Four bills aiming to clean up California’s notoriously under-regulated addiction treatment industry landed on the governor’s desk last month — a meatier batch than had ever made it through the Sacramento sausage grinder before.

Suspense rose to a fever pitch over the weekend as the last sands slipped through the legislative hourglass — and then Gov. Gavin Newsom vetoed two of the bills and signed two others, triggering a combination of elation and disappointment in reformers.

The successful new laws will put some teeth into a ban on “body brokering” — the unsavory practice of paying for patients — and limit the ability of financially interested third parties to buy health insurance policies for patients.

One of the vetoed bills would have taken major steps to reform outpatient centers —  where the vast majority of addiction treatment happens in California — by requiring them to be licensed and meet minimum standards. The other would have prohibited rehabs and sober homes from false or misleading advertising, like telling people they’ll be “cured” in just 30 days.

Batting 500 on the treatment reform front was Assemblywoman Cottie Petrie-Norris, D-Laguna Beach, who authored the successful Assembly Bill 919 as well as the vetoed AB 920.

“I’m very pleased that we’re taking meaningful steps forward, and I’m disappointed, but not despondent, about the veto,” she said. “The governor noted in his veto message that he does support our intent — to license all substance use disorder treatment services — and we’re getting to work right now to address the concerns the administration raised.”

Newsom’s vetoes do not quibble with the big ideas behind the bills, but rather with the devilish details.

“There’s a clear pathway forward on mine,” said Sen. Pat Bates, R-Laguna Niguel, who wrote Senate Bill 589, which targeted false advertising. “We’re not giving up — we just have to thread the needle. There’s some good direction on that.”

On the books

Newsom signed AB 290, by Assemblyman Jim Wood, D-Santa Rosa, which reduces the financial incentive for treatment providers to lure people to California by promising “free” insurance coverage.

Primarily directed at kidney dialysis schemes, the proposal also reins in addiction treatment centers that lure patients from other states, sign them up for private health insurance policies and pay those premiums. That allowed the centers to bill insurers what was often hundreds of thousands of dollars, while paying a fraction of that in premiums.

“Consistent with our imperative to address rising health care costs, I am signing Assembly Bill 290,” Newsom said in a signing letter. “This bill removes financial incentives for providers to steer patients into specific health care coverage by providing that certain health providers, including dialysis clinics and substance use disorder treatment centers, be reimbursed at Medicare rates for services rendered to patients who receive premium assistance.”

Real charities will continue to help people who need help, Newsom wrote.

Petrie-Norris’s AB 919 promises to crack down on financial conflicts-of-interest among rehab operators by limiting how they offer housing and transportation as inducements to treatment. It will require that laboratories that test blood or urine for drugs, or outpatient treatment programs that offer housing to clients, have separate housing contracts specifically stating that payment for housing is the patient’s responsibility and rent should not be indirectly billed to health insurance. The practice has become common in the industry.

It also empowers the Department of Health Care Services to provide enforcement with seven new positions, costing $1.2 million the first year and $1.1 million after that.

Paths forward for vetoes

In his veto message on Bates’ SB 589, Newsom said, “While it is important to protect vulnerable patients and their families from unethical marketing practices, I am concerned that as crafted, this measure creates a false promise.

“The Department of Health Care Services has no jurisdiction or licensing oversight over recovery residences or third parties. As such, it cannot take enforcement against those entities for violations of advertisement requirements.”

Recovery residences is another term for sober living homes — just groups of recovering users who live together as families to support one another in sobriety. They are not licensed or regulated in any way, and are considered by many to be beyond the reach of government regulation because of protections afforded by the federal Americans with Disabilities Act. Addiction is considered a disability under the law.

In that distinction, Bates sees the way forward.

“They’re specifically staying away from the sober living homes,” she said. “They’re basically retreating from touching that particular area because they anticipate litigation. We have, and continue to have, litigation when anything relating to overseeing the sober living homes comes up.

“There’s a pathway on mine, dropping the specific reference to recovery homes,” she said.

Assembly Bill 920, by Petrie-Norris and Sen. Jerry Hill, D-San Mateo, would have ushered in the biggest change — requiring outpatient centers, which are now completely unsupervised by the state, to be licensed and regulated by the Department of Health Care Services. It was named to honor Wendy McEntyre ‘s son Jarrod, who died of an overdose in a sober living home in the San Fernando Valley in 2004.

Outpatient centers would have been required to adopt the American Society of Addiction Medicine’s treatment criteria as the minimum standard of care, steering the industry toward a more medical approach, rather than the 12-step social model that currently dominates and rarely succeeds. The bill was modeled after Hill’s SB 823, requiring the same rules of live-in treatment centers, which was signed into law by Gov. Jerry Brown last year.

In his veto message, Newsom said that “developing a new licensing schema is a significant undertaking, and would require a significant departure from the bill as enrolled.”

“We’re working to have something that is comprehensive and addresses all the details required to implement this,” Petrie-Norris said. “I feel like we’ve been caught in a bit of a Catch 22. Because this has been an area with no regulation and no oversight at all, it’s a yawning chasm. We’re not trying to tweak something on the margins — we’re trying to create something where nothing exists.”

