TRENTON– The State Commission of Examination has its sights set on problems in the addiction rehab market– from self-dealing to double billing to rigging drug tests to keep people from leaving treatment.
The SCI’s last report and legal suggestions are still months away, however the Legislature’s independent fact-finding agency held a public hearing Tuesday at the Statehouse to set out its findings to date.
Mainly, the hearing included SCI detectives, pre-recorded videos in which the voices of witnesses were misshaped to safeguard their identities and an welcomed visitor. One witness who was subpoenaed to appear did disappoint, part of his last-minute battle to prevent affirming.
Susceptible are preyed on
SCI chairwoman Tiffany Williams Maker states addiction treatment is a $42 billion and growing market in the United States with little guideline, making it simple for susceptible people to be made use of.
” Lots of addicted people and their households are preyed on by the extremely system that’s expected to help them recuperate and restore their lives,” Williams Maker stated.
State Commission of Examination chairwoman Tiffany Williams Maker (Screenshot from NJ Legislature video)
The SCI stated business design for some treatment centers is to keep patients in a cycle of addiction, treatment and relapse so they can make the most of make money from personal insurance providers– and that it leaves people with public insurance or no coverage dealt with as second-class patients.
‘ Money for bodies’
The doubtful practices– consisting of patient brokering that SCI unique representative Eric Rennert referred to as ‘money for bodies’– are normally restricted to how they deal with patients with personal insurance, which is even more profitable than those on Medicaid.
A state law enacted in 2015 bars patient brokering, in which people requiring addiction recovery treatment are guided to particular treatment centers in exchange for a financial benefit. However Rennert stated that law is being prevented through contributions and sponsorships that continue to provide a financial gain from patient recommendations.
” Recovery coaches are sending out customers with personal insurance to treatment centers which might not sufficiently provide the essential care they require however rather are motivating them to go there since that’s where the cash originates from,” Rennert stated.
SCI unique representative Eric Rennert (Screenshot from video on NJ Legislature site)
Rennert detailed the example of Recovery Supporters of America, based in Hamilton. More than 35 treatment centers contributed over $600,000 to it integrated in between 2017 and 2020. Customers with insurance were in turn referred to them, in some cases with airplane tickets to centers in Florida.
In video statement in which a patient’s voice was misshaped to provide privacy, someone with a cocaine addiction stated he was advised to consume vodka and use fracture in order to be confessed to a hospital bed for drug treatment.
Rigging drug tests — to fail them, not pass
Other patients were made to resemble they had used drugs to keep the insurance cash coming, stated investigative representative Karen Guhl.
” Based on information we got from staff members of these treatment centers, they were advised to tamper with the urine specimens of the customers to provide incorrect favorable outcomes,” Guhl stated. “This would be a sign of a relapse and would then set the patient up for extra days of treatment at a greater level of care.”
SCI investigative representative Karen Guhl (Screenshot from video on NJ Legislature site)
SCI staff members likewise affirmed about glaring abnormalities in medical billing, which forensic accounting professional Laura Mercandetti stated gets used so that insurance cash can funds extravagant way of lives for some providers.
” Overbilling for services, billing for services that were never ever rendered and billing for overlapping services,” Mercandetti stated. “And all of these doubtful billing practices allow the owners to make millions of dollars.”
The SCI particularly comprehensive practices at Kingsway Treatment Center in Mullica Hill, which detectives stated billed insurance for $15 million in 3 years with around 30 to 40 customers at a time. They stated cash got moved into the personal accounts of its owner and his partner, camouflaged as nontaxable company loan payments, and to associated sober living houses that can not bill insurance.
Kingsway’s owner, Nicholas DeSimone, didn’t affirm at the hearing in spite of getting a subpoena, which he is now attempting to quash in court. The SCI stated it will continue to seek his public statement.
Michael Symons is the Statehouse bureau chief for New Jersey 101.5. You can reach him at michael.symons@townsquaremedia.com
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