Are run down facilities, lack of sanitation, etc., enough to add a location (and operators) to an interstate "do not process insurance claims" blacklist? More regulation isn't the answer for everything, certainly, but as you stated, we are talking about exceptionally vulnerable people. Or is the stigma of addiction and mental health issues the root cause? Would this type of regulatory pressure be DOA because regulators, as people themselves, often believe addiction is a moral failing and not a health consideration?
    - ams6110 9y ago
      Who would do the inspecting? How do you qualify them? Who pays for it? How do you prevent bribes/payoffs?
rdtsc 9y ago
> billed insurance companies for more than $58 million in bogus treatment and tests, and recruited addicts with gift cards, drugs and visits to strip clubs. That is a special kind of evil. I hope they are some harsh penalties involved. I think it is fair to judge a society by how it treats most vulnerable and marginalized individuals. I don't think we are doing very well there by that metric.
- ingenuous2 9y ago
  I agree with you. But there are competitive advantages in a cutthroat industry to being unethical, so over time, it's mostly the bad actors that have the fattest margins and can make plenty of money before getting caught. Just like any industry, people accept it because it's just what happens. So busy being a business owner that you cannot afford to be Sheriff.
  - Joeri 9y ago
    You can make this argument for a lot of crimes: bank robberies are lucrative so over time more and more bad actors will become bank robbers. Except that doesn't happen because bank robbers are pursued vigorously. If there's a zero tolerance policy against drugs there should be a zero tolerance policy against people providing bogus care for drug addicts. Just like you can judge a society by how it treats its weak, you can judge it by which crimes it pursues vigorously and which ones it lets slide.
    - deleted 9y ago
      [deleted]
    - icantdrive55 9y ago
      The Medical/Pharmaceutical/"Therapy" have gotten away with too much shenanigans for way to long. They shouldn't get any more free passes on ethics violations. Ethics--yea something that used to exist, or did it? Not in my lifetime. The bastards can do whatever they wish. They can do practically anything. Right now I have one doctor who won't refill my prescription. A drug I have been on for a decade. He can't be bothered? I don't even care anymore. Just know it's all kinda wrong. So since they have been given a free licence to abuse the vulnerable, and uninformed for way to long; they need to pay for their Art of whatever. A good first start would be legalizing all Drugs except antibiotics. If people want to kill themselves by self diagnoses--so be it. I really use to have so much respect for anyone involved in healing professions. Now--they just look like people who want to take my money. Ironically, I wanted to be one of them, but deep down inside knew so much of it was a fraud. (And we all didn't care when the insurance was covering the bill. It's all changed now.)
sgwealti 9y ago
How fucking evil and cold hearted do you have to be to take advantage of addicts. I'm losing faith in humanity.
- ams6110 9y ago
  Humanity is the same as it's always been. There have always been those who will take advantage of whomever they can.
  - westmeal 9y ago
    I think the shittier parts of humanity rear their ugly heads more simply because of population growth.
  - thinkfurther 9y ago
    I doubt that. Early humans had to cooperate and share. They couldn't afford this parasitism. We still can't afford it, but for most individuals it's easier to just let it go rather than to follow them to their nest and smoke them out.
    - WalterSear 9y ago
      Most early humans cooperated and shared because they spent their entire lives surrounded by the same a few hundred people. It's the same today. We still cooperate and share with about a few hundred closest people, and for everyone else, we have capitalism. Whenever the two meet, we shock-horror a bit about the callousness of others, and then we go back to treating everyone outside our Dunbar number as an object to extract resources from. I don't want to suggest that it's biologically inevitable, but that we aren't going to overcome it until we start recognizing the blind spots in our cognition and empathy.
      - thinkfurther 9y ago
        > Most early humans cooperated and shared because they spent their entire lives surrounded by the same a few hundred people. That and, as far as I understand, when they went hunting, only a few get lucky, and those couldn't eat all the meat themselves before it spoiled.
nanis 9y ago
This is the tip of the iceberg generated by mandated coverage of addiction treatments.
- cguess 9y ago
  What are you trying to say? That insurance companies shouldn't have to cover drug treatments? Perhaps, instead, this is an issue with lack of regulation and inspection. Fund treatment, but also fund inspections and required standards (which it seems, according top the article, is finally happening). It's not like health insurance companies don't want to see the treatment work, they make their money when their patients are healthy.
  - njarboe 9y ago
    Under ACA insurance companies must spend 80% of of premium dollars on claims and activities to improve health care quality. 85% in large markets. Sort of like the cost-plus system in defense spending. The company % take remains the same so there is incentive to increase the amount spent. Just jack up the premiums.