This year’s crop of legislation was the most far-reaching to make it to the governor’s desk to date.The action comes in the wake of the Southern California News Group’s ongoing probe of death, sexual assault, drug abuse and paying for patients inside California’s addiction treatment industry.

Move over, Elmo; Karli has arrived on Sesame Street, and her mom is struggling with addiction.

In another bold stroke for the beloved children’s show, the nonprofit Sesame Workshop launched Karli‘s complicated story online in October. The fuzzy green monster, age 6½, is in foster care as her mother works toward recovery, and wrestles with her own powerful feelings of isolation, fear, shame and guilt, much like the 5.7 million children under age 11 who live with parents struggling with substance abuse disorder.

With the loving support of Elmo, other Muppets and a few humans, Karli learns that she’s not alone, that she’ll be cared for, and that addiction is a sickness where people need help to get better.

But perhaps the most important message she hears lifts the heaviest weight from her small monster shoulders: Her mom’s woes aren’t her fault.

Jerry Moe is, in a way, one of Karli’s creators.

Moe is national director of Hazelden Betty Ford Children’s Program, and an advisory board member for the National Association for Children of Alcoholics. Last year, while in the Minneapolis-St. Paul airport, Moe got an unexpected text: “The people at Sesame Street want to talk to you.”

Moe — who spoke this month in Anaheim, at the California Community Opioid Crisis — had one thought: “Who’s scamming me?”

Nobody, it turned out. Moe has an expertise that Sesame Street wanted to tap. The author of “Through a Child’s Eyes: Understanding Addiction and Recovery” also is the creator of created the Seven C’s, a healing program for children:

“I didn’t cause addiction. I can’t control addiction. I can’t cure addiction. But I can help take care of myself, by communicating feelings, making healthy choices and celebrating me.”

It’s a mantra for children, like Karli, whose parents are controlled by addiction. And the work clearly struck a chord with the creatives at Sesame Street. Karli’s story incorporates much of Moe’s work.

While some have criticized Sesame Street’s effort, saying the show’s viewers — typically ages 3 to 5 — are too young to be exposed to the life and death theme of addiction, Moe believes those kids need the support.

Once, he was one of them.

“One of every three or four kids out there is growing up loving someone who has addiction,” Moe said. “When you think about opioid or meth or alcohol addiction, you don’t think about kids. But children are the first hurt and last helped. It’s a population we don’t give enough attention.”

Soon after the call, Moe became an adviser to Sesame Street. It’s something he calls “bucket-list stuff for me.”

“We really got to guide the process, sit with them and talk about what language to use,” Moe said.

The overall vibe, he added, was thrilling.

“Being on the set of Sesame Street, hanging out with Elmo, trying to be this mature adult who’s a children’s counselor, (was) an unbelievable feeling. Chills.”

Throwing rocks

At the famous Betty Ford Center in Rancho Mirage, Moe runs four-day workshops for kids caught in addiction’s web. It’s open to all kids, he said; they don’t need to have a parent in treatment to attend. And Mrs. Ford set up financial accounts to ensure that no child would be turned away for lack of funds.

They start by playing — tossing a Koosh ball on a string, colorfully decorating folders, sticking pins in a map of the United States as a fun way to see how far some of the kids have traveled to be there. Then they talk.

Everyone there has been hurt by a loved one’s drinking and drug use.

Counselors try to help the kids separate the people they love from the disease that consumes them. To do that, they use metaphors that kids can understand: People, even parents, can get hooked like a fish and can’t get away. And being hooked is like getting gum stuck in their hair; now they need help to get it out.

There’s a backpack filled with 41 pounds of small rocks, each painted with a word: “Hurt.” “Guilt.” “Shame.” “Fighting.” “Abuse.” The kids are urged to try to lift the backpack to feel its heft. Their parents, the kids are told, are carrying this. Some start drinking and using drugs because they don’t know how to get rid of it. And at first, the drinking or the drugs puts the bag to sleep. But when that feeling wears off, the grownup has to pick up the bag again — only now it weighs more.

The kids are encouraged to talk about how it can hurt to have an addicted parent — the broken promises, fighting, chaos, disappointment.

“Because of the chaos and uncertainty you’ve been living through, you’ve got your own bag of rocks,” they’re told. They’re asked to take the rocks out of their bags, releasing the sadness, anger and fear they’ve been carrying.

The older kids also are warned that addiction runs in families, and the only way to be certain they won’t get trapped is to never smoke, drink, or use drugs.

Parents and grandparents participate the last two days. The kids can say “I love you…I don’t want you to die.”

The program gets referrals from the child welfare system, from the courts, from other treatment programs. Anyone interested can call 760-773-4291 for more information.

Moe puts it simply: “The only difference between the kids and their parents or grandparents is that those adults are yesterday’s kids that nobody helped.”

California reboot

Officials from Hazelden Betty Ford have been pushing California to tighten up its notoriously lax regulation of the addiction treatment industry, where success — and failure — trickles down to kids.

A year ago, in a five-part series of news stories, the Southern California News Group probed the links between addiction and the child welfare system. It found that while California social service agencies see addiction as a contributing factor to just 12 percent of the state’s child welfare cases, the reality is that addiction is key to as much as 80 percent of those cases, according to several studies and child welfare experts.

