Pennsylvania Insurance Department: State Agencies Applaud Congressional Passage of ‘Patient Brokering’ Provision in Opioid Law

HARRISBURG, Pennsylvania, Nov. 15 -- The Pennsylvania Insurance Department issued the following news release:

Officials from the Pennsylvania Department of Drug and Alcohol Programs and the Insurance Department today commended Congress for including a "patient brokering" provision in the recently passed Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act.

Under the new federal law, it is illegal for anyone to solicit or receive any remuneration, directly or indirectly, in cash or in kind, in return for referring a patient to a recovery home, clinical treatment facility or laboratory. It is also illegal for anyone to pay or offer remuneration to induce a referral. The law carries punishment of fines up to $200,000 or imprisonment for up to 10 years, or both, for each occurrence. The law contains exceptions for legitimate insurer relationships with treatment, recovery, and laboratory facilities.

"Families' desperate to help their loved ones can fall prey to unscrupulous people preying on them and luring them 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.

"Despite the availability of treatment centers in Pennsylvania, recruiters will often use the attraction 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."

A survey of Pennsylvania's major health insurers, which cover approximately 70 percent of the commercial health insurance market, shows 7,157 Pennsylvanians, or nearly 17 percent of all Pennsylvanians receiving substance use disorder treatment under insurance coverage from these insurers, received substance use disorder treatment out of state over the past two years.

Altman, Pennsylvania Department of Drug and Alcohol Programs Secretary Jennifer Smith, and Lizz DeWolfe, founder of Not One More in Wyoming County and whose 23-year-old son died of an opioid overdose after treatment at a Florida facility, held a Capitol news conference in June to highlight this problem.

"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," Smith 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 use 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 line 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."

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.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.

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). Consumers who suspect patient brokering is occurring may also call the Insurance Department's Consumer Services Bureau at 1-877-881-6388, or online, for referral to the appropriate law enforcement agency.