    - robbiemitchell 9y ago
      I disagree. The incentive is to spend as little as possible on the remaining %, because sick people already cost a ton as it is. Most insurance revenue comes from non-ACA employer plans, which don't have this requirement.
      - vidarh 9y ago
        It is a general problem with "cost plus" type arrangements though, that really always ought to have clauses to explicitly reward cost-cutting (by letting the provider keep a portion) and sound investments towards better care.
  - nanis 9y ago
    > That insurance companies shouldn't have to cover drug treatments? Insurance is for independent, random risks. It doesn't take a genius to see this coming: Here is a law that says "you get to a lot of money if you 'treat' people. Don't worry, there are really no criteria of success you have to achieve, all you have to do is get addicts through the door. Oh, you have repeat customers? Even better. Here take as much as you want."
josephpmay 9y ago
Basically the plot of Inherent Vice (the move at least)
cperciva 9y ago
Why don't the insurance companies get together and blacklist the "bad" rehab facilities? I mean, insurance companies want their patients to get off drugs, so that they stop costing money, right?
- ams6110 9y ago
  One would think. So perhaps there is some other incentive working against this? I'm not trying to suggest anything; honest question.
  - alexanderstears 9y ago
    There is - Obamacare capped the profit margins of insurance companies. So if you're United Health, you can't really improve your profit margins. And if you cut costs, you can't pass the extra value to shareholders. If you want to give more money to your shareholders, you need more revenue and then more costs and you need to maintain your margin - the extra costs defray the extra money you return to your shareholders. If you spend an extra $65 million on 'rehab' - you get to give more money to your shareholders. Here's what's really bad about it, there's no real expectation that the health care improves. The insurance company doesn't care whether the expensive care is better, it cares that expensive care = more money for shareholders. That's such a perverse incentive it's incredible. Healthcare has become a noose around the neck of America - it's 16% of our GDP and it accounts for about half of all the inflation since 1990. Here's a blog post explaining the mechanism in the ACA: http://thehealthcareblog.com/blog/2012/02/04/does-obamacare-limit-profits-for-health-insurance-companies-in-your-state/ http://thehealthcareblog.com/blog/2012/02/04/does-obamacare-... Here's Martin Shkreli saying that insurance companies make more money off expensive epipens than cheap epipens: http://www.businessinsider.com/martin-shkreli-on-epipen-and-mylan-pricing-2016-8 http://www.businessinsider.com/martin-shkreli-on-epipen-and-...
    - chii 9y ago
      Insurance companies shouldn't be making money on the percentage of healthcare cost! They ought to be making money off their actuarial tables that correctly predict risk and make a small margin off that spread.
exogeny 9y ago
I'm not trying to flippant, I really don't know: how much of this specific case is caused by our completely byzantine and backwards health care system? Or is this more of a case of terrible people, well, being terrible? I would wager this sort of thing is beyond unheard of in a country that has both centralized, state-run healthcare and a progressive attitude towards addiction.
- deleted 9y ago
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- CPLX 9y ago
  All of it. This happens just as flagrantly in other branches of the healthcare system as well, from fraudulent diagnoses in personal injury and accident situations to routine overbilling, to recission. You are correct in noting this isn't a story about drugs at all, it's a story about health insurance.
- 55555 9y ago
  These are drug addicts who largely don't have any savings. They are extremely cash poor. But they are "worth money" because each body can be used to bill an insurance company for outrageous amounts (which, one way or another, we all pay). Without an extremely flawed insurance industry this wouldn't be possible. How else could you make lots of money from people who don't have any?
- deleted 9y ago
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tcj_phx 9y ago
A year and a half ago I had to call emergency services to revive my friend. She'd gotten herself a court order for mental health treatment, and the mental health professionals thought she'd benefit from getting addicted to benzodiazepine anxiety drugs too. She'd only wanted the benzo "as needed", but they made her take the full dose every day. After 6 weeks the helpful effect of the benzo wore off, leaving her with just another addiction. She ordered heroin from her street pharmacist to get her through the benzo withdrawal. I later learned from a HN comment that benzos increase the potency of opiates, so they don't actually go well together... The firefighters did more for my friend with their Naloxone than any of the mental health professionals. Her drinking was under control for about two weeks. Then the naloxone wore off... I think the fundamental problem with current approaches to addiction/rehabilitation is that they mostly view addicts as having had a 'moral failure' in choosing to use 'recreational drugs'. ~80% of rehab facilities use some version