Moe was hired by the state of South Carolina as a consultant more than 20 years ago. They worked with a Madison Avenue advertising firm that created the public campaign, “Alcohol abuse. Drug abuse. Child abuse. One thing often leads to another.” California, Moe suggested, might do well to follow that example.

“Just as social welfare needs to ask that question — ‘Is there an issue of substance use disorder in the family?’ — we always have to ask the question, ‘What about child maltreatment?’ We know those two things go together,” he said.

The Sesame Street initiative on this topic is an enormous leap forward, he said. In addition to Karli, it includes articles on how professionals can help these children, how parents can start rebuilding trust, as well as storybooks and interactive coloring.

But right now, Karli’s story unfolds on the online version of “Sesame Street,” not on the TV program piped into millions of homes.

“My hope is that, somewhere down the line, the character can be on the air,” Moe said. “That has been a dream of mine from the beginning.”

But as everyone involved with addiction well knows, it’s one step at a time.

Five people have been arrested in connection with an alleged $3.2 million sober living home fraud scheme that preyed on vulnerable substance abuse patients to swindle millions of dollars from an insurance company, authorities announced Friday.

Taken into custody this week were Steven Lomonaco, 61, of Laguna Beach; Mahyar “Christian” Mohases, 37, of Santa Ana; Robert Williams, 41, of Murrieta; Nicholas Reeves, 42, of Aliso Viejo; and James Frageau, 29, of Temecula. They have been charged with multiple felony counts, including insurance fraud and money laundering, in connection with joint investigative efforts by the Orange County District Attorney’s Office and California Department of Insurance.

In addition, Mohases, Williams, Reeves and Frageau have each been charged with two counts of committing medical insurance fraud, one count of fraudulent written claim to an insurance company, two counts of money laundering in excess of $150,000, four counts of money laundering, and one enhancement for aggravated white collar crime over $200,000, according to authorities. They each face a maximum sentence of 14 years in prison if convicted on all charges.

Lomonaco also has been charged with two counts of committing medical insurance fraud, one count of fraudulent written claim to an insurance company, one count of medical insurance fraud, and one enhancement for aggravated white collar crime over $200,000. He faces a maximum sentence of eight years, four months if convicted on all charges.

“Sober living homes are valuable resources designed to facilitate recovery and healing for patients battling potentially life-threatening addiction issues,” Orange County District Attorney Todd Spitzer said in a statement.

‘Exploited their addictions’

“Instead of helping these patients, these individuals preyed on extremely susceptible people and exploited their addictions for profit. Working closely with the California Department of Insurance, we are cracking down on these criminals and their predatory operations in order to protect substance abuse patients from unknowingly being trafficked, as well as protect their loved ones and insurance companies from these unscrupulous operators.”

Mohases, Frageau, Williams and Reeves allegedly found patients from throughout the United States seeking help for substance use recovery and then flew them to California to enter treatment at Casa Bella International Inc., which was owned and operated by Lomonaco, authorities said.

Then, to obtain payments from an insurance company that was not identified, Mohases, Frageau, Williams and Reeves allegedly directed employees to fill out policies for these patients using false information.

The defendants also are accused of orchestrating a massive money-laundering scheme by filtering funds through a nonprofit, StopB4UStart, by providing so-called donations from Mohases, Frageau, Williams and Reeves from their corporation, Nationwide Recovery.

“These ‘donations’ would be cashed out, and the owner of StopB4UStart would receive cashier’s checks in specified amounts based on the information he received from one of the other co-conspirators,” authorities said in a statement. More than 800 checks in total were used to pay the insurance premiums on the fraudulent policies.”

Actions ‘appalling’

California Insurance Commissioner Ricardo Lara, who carried a bill prohibiting body-brokering when he was a state legislator, described the alleged offenses committed by the defendants as “appalling.”

“These suspects trafficked vulnerable substance abuse patients to California just to make a quick buck from the insurance company, with no regard for their lives, health or recovery. Thanks to the efforts of Department of Insurance investigators, and our close work with District Attorney Todd Spitzer’s office, there is one less fraud ring preying on unsuspecting patients.”

Mohases, Reeves and Frageau have been released on bail from the Orange County jail. Details about whether Williams and Lomonaco are in custody were not immediately available Friday.

Casa Bella Recovery has been battling HealthNet in court for nearly three years, with Mohases and Lomonaco named as cross-defendants. Among other things, the litigation raises the question of whether referral fees — the common industry practice of paying someone to find clients, often on retainer — is a simple business practice or a matter of fraud.

“We’re not quite sure yet what the facts they’re alleging are,” said Jack Earley, Lomonaco’s attorney. “At this point, he maintains his innocence.”

Lomonaco was looking forward to clearing up the issues in the HealthNet proceedings, and now is looking forward to doing that here as well, Earley said.

Attorneys for the others did not immediately return requests for comment Friday.

Rehab Riviera

Orange County and the Greater Los Angeles area are so dense with addiction treatment and sober living facilities that it’s known as the Rehab Riviera.

