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The Problem
For those of you that are unfamiliar with patient brokering it mostly consists of treatment facilities paying directly to a middleman (marketer) for patients who in turn usually pay the patient a cut of that payment (could be several hundred to several thousand dollars depending on the level and duration of care or sometimes the marketer provides them with drugs and shelter between treatment stays or worse. Such as in the case of Kenneth Chatman, who was sentenced to 27 years in federal prison in May of 2018 on charges including conspiracy to commit healthcare fraud and sex trafficking. Six other people have pleaded guilty to charges in that case, including two doctors, a counselor, and two operators of "sober homes". Please read more about his case and others if you want to understand how bad some operators in the industry have become, but also remember they are the worst and in my experience most operators of treatment centers (at least in California) mean well, but are struggling with how the system works to find patients to care for and often will treat patients for free when insurance is not adequate or non existent.
My Opinion
Why do I think that patient brokering is not always a bad thing. And what I believe needs to be considered when regulators and the industry make changes to the regulations coming up to help relieve some of the reasons for engaging in the practice.
The regulators and most of the press seems fixated on the abuse of patients by marketers that aren't trying to help patients with addictive behavior make lasting changes in their lives for the better and that is definitely a problem, also there are well meaning people working in the treatment community that understand that the only feasible avenue to find patients due to competition (through legitimate marketing, referrals, and also by illegitimate marketers) make it financially out of reach to market within the legal parameters set by regulators and the industry putting well meaning treatment providers in the unenviable position of having to bend the rules but only in a way that they feel they are not hurting the patients but sometimes even feeling like they may be helping them while knowing they are being paid by the marketer for going to treatment. Let me explain what I mean.
I feel like almost everyone involved that knows the difference between right and wrong will agree that paying an addict to go to treatment knowing that they will use the money when they leave to use and/or knowing that the patient has no intention of cleaning up and making a positive change in their life is unethical. But what if the patient is unable to go to treatment because of financial obligations in their lives that can only be met if there is a financial incentive offered for going? Money to pay their rent or mortgage, other bills, or maybe to get started after treatment where they would be homeless without a job otherwise making treatment ineffective or impossible to them? And how could the insurance companies possibly change their policies to provide for that but avoid paying out so much more for patients who have no intention of getting better or using any money paid back to them for helping them avoid losing everything that their addiction has already threatened to take from them?
What can be done?
My short suggestion would be to include in all health coverage plans coverage for expenses such as rent, car payments, and other fixed bills a reasonable amount like is offered by companies like Aflac offers (but currently doesn't for any addiction treatment except when provided in a hospital setting.
Conclusion
I know that this doesn't make the need for marketing for smaller facilities go away and I'm not suggesting that this one change to the industry would fix all their problems, but I do believe it would help relieve the need for otherwise honest providers and patients to engage in this unethical practice out of desperation of the patient and the provider knowing that the patient would have no other way to take the time out to try to get better.