of the 12-step program, which is helpful for ~10-15% of people who are addicted to something. I've observed some cases of alcoholism too. It's not very different from street drugs, except every corner store has their vice. About five years ago someone figured out that the brains of alcoholics switch to running on acetate, one of the breakdown products of ethanol. Alcoholism is basically a metabolic problem, as far as I can tell. I found an article by an alternative medicine heretic ~3 years ago that said nerve tissue can run on coconut oil too. I've heard a tablespoon really does help with alcohol cravings. IMHO, it's much more productive to view addiction as self-medicating physical and mental anguish. People who are emotionally stable tend to not get hooked. I was just transcribing the videos my friend made of us frying donuts (in coconut oil), taken two weeks before her first hospitalization. She was doing very well, then she ran out of alcohol & the professionals got hold of her... A very smart woman I know once said, "When a person feels safe, the false ego goes away." Helping people to feel safe is the most important part of all effective drug rehabilitations. Sometimes people need access to their drug of choice to feel safe. It's much better to give them pharmaceutical-grade drugs [1], and wait for them to age out of their addiction, than to train them to be helpless in jail, or help them to feel like failures in a 12-step-based "drug rehab". [1] https://news.ycombinator.com/item?id=14782416 https://news.ycombinator.com/item?id=14782416 - Switzerland gives their most hopeless heroin addicts access to pharmaceutical-grade heroin.
- ThrustVectoring 9y ago
fapjacks 9y ago
Meanwhile, the addiction rehab industry is lobbying hard to make kratom illegal on the state level. Make no mistake, they are sociopaths preying on addicts that will do and say anything to keep them addicted.
qq66 9y ago
I would like to see the organizers of these scams executed, and given the nature of their crimes and their victims, I do not personally believe that this would be cruel or unusual punishment. I know that the Supreme Court would disagree with me.
deleted 9y ago
[deleted]
unixhero 9y ago
Guys. I discovered a sinister rehab clinic in Portugal after an online cry for help was discussed on the Reddit Bureau Of Investigation (yes, it's a real thing, /r/rbi ). It was mentioned that after being "admitted" they were held there against their will. The treatment method was to "break the patient down" and then "build it back up". This clinic is the one which was mentioned. http://novavidarecovery.com http://novavidarecovery.com
- icebraining 9y ago
  Unfortunately, as a Portuguese, that wouldn't surprise me. Do you have a link to the Reddit thread?
  - unixhero 9y ago
    https://www.reddit.com/r/RBI/comments/5utmaz/my_girlfriend_just_called_me_in_panic_to_come_get/ https://www.reddit.com/r/RBI/comments/5utmaz/my_girlfriend_j...
    - icebraining 9y ago
      Thanks. She's young, which fits the profile of the "rehab" houses known to be essentially milking State subsidies while treating the patients as cattle. The girl I knew who spent a few months in one of these could only call her parents, and usually not in privacy. A local news article claims they also treat airline pilots, which should be harder to mistreat, but that was two years ago. Unfortunately there aren't many leads. It's hard to denounce these places without an inside witness.
- fennecfoxen 9y ago
  There was a recent exposé about a chain of mental health clinics in the US which was holding people against their will, again for the insurance and/or Medicaid money. Ah, here it was: https://www.buzzfeed.com/rosalindadams/intake https://www.buzzfeed.com/rosalindadams/intake > A button behind the receptionist’s desk controlled the lock to the front door of the facility, and, she said, “If someone came in voluntarily, I wasn’t allowed to let them out of the door.” > Two dozen current and former employees from 14 UHS facilities across the country told BuzzFeed News that the rule was to keep patients until their insurance ran out in order to get the maximum payment. A criminal probe is ongoing.
amelius 9y ago
Solution: legalization.
- kazagistar 9y ago
  That doesn't solve the need for a safe place where people with destructive addiction to recover. If anything it would make it more important. Hoe do you imagine it would help?
  - amelius 9y ago
    It would help because there would be no incentive to get these people addicted (again).
ada1981 9y ago
Legalize psychedelic therapies. Specifically iboga. I watched a friend who was suicidal and an addict a couple months ago enter into an iboga treatment and the guy hasn't had a smoke or drink since... he looks like a million bucks.. is hitting the gym and talking about "feeling his emotions" and is happily in therapy. This is a dude who has neck tats, was routinely getting into bar fights with skin heads in NYC and is a vet who had pretty severe PTSD. Let's legalize treatments that actually work.
- trcollinson 9y ago
  While I am glad this worked for your friend, or seems to be at the moment, that doesn't actually solve the problem. The problem that this article is pointing out is actually that rehabilitation and treatment centers are money making machines and that some owners of those centers are unscrupulous and unethical at best, and acting completely criminally at worst. By legalizing new treatments you actually cause the problem to get worse, not better, especially if those new treatments lack clinical data and scientific backing. This leaves an open door for desperate people in need to be seduced into treatments that might not help and will cost substantial amounts of money. Many types of treatment do work, and work very well. If someone is in need of treatment, please, do your homework and research and find those people who can really help you.
