Pennsylvania Agencies Praise Passage of ‘Patient Brokering’ Provision in Federal Opioid Law

December 3, 2018

Officials from the Pennsylvania Department of Drug and Alcohol Programs and the Insurance Department have commended U.S. Congress for including a patient brokering provision in the recently passed Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act.

Under the new federal law, it is illegal for anyone to solicit or receive any remuneration, directly or indirectly, in cash or in kind, in return for referring a patient to a recovery home, clinical treatment facility or laboratory.

It is also illegal for anyone to pay or offer remuneration to induce a referral. The law carries punishment of fines up to $200,000 or imprisonment for up to 10 years, or both, for each occurrence. The law contains exceptions for legitimate insurer relationships with treatment, recovery and laboratory facilities.

“Families’ desperate to help their loved ones can fall prey to unscrupulous people preying on them and luring them to facilities that may provide little or no treatment, and can lead to more problems, including financial ruin, and even death,” said Pennsylvania Insurance Commissioner Jessica Altman in a press release issued by the department. “Despite the availability of treatment centers in Pennsylvania, recruiters will often use the attraction of a sunny climate, free air travel, covering insurance payments and a fresh start to lure people in need of treatment to facilities in other states, particularly Arizona, California and Florida.”

A survey of Pennsylvania’s major health insurers, which cover approximately 70 percent of the commercial health insurance market, shows 7,157 Pennsylvanians, or nearly 17 percent of all Pennsylvanians receiving substance use disorder treatment under insurance coverage from these insurers, received substance use disorder treatment out of state over the past two years, according to the release. The release outlined several things to look for to avoid falling victim to an out-of-state addiction treatment scam, including:

  • Any unsolicited referral to an out-of-state treatment facility;
  • Someone offering to pay for airfare or other travel expenses to an out-of-state facility;
  • Someone offering to pay for insurance coverage;
  • Someone asking for personal information, such as a Social Security number or insurance policy ID number.

Solicitors may also attempt to lure someone to a recovery or sober home, so it’s important to be wary of homes claiming insurance will pay rent or other costs of staying at these homes because they provide no medical treatment and do not receive payment from insurance, according to the release.