Opioid Crackdown: Smoke and Mirrors or Did It Target the Real Issues?

Sessions’ Billion Dollar Opioid Crackdown: Was It All Smoke and Mirrors or Did It  Target the Real Issues?

The news was full of reports last week on the national billion-dollar opioid fraud crackdown that occurred on July 13, 2017. Attorney General Jefferson Sessions was center stage making an impassioned case:

Too many trusted medical professionals like doctors, nurses, and pharmacists have chosen to violate their oaths and put greed ahead of their patients. Amazingly, some have made their practices into multimillion dollar criminal enterprises. They seem oblivious to the disastrous consequences of their greed. Their actions not only enrich themselves, often at the expense of taxpayers, but also feed addictions and cause addictions to start. The consequences are real: emergency rooms, jail cell, futures lost, and graveyards.”

The 2017 Healthcare Fraud Crackdown was hailed by the Justice Department as the largest of its kind ever. Over one thousand law enforcement officers participated in several states with more than 200 clinics, pharmacies, and hospitals targeted. The emphasis in the press conference was squarely on opioids and their disastrous effects on individuals and society. But was the crackdown really about opioids and getting crooked addiction providers out of business and off the streets as the press conference implied?

Only 120 of the 412 charged in the July 13th crackdown were arrested for opioid related crimes, just over a quarter in total. Bundled into this opioid crackdown were arrests around the country for health care fraud issues targeting compounding pharmacies, assisted living, and home care providers for fraudulent billing practices; hospice kickbacks, and even the man who kicked in a pharmacy window to steal drugs. While we agree that any form of healthcare fraud is abhorrent and important to end as quickly as possible, the emphasis on putting the brakes on opioid diversion and addiction providers being prosecuted in the press conference simply didn’t meet the hype. While the crackdown included opioid related offenses and one addiction provider, a variety of healthcare fraud issues were lumped together to make the impression of a bigger haul.

Nearly every news report led with the lurid details of an addiction treatment provider in South Florida who was arrested and had been involved in shady enticements to get substance users in the doors and then fraudulently bill on their behalf. Here is where the rest of the story is helpful to know. Of the literally hundreds of Southern Florida addiction treatment providers in business today, during the the biggest crackdown in US history on opioid health care fraud to date, they arrested exactly one addiction provider, Eric Snyder, owner of Real Life Recovery and Halfway There, a sober living house, and his associate, Christopher Fuller. What Attorney General Sessions failed to discuss in the press conference is that that Mr. Snyder had been shut down in 2014 after a large-scale raid on his properties and was already under indictment.

Mr. Snyder’s properties are located in Palm Beach County, specifically Del Ray Beach, which has become known in recent years as “America’s Recovery Capital”. In fact, recovery is not what many of these providers actually work toward as a goal for patients. Their goal is a revolving door of patient relapse to keep beds full and billing, fraudulent or not, at full speed. The well-intentioned healthcare initiatives, like Affordable Care Act, Mental Health Parity and Addiction Equity Act, and Comprehensive Addiction and Recovery Act, have served to grant quicker access to substance use treatment and the end to capped benefits for treatment coverage. These legislative changes have let loose the floodgates of reimbursement and, in doing so, have also enticed predators to cash in on the pain and suffering of people struggling with substance use.

Sadly, the truth is, due to no or lax regulation in Southern Florida, treatment centers have sprung up like weeds. The same situation is true in Southern California where a similar lack of regulation and sunny weather has made that area known as the “Rehab Riviera”. A pattern has evolved that unscrupulous people, with little or no knowledge of how to help people with substance use issues and a lack of interest and integrity, are profiting on human suffering by setting up shop with treatment centers, rehabs, and sober living homes to have access to the millions of dollars possible with public and private insurance. Their interest in their patients’ well-being and future exists only as long as their insurance reimbursement holds out.