Over the past several years, the Southern California News Group has chronicled disturbing reports of deaths, sexual assault, drug abuse and paying for patients inside California’s loosely regulated addiction treatment industry. Those reports have prompted federal probes, the Orange County task force that made these arrests, a sober living registry and new state laws designed to protect vulnerable people struggling with addiction.

Lawmakers are working on a major overhaul of the industry they hope to introduce this year.

Law enforcement appears to be taking the issues more seriously as well. In October, federal agents raided four addiction treatment centers in Los Angeles and Orange counties, seeking evidence in a criminal probe.

A strong social support system is vital to maintaining sobriety for those struggling with addiction, study after study has found.

So how does one do that in the age of coronavirus?

“Addiction is an illness of isolation, and the antidote is community,” said William Moyers, a vice president for Hazelden Betty Ford, the nation’s largest and most esteemed nonprofit treatment empire.

“This is an unprecedented moment in the addiction treatment and recovery field. Never before have we encountered a pandemic of this nature that not only jeopardizes lives, but turns topsy-turvy everybody’s routine.”

Social distancing means that large 12-step meetings — the lifeblood for many in treatment and recovery — are being canceled throughout California and the nation, adherents said. Those meetings are typically held in churches and at community centers and each serves scores, if not hundreds, of people.

But smaller meetings are continuing — in little churches, in coffee shops and restaurants, at public beaches — but with new twists, said the office manager at Orange County Alcoholics Anonymous.

“No holding hands during prayer, no hugging,” said the manager.

Online meetings also are available for people who can’t get out or are reluctant to gather in groups of any size just yet. Visit aa-intergroup.org/ for details on how to join a virtual meeting.

Patients in treatment at the Hazelden Betty Ford centers are no longer taken to 12-step meetings off their campuses, Moyers said. “Virtual care” — interacting clinically via phones and computers — is expanding. Temperatures are monitored regularly for patients, the family members who visit them, vendors making deliveries, staff taking care of them.

“It’s complicated, laborious and necessary,” Moyers said.

And for folks like him — long out of treatment but forever in recovery — finding a way to maintain social support amid social distancing is a matter of survival.

“It’s really important that people in recovery stay connected, even if remotely,” he said. “People feeling lonely, isolated, upset — it’s important they ask for help. Reach out to fellow travelers by phone or text and say, ‘Hey, I’m struggling.’ What’s going to get us through this pandemic is the same that thing that gets us through addiction — stick together and pull in the right, and same, direction.”

Nearly overnight, the Hazelden Betty Ford Foundation switched 1,300 patients from traditional face-to-face addiction treatment to an online platform that, just days earlier, was viewed as a pilot project.

Men joining the Beacon House addiction recovery community in San Pedro are quarantined in separate quarters for up to three weeks before they’re allowed to join the regular houses. After that they live in two- to three-man “pods,” remaining as isolated as possible from other pods.

At New Directions for Women in Costa Mesa, clients are getting used to wearing face masks, having their temperatures checked by staffers in medical PPE, and attending 12-step meetings online.

“I’m a big 12-step gal,” said Nancy Clark, who has run in- and out-patient treatment in Newport Beach and Costa Mesa since 1990.

“Even though we’ve added a lot of the bells and whistles, basically, recovery takes place wherever two or more are gathered, and it relies on one giving and sharing with another,” Clark said.

“So we’re using technology. We’re Zooming. A lot of social distancing; we’re never all gathered together — no visitors, no potluck dinners,” she added.

“This is what we have to do today. Tomorrow? We’ll figure it out tomorrow. If anybody can live one day at a time, it’s my people.”

Addiction, she said, doesn’t stop for a pandemic.

Crisis, rising

The U.S. Substance Abuse and Mental Health Services Administration has urged addiction treatment centers to move as many people into out-patient treatment as possible to reduce the spread of COVID-19. Live-in, residential treatment has proven to be no more effective than outpatient treatment for addiction, SAMHSA said, and responsible providers are doing just that.

But outpatient treatment — where patients live at their own homes and attend counseling and education sessions at the provider’s location several times a week — isn’t an option for everyone, operators say.

Some need medically-overseen detox, like what’s offered at the Betty Ford Center in Rancho Mirage. Some were once homeless and have nowhere else to go, like at Beacon House. And home remains a dangerous place where abusers still live, or where bad influences and deadly temptations still lurk and fester, for others.

Most expect the need for treatment to jump during this time of great stress and uncertainty.

Calls to SAMHSA’s Disaster Distress Helpline (1-800-985-5990, a 24/7 national hotline dedicated to immediate crisis counseling) saw calls jump 338 percent between February and March. Call volume was up 891 percent in March, over March of last year.

At the same time, market researchers reported that online booze sales skyrocketed 243 percent since lockdowns began in mid-March. Overall, sales of alcoholic beverages rose 55 percent.

“Half of Americans say this has had a major impact on their mental health,” said Christopher Yadron, West Region vice president for the Hazelden Betty Ford Foundation.

“And addiction is such an isolating disease. I’d expect, as restrictions lift and hopefully the COVID-19 transmission rates continue to flatten and decline, to see more demand.”

Licensed programs can seek permission to treat more people than their licenses would otherwise allow, according to the state’s emergency guidelines.

