March 7, 2019

Cracking Down on Opioid Opportunists

States, Feds Rein in SUD Treatment and Recovery Fraud

The opioid epidemic is causing a rise in the number of treatment centers and recovery residences that offer services for people with substance use disorder (SUD). SUD treatment and recovery entities are less regulated than other health care settings, creating an opportunity for unethical individuals and corporations to profit off of fraudulent and substandard care. In response, many state lawmakers are moving to protect the SUD population from deceptive and ineffective care.

SUD Treatment Center and Recovery Residence Fraud and Abuse: State Laws

This state law tracker is current as of March 7, 2019 and will be updated monthly. As legislative activities in the SUD treatment and recovery space are rapidly evolving, Faegre Baker Daniels Consulting cannot ensure that the information presented is comprehensive. For the latest developments on these and related issues, please reach out to Colleen Conners.

The map below captures states that have enacted laws targeting unethical practices in SUD treatment and recovery, including deceptive marketing and patient brokering (in which unlicensed “patient brokers” are paid by unethical SUD providers or recovery residences to deliver patients or residents). The map also captures states that have adopted laws concerning licensure of recovery residences. In this tracker, "recovery residence" includes all group-based, drug-free housing intended to facilitate recovery; state laws often differ in the terminology used for such entities.

SUD Treatment Center and Recovery Residence Laws, by State

SUD Treatment Center and Recovery Residence Laws, by State

 

NEW YORK A. 7689-A – Prohibited Practices by Providers of Substance Use Disorder Services
ILLINOIS H.B. 4949 – Prohibition Against Fee Splitting
H.B. 4949 – Deceptive Marketing, Advertising, and Sale of Mental Health Disorder and Substance Use Disorder Treatment
TENNESSEE H.B. 2068 – Substance Abuse – Treatment – Markets and Marketing
FLORIDA H.B. 807 – Prohibition of Deceptive Marketing Practices
H.B. 807 – Patient Brokering Prohibited; Exceptions; Penalties
H.B. 21 – Voluntary Certification of Recovery Residences
ARIZONA S.B. 1451 – Crimes and Offenses – Health Care Providers – Patient Referrals
S.B. 1465 – Alcoholics and Chemically Dependent Persons – Residential Facilities – Sober Living Homes
UTAH H.B. 14 – Substance Abuse Treatment Facility Patient Brokering
CALIFORNIA S.B. 1228 - Alcoholism or Drug Abuse Recovery and Treatment Services: Referrals
INDIANA S.B. 402 – Recovery Residences and County Homes
MASSACHUSETTS H. 1828 – Ensuring the Safety of Sober Homes
MARYLAND H.B. 1411 – Health Recovery Residences - Certification
OHIO H.B. 483 – Recovery Housing
CONNECTICUT H.B. 5149 - Alcoholics and Chemically Dependent Persons – Halfway Houses
PENNSYLVANIA S.B. 446 – Standards for Drug and Alcohol Recovery Homes
RHODE ISLAND S. 2579 – Relating to Behavioral Healthcare, Developmental Disabilities and Hospitals

 

SUD Treatment Center and Recovery Residence Fraud and Abuse: State and Federal Criminal Charges

This tracker is current as of March 7, 2019 and will be updated monthly. As law enforcement activities in the SUD treatment and recovery space are rapidly evolving, Faegre Baker Daniels Consulting cannot ensure that the information presented is comprehensive. For the latest developments on these and related issues, please reach out to Colleen Conners.

Federal and state governments are increasingly responding to unethical SUD providers, patient brokers and recovery residence administrators with criminal charges. The map below captures states that are prosecuting individuals involved in patient brokering schemes, deceptive marketing of SUD services and insurance fraud.

The map also captures states in which a U.S. District Attorney’s Office has brought criminal charges against individuals allegedly involved in SUD-related crimes. Many federal criminal charges arising from patient brokering schemes have been health care fraud related, including conspiracy to commit health care fraud. This is because, until recently, the federal government has not had enforcement authority over individuals who offer, solicit or accept kickbacks in exchange for referrals of privately insured patients. The most recent iteration of comprehensive opioid legislation passed in October 2018, commonly referred to as the “SUPPORT Act,” now expands the reach of the federal government to prosecute kickback schemes involving privately insured patients in recovery residences, clinical treatment facilities or laboratories.

SUD Treatment Center and Recovery Residence Criminal Charges, by State

SUD Treatment Center and Recovery Home Criminal Prosecutions, by State

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