  - _lex 9y ago
    Seriously - what types of treatment actually work for people addicted to drugs? As far as I know, none of them work ( where working is defined as >50% of people who complete the treatment course being able to move on to lead a normal, drug free life). A lot of them do make a ton of noise though, and several basically lower your expectations from the outset (like AA) - so you treat addiction as a chronic disease: something you'll never be cured of, and have to always deal with. The parent poster seemed to be arguing that iboga can cure addiction. If he's right, this is a big deal.
    - ada1981 9y ago
      My general thesis on this is that "addiction" is really an addiction to dopamine which is triggered by various other things (drugs, sex, booze, power, money, shopping, porn, etc). That dopamine release is the nervous systems attempt to sooth itself when in a state of disregulation. A healthy nervous system in a healthy environment (with attuned caregivers and limited traumatic experience) will equipt a person with the neural pathways (and associated beliefs and behaviors) to regulate their nervous system. In compromised development, either through lack of attunement or childhood / early trauma folks don't have the ability to automatically regulate and they are in a constant state of fight / flight. The dopamine helps to deal with this temporarily. Psychedelics, some therapy, and sometimes near death / mystical experiences (moments of clarity) can offer a window of opportunity in which the ego loosens its grip enough for the nervous system to relax and for the subconscious material (traumas) to come to the surface and be released with the accompanying rewiring of the fight / flight response. When one experiences reality from an undefended state it is generally such a pleasurable, rich experience that the desire to use other mechanisms of self-soothing organically fade away and the cognition and behavior reorient to healthier more nourishing alternatives. These experiences and therapy combined with a healthy environment and relationships that support the honest expression of emotion (ie, not co-dependent) can rapidly support healing. The basic idea is that traumas are trapped in the somatic system and that altered states of consciousness combined with the right context can allow for an unfolding and healing of the underlying issues. Depending on the underlying issue and severity of the defense structures folks may find help with various psychedelic substance from MDMA, Iboga, LSD, Mushroom or Ayahuasca. We also have seen great result using Holotropic Breathwork which was developed as a legal alternative to LSD Psychotherapy. This is essentially the same process I used to heal from bipolar, as I began to see bipolar as an "addiction" to states of depression and mania as a protective, adaptive response. It's also the process I now use with my clients and the underlying philosophy that I bring to the communities that support. If anyone is interested, there is a new book out (published anonymously) that documents accounts of a number of people who have been helped by an underground MDMA therapy practice. (Not specific to substance addiction, but includes some accounts.) https://smile.amazon.com/Trust-Surrender-Receive-Release-Trauma/dp/1619617382/ref=sr_1_1?ie=UTF8&qid=1502907574&sr=8-1&keywords=trust+surrender+receive https://smile.amazon.com/Trust-Surrender-Receive-Release-Tra...
maxxxxx 9y ago
There was a thing on NPR a while ago about billions paid to scam therapy centers. They would prescribe useless therapies to people with chronic back problems and other injuries. Without quality control this happens in every industry.
- Sleeep 9y ago
  Uh! I was once referred by a real MD to a real (licensed) physical therapist who worked in a real physical therapy office who performed a purely quack "procedure" (craniosacral therapy) on me and they billed my insurance for "physical manipulation" which they paid. My insurance specifically excludes craniosacral therapy as a covered expense. Uh,I felt terrible about the whole thing, it seems like a cut and dried case of insurance fraud to me. My MD said she was sending me to physical therapy so I thought I'd be getting real treatment and didn't think about it further. I never heard of craniosacral therapy before that but it was clear that the physical therapist was practicing woo once I was actually there. The worst thing is, since craniosacral therapy claims to treat almost every symptom and every disease she may refer 90% of her patients. :(
  - theEXTORTCIST 9y ago
    Report it anonymously to your insurance provider (*not sure if this is possible and/or would actually do anything)
- enraged_camel 9y ago
  >>There was a thing on NPR a while ago about billions paid to scam therapy centers. They would prescribe useless therapies to people with chronic back problems and other injuries. So... chiropractic?
  - maxxxxx 9y ago
    Much more fraudulent.
  - BenjiWiebe 9y ago
    Funny, I've had very good luck with chiropractors. And no, she actually has never told me to come back.