Virtual sobriety

Hazelden Betty Ford offers several different levels of care, from 24/7 inpatient services to varying levels of outpatient treatments

that combine education, therapy and support. Just a couple of months ago, the organization was testing RecoveryGo, a new, virtual outpatient platform to deliver treatment to people online.

Then came the pandemic.

“We just said, ‘We don’t want to interrupt care for people,’ ” Yadron said. ” ‘So we’re going to flip the switch on all of this and figure out the details as we go.”

So far, the virtual program has been running fairly smoothly. When there are technical glitches, people have been understanding, he said. Virtual support and programming for children and family members — an important part of the program — is also operating as well.

Residential treatment now looks very different, with intake staffers clad in masks and gloves. It includes a new layer of questions: Have you been traveling? Where? When? Have you been exposed to anyone who may have had COVID-19? Do you have a fever or cough?

At Hazelden Betty Ford, new patients also get a molecular diagnostic test — the one that swabs inside the nose and throat — to find out if they have the virus.

Off-campus quarantine houses are now the first order of operations for places like New Directions and Beacon House. At Nancy Clark’s properties, no visitors are allowed.

Everywhere, meetings once held out in the world are now held only online. Every medical appointment that can be done virtually is done via virtually. Staffers who can work remotely are working remotely, while the rest are clad in face masks, gowns and gloves. Surfaces are regularly sanitized. Temperatures are taken, logged and tracked. The biggest excursions are walks through the neighborhood, with all participants wearing masks and walking six feet apart.

The new rules have been particularly hard for Beacon House, where work is an integral part of the recovery program. Its store is shut down. Job contracts are on hiatus. And tens of thousands of dollars in income has disappeared.

“We’re trying to take advantage of this time and build out our online sales. We do have a couple of catering contracts that we’re maintaining, but there’s no interaction with the community,” said spokesman Mitch Harmatz. “That’s tough for some of the guys.”

Clark’s program has its own apartment complex, which affords privacy and supports social distancing. “We’re never all gathered together,” she said. “We’re Zooming yoga; Zooming nutrition. And when we Zoom, each person is in a separate room Zooming on their own device.

“What we’re not Zooming is individual counseling sessions,” she added. “That’s mask and social distancing.”

At New Directions, where the pandemic has put its main fundraising event on hiatus, the women have been amazingly creative, said Executive Director Sue Bright.

“As you can imagine, they’re very closely knit right now, leaning on one another and the staff in a much more intimate way,” she said. “My fear is for not them so much. I worry more for those who haven’t gained access to treatment services.

“This (pandemic) has given those who suffer from substance use disorder the opportunity to have a free-for-all,” Bright said. “They don’t have to show up at work, drive anywhere, be responsible for the most part.”

Outreach

That’s a worry for people in treatment as well.

“The world was a crazy, busy place even before,” said E.M., a client at New Directions, in an emailed statement. “Being in treatment helps me stay calm, clean and sober. I live with other women whose goals are the same as mine: To take each day as it comes. We watch our meetings online and the staff is available around the clock. We have a smaller group of women here than usual, that’s just how it goes for now.

“I’m concerned about the alcoholics and addicts out there, sitting at home, not getting the needed help as we are,” she said.

“If I were to go home now, into the craziness, I couldn’t guarantee that I would still be clean and sober… I’m right where I need to be at the right time.”

With an eye to that stress, outreach to alumni has increased as well, said Tania Bhattacharyya, executive director of the New Directions For Women Foundation.

Treatment providers stress that, even through COVID-19, help is available. Some patients say that’s saving their lives.

“With everything going on, it is so important to be in treatment with supportive people, rather than being out on the streets drinking in an unsafe environment,” said B.V. in an emailed statement.

“Being at New Directions for Women right is the best place I can be because otherwise I would be blowing all my $ at one of the many liquor stores that are staying open during this lockdown.”

Before landing in the Orange County Jail, they were remodeling a $3.2 million mansion — with “jetliner” views of the Pacific Ocean, Santa Monica mountains and downtown Los Angeles; complete with lap pool and wine cellar — high in the hills of Brentwood.

They had high-priced cars. Expensive purses and jewelry. Eclectic art. Bars of silver and gold.

But the lifestyle enjoyed by Dr. Randy Rosen, girlfriend Liza Vismanos and their two children was built on the backs of often-desperate drug users eager to make a buck however they could — even if it meant enduring unnecessary surgeries, getting unnecessary lab tests and receiving unnecessary injections for inflated prices, according to Orange County prosecutors.

Rosen ran Wellness Wave, a surgical center in Beverly Hills, and Vismanos owned Lotus Laboratories, a toxicology lab in Los Alamitos. Over the course of just a few years, they billed health insurance companies $676 million for medical procedures and tests and collected $52 million in reimbursements, according to court documents that paint a picture of unrepentant greed and callous disregard for human suffering.

A slice of the money they brought was used to pay so-called “body brokers,” also known in the rehab industry as “junkie hunters” — usually recovering users who recruited other addicts for unneeded medical procedures. Those recruiters got kickbacks of some $12 million for their troubles, according to prosecutors.

And a smaller slice of the money went to the users themselves, as recompense for the use of their insurance cards and their bodies. Some got just a few hundred dollars, often withdrawn from ATMs after the procedures were complete. Others got $2,500 or more.

