Harrisburg, PA – Wolf Administration officials with the mother of a Pennsylvania man who was recruited to an out-of-state treatment facility today issued a warning to Pennsylvanians to be wary of predatory practices used by some addiction treatment centers and sober living homes, many of which are located outside of Pennsylvania.
Pennsylvania Department of Drug and Alcohol Programs Secretary Jennifer Smith and Pennsylvania Insurance Commissioner Jessica Altman were joined by Lizz DeWolfe, founder of Not One More in Wyoming County and mother of J.J. Baker, who died of an opioid overdose at 23 after having sought treatment at a Florida treatment facility.
“The opioid epidemic has made families desperate to get help for their loved ones and has unfortunately opened the door to unscrupulous people who prey on these families to lure unsuspecting individuals in need of treatment to facilities that may provide little or no treatment, and can lead to more problems, including financial ruin, and even death,” said Insurance Commissioner Jessica Altman. “Operators of these facilities have also found ways to bilk insurers and consumers out of hundreds of millions, or even billions of dollars, through fake and inflated insurance claims.”
“While there are many reputable facilities in other states, instances of individuals being recruited to other treatment centers with offers of payment for travel or health insurance coverage can lead to insurance fraud, misleading or dangerous living conditions, and individuals with substance use disorder failing to receive the treatment they need,” Jennifer Smith, Secretary of the Department of Drug and Alcohol Programs said.
“Individuals affected by substance use disorder and seeking recovery are among our most vulnerable Pennsylvanians. Entering treatment can be a pivotal step in one’s recovery journey, and we must be sure that they are able to do so in a safe and supportive environment. I strongly encourage Pennsylvanians seeking treatment for themselves or a loved one to utilize their Single County Authority (SCA), the local drug and alcohol treatment information centers in Pennsylvania’s counties to help locate a DDAP-licensed treatment facility, or the free PA Get Help now at 1-800-662-HELP (4357). SCAs receive funding through DDAP that will help if you are not sure how you will pay for treatment.
The Washington Post reported earlier this year federal and state authorities in Florida charged the operators of one bogus operation alone with $58 million in fraudulent insurance claims. Facilities have been charged for billing insurers for services never provided, filing multiple claims for the same service, and charging exorbitant rates for drug testing.
A survey of Pennsylvania’s major health insurers, which cover approximately 70 percent of the commercial health insurance market, shows 7,157 Pennsylvanians insured by these companies received substance use disorder treatment out-of-state over the past two years. This is nearly 17 percent of all Pennsylvanians receiving substance use disorder treatment under insurance coverage from these insurers.
Despite the availability of treatment centers in Pennsylvania, recruiters will often use the lure of a sunny climate, free air travel, covering insurance payments, and a fresh start to lure people in need of treatment to facilities in other states, particularly Arizona, California, and Florida.
“Addiction is really complicated, and sometimes in our efforts to get our loved ones into recovery, we don’t see things that should make us ask questions,” DeWolfe said. “J.J. was offered free rent but we all know that nothing is free. Remember if they offer anything free, it is a sign that it may not be a reputable facility.”
After an initial, successful rehab, Baker relapsed, and returned to Florida in 2015, where he was offered a rent-free room at a recovery home while getting treatment. During this time, Baker’s parents received a bill of more than $208,000 for drug testing. In August 2015, he received a prescription from a doctor for testosterone. He showed the prescription to the house managers. The next day, he was evicted because the prescription violated the home’s rules. Three days later Baker was found dead in his car from a heroin overdose.
“My hope is by telling my story other parents won’t go through what I did. Other parents need to know how important it is to do your research, ask questions, get referrals, see what the laws are in that state,” said DeWolfe. “If you receive a bill from the insurance company that feels out of the ordinary, don’t be afraid to ask questions. If I only would have known what I know now there is a chance my son would still be here.”
Smith and Altman said that there are several things people should look for to avoid falling victim to an out-of-state addiction treatment scam. These include:
- Any unsolicited referral to an out-of-state treatment facility;
- Someone offering to pay for airfare or other travel expenses to an out-of-state facility;
- Someone offering to pay for insurance coverage — these payments could end at any time leaving you with no coverage;
- Someone asking you to provide personal information, such as your Social Security number or insurance policy ID number.
Solicitors may also attempt to lure someone to a recovery or sober home. Be wary of homes claiming insurance will pay rent or other costs of staying at these homes because they provide no medical treatment and do not receive payment from insurance. Also ask if the sober or recovery home is registered or certified by a state agency or designee. In Florida, this is the Florida Association of Recovery Residences, which certifies sober homes meet 38 standards for recovery, housing, administration, training, finance and good-neighbor practices.
Keep a close eye on medical bills and insurance payments and question any that seem out of line. Altman said private insurance payments for tests will vary, but Medicare typically pays about $80 for screening tests to detect the presence of drugs, and between $117 and $254 for a more sensitive confirmation test to determine the amount of specific drugs present.
Governor Wolf signed a bill in December giving DDAP authority over recovery homes located in Pennsylvania that receive public funding. The department has until June 2020 to promulgate regulations for recovery homes, but many already exist and operate in Pennsylvania and may work with a county’s SCA. Smith encouraged consumers considering a recovery home for themselves or a loved one to contact their SCA before making a financial commitment.
“Getting timely help can be key to saving a loved one’s life, but families need to be sure they are dealing with a reputable facility,” Altman said. “The bottom line is, if someone is being paid to recruit you or a loved one to an out-of-state facility, they may not have your best interests in mind.”
Pennsylvanians looking for treatment for themselves or a loved one can call the PA Get Help Now helpline toll-free, 24/7 at 1-800-662-HELP (4357). Information on questions to ask if consumers are solicited for an out-of-state recovery home or addiction treatment center are at www.insurance.pa.gov, on the Health page. A list of licensed treatment facilities in Pennsylvania is also available at www.ddap.pa.gov. Suspected insurance fraud can be reported to the National Insurance Crime Bureau at 1-800-TEL-NICB (1-800-835-6422).