167 points by Mz 9y ago

Glad to see this problem getting visibility. I worked briefly for a rebilling company that specialized in rehab centers in SoCal. With the right billing codes, those places could pull incredible incomes.

deleted 9y ago
[deleted]

hn_throwaway_99 9y ago

I'm not particularly religious, or superstitious, but I have to believe there is a special place in hell for those that would prey on the sick like this.

alexanderstears 9y ago
There's a special place on Earth too: private beaches.

chefandy 9y ago

Been going on in Boston for a few years.

eropple 9y ago
Can you substantiate this? I have some friends who would be interested in this if you can.

Mtinie 9y ago

In theory, it should be straightforward to validate if a halfway house is legit or not. Professional help offered generates fees through insurance charges which means income for the businesses that can be traced... ...so why am I so cynical about being optimistic for an actual consumer-beneficial outcome in cases like these?

ingenuous2 9y ago
It turns out, it's very hard to determine "legit" or not. Standard of care has not permeated much of the AA/NA [edit: treatment] culture. This is a heavily stigmatized group of people who frequently do not have the response reactions you or I might. Insurance companies like scans from MRI tests, not reports written from mental health consultants. These are some of our most vulnerable people. We need to take care of them. It's less competitive as a business to do so. [edit - like much of mental health issues, 'success' is difficult to define, so outcome based measurement is difficult.]
- honestoHeminway 9y ago
  It actually is. Request treatment documentation. If they screw that up, they will screw up treatment.
- Mtinie 9y ago
  Thank you for the response. In your opinion, in the facilities such as those discussed in the article and ones like them, would physical inspections address the more egregious cases? Are run down facilities, lack of sanitation, etc., enough to add a location (and operators) to an interstate "do not process insurance claims" blacklist? More regulation isn't the answer for everything, certainly, but as you stated, we are talking about exceptionally vulnerable people. Or is the stigma of addiction and mental health issues the root cause? Would this type of regulatory pressure be DOA because regulators, as people themselves, often believe addiction is a moral failing and not a health consideration?
  - ams6110 9y ago
    Who would do the inspecting? How do you qualify them? Who pays for it? How do you prevent bribes/payoffs?

rdtsc 9y ago

> billed insurance companies for more than $58 million in bogus treatment and tests, and recruited addicts with gift cards, drugs and visits to strip clubs. That is a special kind of evil. I hope they are some harsh penalties involved. I think it is fair to judge a society by how it treats most vulnerable and marginalized individuals. I don't think we are doing very well there by that metric.

ingenuous2 9y ago
I agree with you. But there are competitive advantages in a cutthroat industry to being unethical, so over time, it's mostly the bad actors that have the fattest margins and can make plenty of money before getting caught. Just like any industry, people accept it because it's just what happens. So busy being a business owner that you cannot afford to be Sheriff.
- Joeri 9y ago
  You can make this argument for a lot of crimes: bank robberies are lucrative so over time more and more bad actors will become bank robbers. Except that doesn't happen because bank robbers are pursued vigorously. If there's a zero tolerance policy against drugs there should be a zero tolerance policy against people providing bogus care for drug addicts. Just like you can judge a society by how it treats its weak, you can judge it by which crimes it pursues vigorously and which ones it lets slide.
  - deleted 9y ago
    [deleted]
  - icantdrive55 9y ago
    The Medical/Pharmaceutical/"Therapy" have gotten away with too much shenanigans for way to long. They shouldn't get any more free passes on ethics violations. Ethics--yea something that used to exist, or did it? Not in my lifetime. The bastards can do whatever they wish. They can do practically anything. Right now I have one doctor who won't refill my prescription. A drug I have been on for a decade. He can't be bothered? I don't even care anymore. Just know it's all kinda wrong. So since they have been given a free licence to abuse the vulnerable, and uninformed for way to long; they need to pay for their Art of whatever. A good first start would be legalizing all Drugs except antibiotics. If people want to kill themselves by self diagnoses--so be it. I really use to have so much respect for anyone involved in healing professions. Now--they just look like people who want to take my money. Ironically, I wanted to be one of them, but deep down inside knew so much of it was a fraud. (And we all didn't care when the insurance was covering the bill. It's all changed now.)

sgwealti 9y ago

How fucking evil and cold hearted do you have to be to take advantage of addicts. I'm losing faith in humanity.

ams6110 9y ago
Humanity is the same as it's always been. There have always been those who will take advantage of whomever they can.
- westmeal 9y ago
  I think the shittier parts of humanity rear their ugly heads more simply because of population growth.
- thinkfurther 9y ago
  I doubt that. Early humans had to cooperate and share. They couldn't afford this parasitism. We still can't afford it, but for most individuals it's easier to just let it go rather than to follow them to their nest and smoke them out.
  - WalterSear 9y ago
    Most early humans cooperated and shared because they spent their entire lives surrounded by the same a few hundred people. It's the same today. We still cooperate and share with about a few hundred closest people, and for everyone else, we have capitalism. Whenever the two meet, we shock-horror a bit about the callousness of others, and then we go back to treating everyone outside our Dunbar number as an object to extract resources from. I don't want to suggest that it's biologically inevitable, but that we aren't going to overcome it until we start recognizing the blind spots in our cognition and empathy.
    - thinkfurther 9y ago
      > Most early humans cooperated and shared because they spent their entire lives surrounded by the same a few hundred people. That and, as far as I understand, when they went hunting, only a few get lucky, and those couldn't eat all the meat themselves before it spoiled.