“The procedure takes me less than 5 minutes. So on an hourly that would be about 120k. Lol,” Rosen wrote a text message to one of his body brokers, according to court records.

In another exchange, Rosen wrote of billing $18,400 for a single injection on a single patient, and how he’d get another $10,000 for an MRI that was never performed. “I guess I did an MRI but he didn’t really have any findings.-Lol”

Rosen and Vismanos have been charged with dozens of felony counts of insurance fraud and related crimes. They have pleaded not guilty. Vismanos posted a $100,000 bail bond on July 15 and was released; Rosen remains in the Orange County Jail.

‘Manslaughter?’

A disheveled Rosen sat in the jury box at his preliminary hearing of Monday, July 20, black glasses perched crookedly atop his white face mask, unruly salt-and-pepper stubble blanketing his cheeks. Beneath his orange jail uniform, a chain snaked around his waist. His handcuffs were attached.

That image of the mighty doctor brought low is small comfort to parents like Debbie Berry of Ashland, Missouri, who wants to make sure Rosen never practices medicine again.

“My first question was, ‘Is he going to be charged with manslaughter?’ ” asked Berry, whose son Brennen died with a naltrexone implant inside him in February 2018. Two months earlier, Rosen billed $59,000 to Berry’s insurance for the procedure.

Naltrexone binds to the brain’s opioid receptors, blunting an opioid high. It’s designed to be part of a comprehensive program to address addiction, not as a cure in and of itself. But prosecutors say that’s not how Rosen used it. Instead, they say, he performed as many as 72 procedures in a single day, with the quickest surgery lasting just one minute.

“Paying for patients turns the patients into a commodity and treats them as ATM machines. The doctor ends up treating the patient as a way to make money instead of treating the patients’ best interests,” prosecutors said.

Berry learned that her son was paid $1,000 to get the implant.

“To me, if you give an addict something like that, they’re just going to do more to get the buzz,” Berry said. “My son thought he had that security blanket in him, that it would save him. And it didn’t.”

Brennen Berry died after using heroin laced with fentanyl in 2018. He was 22.

Rosen’s attorneys declined comment on the case, and did not respond to requests for comment on assertions he should face more serious charges.

The scheme

In the wake of the Southern California News Group’s disturbing probe of fraud and death on the “Rehab Riviera,” Orange County District Attorney insurance fraud investigators Todd Franssen and Domingo Cabrera began probing addiction recovery schemes in 2018. It didn’t take long to find a group of body brokers trolling Orange County sober living homes, offering cold, hard cash to recovering addicts with good insurance.

Jeffrey Koelsch of Oklahoma City was one of those lured in. He came to California for treatment and moved into a sober living home, where the house manager hooked him up with “Lizardo,” one of Rosen’s brokers. Koelsch soon went to Beverly Hills for the surgery and was paid $400, prosecutors said.

Kari Sollenberger was lured in as well. She was paid $1,200 for getting the implant and agreeing to complain of back pain to justify a cortisone injection. Her insurance company was billed about $87,000, prosecutors said.

A big break for investigators apparently came when Josiah Shafer, one of Rosen’s body brokers, was granted immunity in exchange for his cooperation. Investigators downloaded Shafer’s cell phone, providing a trove of detail that included surreptitious audio recordings and thousands of text messages, prosecutors said.

Shafer worked with Rosen from April 2017 through October 2018. He said Rosen knew patients were paid and actually encouraged brokers to pay even more because another facility — SoberLife, where similar charges were soon levied — was outbidding them.

The workflow was pretty simple, according to court documents. Shafer and other brokers took photos of a prospective patient’s ID and insurance card. Wellness Wave staff determined if insurance was likely to pay. If so, surgery was scheduled. Though the naltrexone implant could be done as a simple outpatient procedure — costing as little as $4,000, including pre-care and followup care — Rosen required them to undergo riskier general anesthesia, and billed for tens of thousands of dollars.

“The purpose of this scheme was to collect as much money as possible, not to care for the patient,” prosecutors said. “As is clear, there are no medical personnel or doctors involved in this process; it almost entirely consists of recovering addicts recruiting other addicts to undergo this procedure for money.”

To avoid the appearance of a doctor paying large amounts of money directly to recovering addicts, the brokers formed various businesses. Rosen paid those entities based on the number of patients referred and the cut of insurance proceeds everyone had agreed to on the “back end,” which could be as high as 25%.

“We have a great thing going and we don’t want to mess things up with something stupid. We are flying nicely under the radar,” Rosen said in a text on Aug. 20, 2017, according to court documents.

But by the end of 2018, word had gotten out that Shafer was talking to authorities. “Rosen will literally have him killed,” a broker texted. In later exchanges, prosecutors say Rosen wrote: “better he dies than gets arrested,” “why won’t he just die” and “hopefully he will go on a bender and that will be it.”

Major risks

Addiction medicine specialists say that the risk of a patient overdosing after a naltrexone implant is real.

Users seeking a high may take opiates despite the implant, and won’t feel the euphoria because naltrexone is already bound to the brain’s opioid receptors. So they do more and more, unable to gauge how much is in their system, until there’s so much in the system they stop breathing.

