Congress Urged to Act to Reduce Fraudulent Addiction Treatment Coverage

The leader of an addiction treatment organization this week urged Congress to crack down on a fraudulent practice called “patient brokering,” Modern Healthcare reports.

The practice involves a third party, such as a treatment center that does not meet adequate care standards, paying a recruiter to fraudulently enroll a patient with a substance use disorder in a flexible Obamacare individual market plan that offers out-of-state coverage.

The patient then goes to a treatment center that may not offer adequate care. The centers involved often are in Florida, Southern California or Arizona. If the fraud is uncovered and can be proven to the Centers for Medicare and Medicaid Services, the agency will rescind coverage and the patient must leave the treatment center.

Marvin Ventrell, Executive Director of the National Association of Addiction Treatment Providers, urged the House Energy and Commerce Oversight Committee to pass a federal law to ban the practice. “The law has been confusing and sometimes nonexistent, state by state,” he said.