nanis 9y ago

This is the tip of the iceberg generated by mandated coverage of addiction treatments.

cguess 9y ago
What are you trying to say? That insurance companies shouldn't have to cover drug treatments? Perhaps, instead, this is an issue with lack of regulation and inspection. Fund treatment, but also fund inspections and required standards (which it seems, according top the article, is finally happening). It's not like health insurance companies don't want to see the treatment work, they make their money when their patients are healthy.
- njarboe 9y ago
  Under ACA insurance companies must spend 80% of of premium dollars on claims and activities to improve health care quality. 85% in large markets. Sort of like the cost-plus system in defense spending. The company % take remains the same so there is incentive to increase the amount spent. Just jack up the premiums.
  - robbiemitchell 9y ago
    I disagree. The incentive is to spend as little as possible on the remaining %, because sick people already cost a ton as it is. Most insurance revenue comes from non-ACA employer plans, which don't have this requirement.
    - vidarh 9y ago
      It is a general problem with "cost plus" type arrangements though, that really always ought to have clauses to explicitly reward cost-cutting (by letting the provider keep a portion) and sound investments towards better care.
- nanis 9y ago
  > That insurance companies shouldn't have to cover drug treatments? Insurance is for independent, random risks. It doesn't take a genius to see this coming: Here is a law that says "you get to a lot of money if you 'treat' people. Don't worry, there are really no criteria of success you have to achieve, all you have to do is get addicts through the door. Oh, you have repeat customers? Even better. Here take as much as you want."

josephpmay 9y ago

Basically the plot of Inherent Vice (the move at least)

cperciva 9y ago

Why don't the insurance companies get together and blacklist the "bad" rehab facilities? I mean, insurance companies want their patients to get off drugs, so that they stop costing money, right?

ams6110 9y ago
One would think. So perhaps there is some other incentive working against this? I'm not trying to suggest anything; honest question.
- alexanderstears 9y ago
  There is - Obamacare capped the profit margins of insurance companies. So if you're United Health, you can't really improve your profit margins. And if you cut costs, you can't pass the extra value to shareholders. If you want to give more money to your shareholders, you need more revenue and then more costs and you need to maintain your margin - the extra costs defray the extra money you return to your shareholders. If you spend an extra $65 million on 'rehab' - you get to give more money to your shareholders. Here's what's really bad about it, there's no real expectation that the health care improves. The insurance company doesn't care whether the expensive care is better, it cares that expensive care = more money for shareholders. That's such a perverse incentive it's incredible. Healthcare has become a noose around the neck of America - it's 16% of our GDP and it accounts for about half of all the inflation since 1990. Here's a blog post explaining the mechanism in the ACA: http://thehealthcareblog.com/blog/2012/02/04/does-obamacare-limit-profits-for-health-insurance-companies-in-your-state/ http://thehealthcareblog.com/blog/2012/02/04/does-obamacare-... Here's Martin Shkreli saying that insurance companies make more money off expensive epipens than cheap epipens: http://www.businessinsider.com/martin-shkreli-on-epipen-and-mylan-pricing-2016-8 http://www.businessinsider.com/martin-shkreli-on-epipen-and-...
  - chii 9y ago
    Insurance companies shouldn't be making money on the percentage of healthcare cost! They ought to be making money off their actuarial tables that correctly predict risk and make a small margin off that spread.

exogeny 9y ago

I'm not trying to flippant, I really don't know: how much of this specific case is caused by our completely byzantine and backwards health care system? Or is this more of a case of terrible people, well, being terrible? I would wager this sort of thing is beyond unheard of in a country that has both centralized, state-run healthcare and a progressive attitude towards addiction.

deleted 9y ago
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CPLX 9y ago
All of it. This happens just as flagrantly in other branches of the healthcare system as well, from fraudulent diagnoses in personal injury and accident situations to routine overbilling, to recission. You are correct in noting this isn't a story about drugs at all, it's a story about health insurance.
55555 9y ago
These are drug addicts who largely don't have any savings. They are extremely cash poor. But they are "worth money" because each body can be used to bill an insurance company for outrageous amounts (which, one way or another, we all pay). Without an extremely flawed insurance industry this wouldn't be possible. How else could you make lots of money from people who don't have any?
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tcj_phx 9y ago

