We should all be afraid when there is a “war” declared on anything in our culture because it usually means the complex will be simplified, the innocent will be presumed guilty, details will be ignored and the baby will be thrown out with the bathwater. Nowhere is that more apparent than the current War on Sober Homes in Palm Beach County.
It is illegal for a sober home to receive payment from an addiction treatment facility for providing so called “case management” services;
Addiction treatment providers unethically bill thousands of dollars for urine tests that could be provided for pennies via a cup for sale at Walgreens; and
The Patient Brokering Act, a state criminal law, is being broken left and right by sober homes and addiction treatment providers.
Hooey! It’s completely misleading. Here’s why:
Case Management Issue. The arrangement reported In the Post and described in charging documents describes a business arrangement where sober homes are paid by state licensed addiction treatment providers for helping addicts along their path of recovery. Addiction treatment sees these patients maybe 20 hours a week. Where are they the rest of the time? What are they doing? Addicts seeking treatment often have soft life skills from being off the grid, are often receiving assistance from supportive staff at sober homes who help them get on their feet. They often come into treatment with no clothes, no money, no food, no job skills and a whole host of medical and psycho social needs. And addiction treatment facilities want (and sometimes pay for) sober home staff to serve a function in the continuum of care, sometimes want to give them food cards, clothing, cigarettes and whatever they need to accept treatment. And our sole focus is to do what, focus our regulatory attention on a business relationship that may exist in the treatment industry? Continue reading →
Commercial plans continue their audit activity in 2016 demanding many changes and adjustments yet giving little in return. The 2015 audits have not been completed for the majority of substance abuse providers in South Florida, yet the commercial plans have arbitrarily stopped paying new claims even though it takes them at least 6 months to complete a post payment audit. If and when a provider finally gets an audit result, payors are imposing requirements that just are impossible to meet.
Payors do not appear to be paying attention to the public health crisis of substance abuse addiction and the ever growing need for treatment. The assumption is being made by the payors that all providers in this space are over utilizing services and engaged in fraudulent practices, despite the reality that many providers are doing just the contrary. Continue reading →
By now, it’s not news in Florida that drug and alcohol recovery providers are staring devastation in the face as payers continue to mount non-payment offensives. As payers one by one march on the industry and starve providers of cash flow for operations, many providers can be expected to shut down. To make matters worse, as the popular media continues to act as a conduit for gross misrepresentations of industry providers, the public’s affection for the industry can’t be expected to improve. This makes the future look especially bleak for the industry, and yet the silence and stillness of providers is baffling.
Given the breadth of the payer problem (many simply aren’t paying providers), why are we not seeing a slew of lawsuits filed by providers? In nearly 30 years as a Florida healthcare lawyer, I’ve never seen a healthcare sector so hammered by insurance companies. And I’ve never seen it unanswered in court. Continue reading →
I read an article in a local paper the other day. It was about (a) a guy who owned a treatment center (who has not been charged with committing a crime), (b) a lawsuit filed by a large insurance company against a toxicology lab that the insurer owes millions, and (c) the fact that insurance companies pay a lot for toxicology lab testing. I scratched my head, wondering how there was anything newsworthy there. The “story” being sold by the paper, however, created a story with a villain (the providers of services to people in recovery from drug and alcohol addiction) and a “victim” (people receiving care for addiction). I can’t resist responding.
There’s a difference between something that’s interesting and worthy of comment vs. a journalistic attempt to concoct controversy and intrigue that people might buy. There’s not much of the former, but a lot of the latter. People in recovery being victimized by horrible, greedy people is an interesting story. Unfortunately, it’s off the mark and really not helpful to anyone.
There are three pretty safe assumptions we can almost all agree on: first, there are a lot of people who want to live life without active addiction. Second, many of them think they need help to create a better life. Third, some providers of help to people in recovery make a bunch of money providing that service. Continue reading →
Two separate legislative proposals are aimed to tighten up the sober home industry. The Bills follow on the heels of legislation proposed last year, which did not become law. We have a couple weeks left till the Legislative session ends (May 1st), after which time we will see what regulation made its way through the process. Until then, it’s important to have an idea of what is on the horizon.
Creates “voluntary” certification for recovery residences;
A. Specifies the requirement of a “recovery residence administrator;”
B. Specifies that the credentialing entity of both the recovery residence and the recovery residence administrator will be a nonprofit organization (not necessarily one that is tax exempt) that “develops, administers professional, facility, or organization certification programs according to applicable nationally recognized certification or psychometric standards,” and requires the credentialing entity to:
Establish the recovery residence certification requirements. Interestingly, the Legislature, which states that those in recovery are vulnerable and need to be protected, is offloading to an unspecified nonprofit organization (which anyone can form in five minutes) the responsibility for developing certification requirements;
Establish procedures to, among other things, to monitor, inspect and insure compliance with the certification requirements established by this unspecified nonprofit organization entrusted by the state of Florida with this responsibility;
Require recovery residences (who are volunteering to be regulated) to submit documents such as job descriptions, drug testing procedures and requirements, to be managed by a “certified recovery residence administrator.”
The Bill also states that a recovery residence cannot be certified if an owner, director or CFO plead guilty, no contest or was found guilty of certain offenses. Moreover, the non-governmental, not for profit certifying body has authority to suspend or revoke a certification if the entity determines the residence isn’t complying with the law. No due process is required. Oh, and finally, as of July 1, 2016, a provider licensed under Chapter 397 may not refer a patient (current or discharged) to a recovery residence unless the residence, which is not required to be certified, actually becomes certified, making the voluntary certification requirement, ummm….mandatory! Continue reading →