RIVERVIEW, Fla. — Residential drug treatment centers are doing big business as the opioid epidemic continues to grows.
Facilities routinely charge patients' insurance thousands of dollars a day for treatment. But the ABC Action News I-Team uncovered not all of those charges are justified and may be helping to drive up insurance rates for everyone.
“I went on a bender. By the time it was done, I was in handcuffs in the back of a sheriff's car,” said Rachel, a registered nurse from Florida’s East Coast who didn't want to give her last name because she worries it might affect her job.
Rachel sought help last year, after years of substance abuse and depression issues.
“A 1-800 number popped up on the internet and I said 'alright, call it,'" she said.
The number belonged to American Addiction Centers (AAC) which is one of the nation's biggest rehab companies.
“They have a team that looks for clients. They have a 1-800 number that's always ready to go,” said retired sheriff’s deputy Michael Isom, who is the former Transportation Manager for River Oaks Treatment Center in Riverview — one of three Florida-based AAC facilities.
“The most important thing are the numbers. Keep the money coming in,” said Isom.
“That was the biggest thing, was do you have insurance?” Rachel said, describing her call with a company representative. “I gave them my id number, my group number and everything. And they were like 'hey, we can take you.'"
Rachel said they arranged to send an Uber to pick her up and transport her to River Oaks within hours of the call.
At River Oaks, AAC billed her insurance, Blue Cross/Blue Shield of Texas, more than $30,000 for drug tests in just 31 days.
AAC says it is their policy to test patients on their arrival, 48-hours later, randomly and whenever they leave and return to the facility.
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“We take them out for a haircut which is right across the street, they got to come back and do a urinalysis,” said Isom. “I take 20 out, they got to come back and do a urinalysis. All this is getting billed.”
What is called a “point of care” drug test is readily available over the counter and tests that screen for marijuana, opium, cocaine and methamphetamines boast 99-percent accuracy rates and cost less than $20.
One purchased by the I-Team at Wal-Mart includes free confirmatory lab testing for positive results.
Healthcare Bluebook says the fair price for a professional drug screening in Tampa is $152. This type of test is conducted in a doctor’s office, a hospital or a lab.
But Rachel’s insurance statements show AAC billed her insurance $1,200 each for five on-site urine tests, then $3,440 each for seven follow-up or confirmatory tests performed at a lab owned by AAC.
AAC says all urine testing is based on a physician order, and all results are reviewed by a medical provider. They say they run confirmation tests on all samples in which the presumptive screen is positive, when the presumptive screen is negative but is expected to be positive and when no presumptive screen is available for the drug being requested by the physician.
“It's all about the holy dollar,” said Palm Beach County State’s Attorney Dave Aronberg.
Aronberg convened a grand jury to investigate fraud and abuse in Florida's addiction treatment industry.
While that investigation did not focus on AAC or River Oaks, it did look into similar complaints at other rehab facilities in the state.
He says he doesn’t know of any good reason a facility should conduct seven confirmatory tests in just 30 days.
“It is frustrating because the good providers, the good doctors, the good treatment centers know that you don't need all this over billing insurance fraud to get someone healthy,” Aronberg said.
AAC told us they base their testing practices on guidelines from the American Society of Addiction Medicine's best practice recommendations. But ASAM testing guidelines say the routine use of elaborate tests “are harmful not only because they waste valuable resources, but because they do not fit the standards of appropriate clinical care."
Rachel's insurance refused to pay for some of her tests, including the expensive confirmatory tests.
A spokesperson for the insurance company issued the following statement:
“Patient privacy laws prevent us from commenting on a specific member's case. However, as a general matter, we are disappointed as well as concerned whenever any Blue Cross and Blue Shield of Texas member is surprised by an excessive charge for a seemingly routine service or receives services that may not be medically necessary. BCBSTX works hard to protect our members from fraud, waste, and abuse in provider billing practices.
Members who receive medical services that appear unnecessary or have other concerns about excessive billing should report such issues to the number on the back of their ID card."
It's not the first time AAC's billing for drug testing has been questioned.
In New Jersey, Blue Cross/Blue Shield sued AAC, alleging more than $6 Million in over billing for drug tests. That case has since been settled.
Both Rachel and Isom say they knew of no repercussion, if a patient tested positive on any of the drug tests.
AAC said, of the importance of testing:
“All positive results are clinically addressed on an individual basis by the treatment team. Clinical results can include a revision and reconsideration of level of care, revision of the individualized treatment plan including goals and objectives, extension of treatment, or consideration if this placement is the safest and most effective for the client.”
AAC billed Rachel's insurance $88,000 — nearly $3,000 a day. That's a lot of money, when you consider that River Oaks alone has 140 patient beds.
“It’s all about getting a ton of money from really sick people who do need help,” Rachel said.
If you would like to share information about your or a loved-one’s experience in residential drug treatment, contact us at firstname.lastname@example.org.