A year and a half ago I had to call emergency services to revive my friend. She'd gotten herself a court order for mental health treatment, and the mental health professionals thought she'd benefit from getting addicted to benzodiazepine anxiety drugs too. She'd only wanted the benzo "as needed", but they made her take the full dose every day. After 6 weeks the helpful effect of the benzo wore off, leaving her with just another addiction. She ordered heroin from her street pharmacist to get her through the benzo withdrawal. I later learned from a HN comment that benzos increase the potency of opiates, so they don't actually go well together... The firefighters did more for my friend with their Naloxone than any of the mental health professionals. Her drinking was under control for about two weeks. Then the naloxone wore off... I think the fundamental problem with current approaches to addiction/rehabilitation is that they mostly view addicts as having had a 'moral failure' in choosing to use 'recreational drugs'. ~80% of rehab facilities use some version of the 12-step program, which is helpful for ~10-15% of people who are addicted to something. I've observed some cases of alcoholism too. It's not very different from street drugs, except every corner store has their vice. About five years ago someone figured out that the brains of alcoholics switch to running on acetate, one of the breakdown products of ethanol. Alcoholism is basically a metabolic problem, as far as I can tell. I found an article by an alternative medicine heretic ~3 years ago that said nerve tissue can run on coconut oil too. I've heard a tablespoon really does help with alcohol cravings. IMHO, it's much more productive to view addiction as self-medicating physical and mental anguish. People who are emotionally stable tend to not get hooked. I was just transcribing the videos my friend made of us frying donuts (in coconut oil), taken two weeks before her first hospitalization. She was doing very well, then she ran out of alcohol & the professionals got hold of her... A very smart woman I know once said, "When a person feels safe, the false ego goes away." Helping people to feel safe is the most important part of all effective drug rehabilitations. Sometimes people need access to their drug of choice to feel safe. It's much better to give them pharmaceutical-grade drugs [1], and wait for them to age out of their addiction, than to train them to be helpless in jail, or help them to feel like failures in a 12-step-based "drug rehab". [1] https://news.ycombinator.com/item?id=14782416 https://news.ycombinator.com/item?id=14782416 - Switzerland gives their most hopeless heroin addicts access to pharmaceutical-grade heroin.

ThrustVectoring 9y ago

fapjacks 9y ago

Meanwhile, the addiction rehab industry is lobbying hard to make kratom illegal on the state level. Make no mistake, they are sociopaths preying on addicts that will do and say anything to keep them addicted.

qq66 9y ago

I would like to see the organizers of these scams executed, and given the nature of their crimes and their victims, I do not personally believe that this would be cruel or unusual punishment. I know that the Supreme Court would disagree with me.

deleted 9y ago

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unixhero 9y ago

Guys. I discovered a sinister rehab clinic in Portugal after an online cry for help was discussed on the Reddit Bureau Of Investigation (yes, it's a real thing, /r/rbi ). It was mentioned that after being "admitted" they were held there against their will. The treatment method was to "break the patient down" and then "build it back up". This clinic is the one which was mentioned. http://novavidarecovery.com http://novavidarecovery.com

icebraining 9y ago
Unfortunately, as a Portuguese, that wouldn't surprise me. Do you have a link to the Reddit thread?
- unixhero 9y ago
  https://www.reddit.com/r/RBI/comments/5utmaz/my_girlfriend_just_called_me_in_panic_to_come_get/ https://www.reddit.com/r/RBI/comments/5utmaz/my_girlfriend_j...
  - icebraining 9y ago
    Thanks. She's young, which fits the profile of the "rehab" houses known to be essentially milking State subsidies while treating the patients as cattle. The girl I knew who spent a few months in one of these could only call her parents, and usually not in privacy. A local news article claims they also treat airline pilots, which should be harder to mistreat, but that was two years ago. Unfortunately there aren't many leads. It's hard to denounce these places without an inside witness.
fennecfoxen 9y ago
There was a recent exposé about a chain of mental health clinics in the US which was holding people against their will, again for the insurance and/or Medicaid money. Ah, here it was: https://www.buzzfeed.com/rosalindadams/intake https://www.buzzfeed.com/rosalindadams/intake > A button behind the receptionist’s desk controlled the lock to the front door of the facility, and, she said, “If someone came in voluntarily, I wasn’t allowed to let them out of the door.” > Two dozen current and former employees from 14 UHS facilities across the country told BuzzFeed News that the rule was to keep patients until their insurance ran out in order to get the maximum payment. A criminal probe is ongoing.

amelius 9y ago

Solution: legalization.

kazagistar 9y ago
That doesn't solve the need for a safe place where people with destructive addiction to recover. If anything it would make it more important. Hoe do you imagine it would help?
- amelius 9y ago
  It would help because there would be no incentive to get these people addicted (again).

ada1981 9y ago

Legalize psychedelic therapies. Specifically iboga. I watched a friend who was suicidal and an addict a couple months ago enter into an iboga treatment and the guy hasn't had a smoke or drink since... he looks like a million bucks.. is hitting the gym and talking about "feeling his emotions" and is happily in therapy. This is a dude who has neck tats, was routinely getting into bar fights with skin heads in NYC and is a vet who had pretty severe PTSD. Let's legalize treatments that actually work.