Opioid users suddenly cut off from the drug of choice might also start experimenting with new drugs, which carries other risks. That’s one reason why comprehensive follow-up care — medical and behavioral — is so vital in managing addiction, experts said.

DA Investigator Franssen will testify that Rosen’s patients never received follow-up care, prosecutors said. And Berry, Brennen’s mother, feels certain that lack of follow-up played a role in her son’s overdose death, and in the deaths of many others.

“We thought we were doing the right thing by sending our child to another state for treatment,” Berry said. “Then you have these people who don’t care about any part of another human; this person who spent years going to school, taking an oath to heal and protect people….” her voice trailed off.

“He helped bury children. He should be held accountable.”

Hard to prove

From the prosecution standpoint, insurance fraud offers the cleanest path to conviction on a case like this, legal experts said. Trying to forge a causal link between implants and later overdoses could be difficult: Patients typically sign consent forms, whether they understand them or not.

“Historically in the United States, we’ve been very slow to use criminal law tools in order to pursue justice involving doctors who have harmed people,” said Michele Bratcher Goodwin, Chancellor’s Professor of Law at UC Irvine and founding director of the Center for Biotechnology and Global Health Policy.

Doctors and even drug companies also tend to be lionized: “They’d never do anything to intentionally harm patients” was a refrain she heard often back in 2010, as opioid prescriptions, and abuse, were raging.

And when the people harmed are at the bottom rungs of society — drug users, as here, or poor Black men with syphilis, as in the infamous Tuskegee experiment — the law doesn’t seem able to keep up, Goodwin said.

“We have not been engaging in that space of human exploitation, that Frankensteinian, profit-driven trafficking of people’s bodies,” she said.

“If a pimp or a john was doing it, we’d know how to prosecute.”

But sometimes such prosecutions happen. Michael Mastromarino, a former dental surgeon nicknamed “the Body Snatcher,”  built a multi-million dollar business buying dead bodies from funeral homes and selling bones, organs and tissue to medical companies without the families’ consent. Some of the dead had cancer or HIV — diseases that would prohibit such donations — but Mastromarino forged paperwork so he could profit nonetheless.

“It’s not exactly obvious what to charge someone with in a case like that,” said Goodwin. “But a plucky DA was able to find a way.”

Mastromarino pleaded guilty in 2008 to numerous charges of enterprise corruption, reckless endangerment and body stealing. He was sentenced to 15 to 30 years in prison.

“A crusading, courageous DA could take that on,” Goodwin said. “It could be now.”

From the boy’s obituary: “Alexander Hastings Neville, 14 years old, died on 23 June 2020 due to an overdose of fentanyl — a drug he mistook for something else.”

Alex was a smart, sensitive, curious kid, prone to a philosophical and distinctively teenage anxiety. He had recently switched schools, was learning online due to the pandemic. He also used pot as a way to, as his parents see it now, self-medicate. In classic style, Alex learned the pharmacology and horticulture of hemp.

The day before he died, Alex sat down at their kitchen table in Aliso Viejo and told his parents he was taking Oxycontin. That little pill designed to eliminate pain. The one that induces a euphoria so powerful it has addicted millions around the globe.

It had been less than two weeks, but he was done, Alex said. He wanted to return to the Long Beach treatment program where he went months earlier to deal with his anxiety, to get back on track. His parents made the call. Everyone felt hopeful.

The next morning, Alex’s mom tried to wake him for a dental appointment. She couldn’t. She called 911 — and held back his 12-year-old sister — as Alex’s dad performed CPR. Alex was pronounced dead at the hospital.

He’d be starting his first year of high school right now.

Deadly masquerade

Though Alex’s autopsy is not complete, authorities told his parents they found a pill containing fentanyl — not Oxycontin — in his room. Fentanyl is a powerful synthetic opioid that’s 50 to 100 times stronger than morphine. It’s manufactured on the cheap and sold on the street, masquerading as the real thing. A single pill can pack enough fentanyl to kill.

“You read about opioid overdoses and you think it’s people taking too many Oxycontin pills, drinking and partying,” said Aaron Neville, Alex’s father. “This isn’t that. This is more like poison. This is people being killed. It’s accidental, but it’s almost like murder.”

Another 14-year-old, Scotty Hemstreet of Hermosa Beach, died Aug. 3 under similar circumstances.

“It’s important to know that Alex was a normal kid,” said his mother, Amy Neville. “These kids, they feel invincible. It won’t happen to them. They’re at a party and a friend has these pills, and it’s a good friend and they trust them. We need these kids to understand that one mistake can cost you your life.”

Carnage

Drug overdose deaths are rising in many parts of California in this weird pandemic year, and fentanyl is responsible for more and more of the carnage.

According to the U.S. Drug Enforcement Administration:

• In 2013, only 3% of overdose deaths in Los Angeles County involved fentanyl.
• In 2018, fentanyl was involved in nearly 25% of overdose deaths.
• In 2019, fentanyl contributed to about 33% of overdose deaths.
• And in March and April — the first two months of the pandemic — 50% of overdose deaths involved fentanyl.

