The addiction treatment industry is a multi-billion dollar industry that is supposed to help people overcome their addiction and lead a healthy life. However, there are many unethical and illegal practices that are prevalent in this industry. These practices not only harm the patients but also tarnish the reputation of the industry as a whole. In this article, we will discuss some of the unethical and illegal practices in the addiction treatment industry and six ways to find the best addiction treatment option for you.
Unethical and Illegal Practices in the Addiction Treatment Industry
1. Patient Brokering: Patient brokering is a practice where addiction treatment centers pay a commission to third-party marketers for referring patients to their facility. This practice is illegal and unethical as it puts profits over the well-being of the patient.
2. Insurance Fraud: Some addiction treatment centers engage in insurance fraud by billing insurance companies for services that were not provided or were unnecessary. This practice not only defrauds insurance companies but also puts patients at risk by providing them with unnecessary treatments.
3. Over-Medication: Some addiction treatment centers over-medicate their patients to keep them sedated and compliant. This practice is unethical and can lead to serious health consequences for the patient.
4. Lack of Qualified Staff: Some addiction treatment centers hire unqualified staff to save money. This practice is unethical as it puts the patient’s well-being at risk. (Any company that bills itself as a “concierge” or “premiere” service should not be filling it’s ranks with interns and inexperienced staff while still charging you top rates).
Things to Look for in a Good Treatment Program
If you are looking at higher level care like residential / in patient or even intensive out patient services it’s good to start by looking for treatment programs that are accredited by a recognized organization such as the Joint Commission or the Commission on Accreditation of Rehabilitation Facilities (CARF). (If you are looking at out patient groups or individual sessions, look at the credentials of the individual, how long they have been in practice and what their peers in the community think of them.)
2. Evidence-Based Treatment:
Look for a treatment program that uses evidence-based treatment methods such as cognitive-behavioral therapy (CBT) or medication-assisted treatment (MAT). Ask them what specific training their staff have in these methods and how often they are retrained/updated in their training. I look for it in writing – in an email response or listed on their website. A reputable facility won’t have any hesitance in providing this – in fact, it should be a point of pride for them.
3. Qualified Staff:
Look for a treatment program that has qualified staff such as licensed therapists, doctors, and nurses. Ask them who is actually leading the groups, are those staff seasoned or are they intern-level, are these staff licensed in addiction only or do they also have licenses in emotional/mental health as well and how often do patients see the doctor, for how long are their sessions and are they in person?
4. Real Individualized Treatment:
Look for a treatment program that provides individualized treatment plans based on the patient’s needs and preferences. Beware of “cookie cutter” programs that think one type of approach works for all – ask them to explain how they adapt their program for different needs of their clients.
5. Aftercare Support:
Look for a treatment program that provides aftercare support such as counseling and support groups to help patients maintain their sobriety. And yes, ideally there should be Family Services while in the program and ongoing family support afterwards.
6. “Glass Kitchen” Approach:
Patiently and openly informing you of your complete financial costs and what your insurance may or may not cover. Clearly explaining if there are any additional charges such as alcohol / drug testing and physician fees that might not be covered. Ethical programs will be up front and concrete about the charges for these and whether or not they are included or will be additional charges you will be responsible for.
7. Personalized and Accessible Discharge Plan:
You should be included in the discharge planning from the very first week. In Texas, a facility is required to provide no less than 3 referrals to the next appropriate level of care and thee referrals are to be “accessible” to the client. This means that if you must use your insurance, than the three referrals must be ones that accept your insurance. If none exist, they must provide the next most accessible and appropriate options they can find. A facility can’t magically make options appear out there. But in a big city, there are so many options and no excuse for not providing them. This is about what is best for you, individually, not necessarily who the facility likes to work or partner with in the service area.
One last point on avoiding financial “scam” behaviors:
If you are using your in network insurance (INN) benefits then you should know exactly what this will cost from the very beginning. It’s also important to know what is really going on. When using your in network coverage you should owe nothing after your copay/deductible/out of pocket – beware balanced billing. If something seems wrong, call your insurance company and ask them to review it with you. (Some facilities do not bill for the physicians you see and those doctors bill separately. They should tell you this from the beginning. Always ask, if physicians or any other service is not included.)
If you are using your out of network (OON) benefits you are responsible for what your insurance company does not cover. However, some facilities inflate the charges on billing sent to insurance companies. In these cases, they may inflate the amount the insurance is asked to pay out and consequently what you will owe, as well. Ask them for their full cost and make a note of date, time, amount and who you spoke with. It’s unethical for a company to charge you one price and someone else another for the same service.
When You Need Help With Claims
If it happens and you can’t get the facility to correct it – file a complaint with your insurance company. If your insurance company doesn’t act in your best interests within an appropriate amount of time, consider filing a complaint against them with your state’s Department of Insurance. It can be incredibly effective and it’s not hard to do. Unfortunately, too many people don’t realize the support they have in these and end up with insurmountable costs that they should not be facing.
Unfortunately, the addiction treatment industry is plagued by unethical and illegal practices that harm patients and tarnish the reputation of the many honest and trustworthy professionals in the industry. It is important to be aware of these practices. Look for a treatment program that is accredited, uses evidence-based treatment methods, has truly qualified staff, provides individualized treatment, and offers aftercare support. By doing so, you can ensure that you or your loved one receives the best possible care and support to overcome addiction.
Remember – You and your loved one are the client (ie the customer). You have every right to ask questions and a have clear, complete understanding of what to expect.
To learn more – check out our Addiction Recovery 101 seminars for parents, partners and spouses.