trcollinson 9y ago
While I am glad this worked for your friend, or seems to be at the moment, that doesn't actually solve the problem. The problem that this article is pointing out is actually that rehabilitation and treatment centers are money making machines and that some owners of those centers are unscrupulous and unethical at best, and acting completely criminally at worst. By legalizing new treatments you actually cause the problem to get worse, not better, especially if those new treatments lack clinical data and scientific backing. This leaves an open door for desperate people in need to be seduced into treatments that might not help and will cost substantial amounts of money. Many types of treatment do work, and work very well. If someone is in need of treatment, please, do your homework and research and find those people who can really help you.
- _lex 9y ago
  Seriously - what types of treatment actually work for people addicted to drugs? As far as I know, none of them work ( where working is defined as >50% of people who complete the treatment course being able to move on to lead a normal, drug free life). A lot of them do make a ton of noise though, and several basically lower your expectations from the outset (like AA) - so you treat addiction as a chronic disease: something you'll never be cured of, and have to always deal with. The parent poster seemed to be arguing that iboga can cure addiction. If he's right, this is a big deal.
  - ada1981 9y ago
    My general thesis on this is that "addiction" is really an addiction to dopamine which is triggered by various other things (drugs, sex, booze, power, money, shopping, porn, etc). That dopamine release is the nervous systems attempt to sooth itself when in a state of disregulation. A healthy nervous system in a healthy environment (with attuned caregivers and limited traumatic experience) will equipt a person with the neural pathways (and associated beliefs and behaviors) to regulate their nervous system. In compromised development, either through lack of attunement or childhood / early trauma folks don't have the ability to automatically regulate and they are in a constant state of fight / flight. The dopamine helps to deal with this temporarily. Psychedelics, some therapy, and sometimes near death / mystical experiences (moments of clarity) can offer a window of opportunity in which the ego loosens its grip enough for the nervous system to relax and for the subconscious material (traumas) to come to the surface and be released with the accompanying rewiring of the fight / flight response. When one experiences reality from an undefended state it is generally such a pleasurable, rich experience that the desire to use other mechanisms of self-soothing organically fade away and the cognition and behavior reorient to healthier more nourishing alternatives. These experiences and therapy combined with a healthy environment and relationships that support the honest expression of emotion (ie, not co-dependent) can rapidly support healing. The basic idea is that traumas are trapped in the somatic system and that altered states of consciousness combined with the right context can allow for an unfolding and healing of the underlying issues. Depending on the underlying issue and severity of the defense structures folks may find help with various psychedelic substance from MDMA, Iboga, LSD, Mushroom or Ayahuasca. We also have seen great result using Holotropic Breathwork which was developed as a legal alternative to LSD Psychotherapy. This is essentially the same process I used to heal from bipolar, as I began to see bipolar as an "addiction" to states of depression and mania as a protective, adaptive response. It's also the process I now use with my clients and the underlying philosophy that I bring to the communities that support. If anyone is interested, there is a new book out (published anonymously) that documents accounts of a number of people who have been helped by an underground MDMA therapy practice. (Not specific to substance addiction, but includes some accounts.) https://smile.amazon.com/Trust-Surrender-Receive-Release-Trauma/dp/1619617382/ref=sr_1_1?ie=UTF8&qid=1502907574&sr=8-1&keywords=trust+surrender+receive https://smile.amazon.com/Trust-Surrender-Receive-Release-Tra...

maxxxxx 9y ago

There was a thing on NPR a while ago about billions paid to scam therapy centers. They would prescribe useless therapies to people with chronic back problems and other injuries. Without quality control this happens in every industry.

Sleeep 9y ago
Uh! I was once referred by a real MD to a real (licensed) physical therapist who worked in a real physical therapy office who performed a purely quack "procedure" (craniosacral therapy) on me and they billed my insurance for "physical manipulation" which they paid. My insurance specifically excludes craniosacral therapy as a covered expense. Uh,I felt terrible about the whole thing, it seems like a cut and dried case of insurance fraud to me. My MD said she was sending me to physical therapy so I thought I'd be getting real treatment and didn't think about it further. I never heard of craniosacral therapy before that but it was clear that the physical therapist was practicing woo once I was actually there. The worst thing is, since craniosacral therapy claims to treat almost every symptom and every disease she may refer 90% of her patients. :(
- theEXTORTCIST 9y ago
  Report it anonymously to your insurance provider (*not sure if this is possible and/or would actually do anything)
enraged_camel 9y ago
>>There was a thing on NPR a while ago about billions paid to scam therapy centers. They would prescribe useless therapies to people with chronic back problems and other injuries. So... chiropractic?
- maxxxxx 9y ago
  Much more fraudulent.
- BenjiWiebe 9y ago
  Funny, I've had very good luck with chiropractors. And no, she actually has never told me to come back.