As Attorney General Sessions laid out so luridly in Thursday’s press conference, people like Snyder prey on substance users by offering inducements to get them in their rehabs and sober living facilities. Christopher Fuller, Snyder’s associate and paid “junkie hunter”, would pay motels to call him when likely drug using prospects checked in. Fuller would also hang around AA meetings hoping to find new patients to fill Snyder’s enterprises. Even current patients at Snyder’s facilities recruited for him to earn cash incentives to pocket as their own. The unscrupulous practices didn’t end there. Snyder billed for bogus medical testing and therapy services that were never provided to patients. He would promise free plane tickets to get patients to the rehab. He and Fuller made promises of strip club outings, free cigarettes, and other enticements for patients to come and stay- all in an effort to keep the profits flowing from insurance but not to get these people the help they were looking for. Thus far, Snyder is charged with billing and receiving over $58 million in fraudulent gains from his enterprise.

Florida State Attorney Dave Aronberg, who headed the Palm Beach County Sober Home Task Force, has made 30 arrests in 8 months focused on patient brokering and other fraudulent practices of the addiction treatment industry in Southern Florida. The Task Force has concentrated on shutting down patient brokers, treatment center operators, and sober home operators who conspire to trade patients with robust health insurance like baseball cards, shuffling them from the street to treatment to sober homes and back through again, as long as the insurance pays. Aronberg welcomes Federal help if he can get it as Federal crimes mean higher fines and longer sentences for those convicted and a larger deterrent factor to those operators thinking of or committing healthcare fraud. The focus last week was on other issues and not on  Del Ray Beach.

Only one addiction provider arrested amongst all the treatment providers, rehab and sober living operators, and patient brokers nationwide from the largest opioid crackdown ever? It was a disheartening message to those substance users, families, and advocates touched by substance use issues who had been used. The hype clearly didn’t match the outcome. The focus on healthcare providers was not unwarranted. There are doctors, nurses, pharmacists, and licensed healthcare professionals who are practicing healthcare fraud alone, as part of a large scale coordinated system, or engaging in opioid diversion activities. These arrests are very important. The misleading narrative at the press conference left the impression that the arrests made in this opioid crackdown were similar to Mr. Snyder’s arrest– and they were not.

The emphasis on Mr. Snyder’s arrest was interesting as he was an outlier in the arrests made under the crackdown. Mr. Snyder is not a healthcare professional and he was only one addiction treatment provider to be arrested. He was charged, arrested, and his facilities closed down in 2014. This second arrest in 2017 doesn’t add to the impact. The fact that his arrest was placed front and center was a deliberate positioning to make the 2017 opioid crackdown seem broader and more effective than it was. It was the most blatant kind of political theater. It’s disappointing that the Attorney General led with smoke and mirrors instead of focusing on shutting down such treatment centers, rehabs, sober homes, and those who prey on substance users to exploit them.

As a program that works with substance users, we see the effects of these fraudulent and dangerous providers every day. We talk to people who are genuinely seeking help to free themselves or their loved ones from substance use issues and redirect their lives. Too often, they have spoken to a new rehab or treatment center in Florida or California that promises to fly them there free, assured them it won’t cost a thing to get help, or made other extravagant enticements. The sad truth is these providers will likely cost them far more than they realize.

It’s important to shine to a light on the dark practices of an addiction treatment industry that has exploded in recent years. States like Florida and California should be encouraged to continue their local efforts to root out those unscrupulous providers who seek to inflict further harm on substance users in the guise of help. The Federal authorities need to partner more aggressively with local authorities to put their efforts where the Attorney General’s press conference staging was and crack down on addiction treatment providers, rehabs, and sober homes whose owners and operators are fraudulently profiting at the cost of innocent lives and families. Hopefully, next year’s Federal crackdown will reflect these initiatives and not the token enforcement promoted this year. If not, the ravages from these addiction treatment industry practices will continue to play out and the costs in human suffering will only continue to rise.

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