The Los Angeles County Department of Public Health’s data shows that drug overdose deaths leapt 29% in the first four months of this year over the same period last year.

But zero in on March 21 through April 30 — after the stay-at-home order was issued — and accidental overdoses skyrocketed 50 percent over the same period last year.

In Riverside County, deaths overall are up this year compared to the previous five. “Overdose deaths in youths, age 15-24 years and emergency department visits due to overdose in 2020 is concerning,” officials said in a recent presentation. “Most overdose deaths in youth involve fentanyl.”

In Orange County, a preliminary analysis shows that overdose deaths were similar from January through March of 2019 and 2020, but too many pending cases make it hard to say anything definitive, said Curtis Condon, research manager for the OC Health Care Agency.

In San Bernardino County, overdose deaths appear to have declined in the first few months of the year.

Barriers fall

Back when Bill Bodner was a kid, in the 1970s, opioid addiction meant shooting heroin straight into your veins. There was great stigma attached, which created a big “barrier to entry,” as Bodner calls it.

Then oxycodone hit the market in a harmless-looking pill. The barrier fell, the stigma essentially disappeared and legions of people became addicted, said Bodner, now Special Agent in Charge of the Drug Enforcement Administration’s Los Angeles Field Division.

As the DEA cracked down on oxy abuse — prescriptions dropped about 30% over the past three years — Mexican drug cartels swept in with counterfeit product to meet the demand. “Fentanyl is the most dangerous drug because it takes so little of it to kill you,” Bodner said.

Authorities are cracking down on dealers who traffic in these pills, sometimes charging them with murder. Eric Kay, a longtime Angels public relations employee, was charged with conspiracy to distribute fentanyl after star pitcher Tyler Skaggs died last year.

But murder is tough to prove, as there must be intent to kill. In the federal system, though, the charge of “drug distribution resulting in death” carries a 20-year mandatory prison sentence, and can be applied even if a person sold just a single pill.

That, however, isn’t likely to keep kids from experimenting, and experimenting is much more dangerous than it was a few decades ago.

“The message we try to get out, to kids especially, is to have something in life that you’re passionate about,” Bodner said. “Don’t let drugs distract you from that passion. Don’t let drugs become that passion.”

Finding a path forward

Alex was passionate, impulsive, introspective, always trying to learn and understand and be better, his parents said.

“He pushed himself to be a better skateboarder, a better gamer, a better Boy Scout, a better fencer, a better student, a better friend, and a better person,” Alex’s obituary says. “Whether becoming Tony Stark when he was 1.5 years old or considering a career as the director of the Smithsonian, he often thought to the future.”

Alex’s parents are tormented by what they might have done differently, and they don’t want this to happen to anybody else.

To that end, they’ve requested nonprofit status for the Alexander Neville Foundation for Opiate Education and Assistance, which plans to give 11-to-17-year-olds the information that might have saved Alex’s life — with a program shaped by the children themselves. They also want to help parents learn how to intervene quickly and effectively when children are experimenting with drugs.

“We want something positive to come out of this,” said Aaron Neville.

An Overdose Awareness walk will be held in Alex’s memory Sunday, Aug. 30, in Laguna Niguel Regional Park. Walkers will meet at the shelter at 10 a.m. The family asks that walkers wear red, Alex’s favorite color, as well as masks, and practice social distancing.

“I had no idea that someone could die from taking one pill,” Aaron Neville said. “I had no idea.”

Timmy Solomon, whose drug treatment odyssey was profiled in Southern California News Group’s law-changing Rehab Riviera series, died in early September.

The 31-year-old overdosed at a house in Buena Park the morning of Sept. 2 and was rushed to La Palma Intercommunity Hospital where he was pronounced dead.

SCNG profiled Solomon in 2017 while he was living on the streets of Orange County, part of the wave of young people dipping in and out of addiction treatment facilities and sober living homes in Southern California.

His mother, Patty Solomon, said at the time that being unable to save her son was an emotional rollercoaster, an ongoing nightmare.

“You are out of your mind with worry,” she had said in a phone call from her home in Boston. “And you don’t know where it ends. Well, you do. It ends with death.”

Patty Solomon is a special education teacher and was at school when she got the news. A doctor was on the phone telling her all the things that he had done to save her son.

She had been here before, on the phone with hospitals aiding her son, and in her mind he had been saved and she was already plotting the next step: Getting him out of the hospital and back in rehab.

And then she heard the doctor say: We did everything we could. But it didn’t work.

“I’m devastated,” she said.

She thought her son was finally sober. He had gotten clean shortly after the Rehab Riviera newspaper series blew up, exposing a multi-billion industry that is often more interested in cashing in on addicts than helping them. Orange County alone had 404 licensed addiction treatment facilities at the time, many of them flying addicts in from around the country to suck dry their insurance money.

Solomon became a sherpa for the story, guiding journalists as he checked in and out of sober living homes, rehabs and hospitals over the course of several months. When the series came out, though, it threw him into the spotlight – and he didn’t like it. He vowed to get clean and stay clean.

Patty Solomon said her son moved in with his girlfriend, got a job as a busboy and started bicycling.

“He had pulled it together,” she said. “He wanted to get married and have a profession. He was paying off his debts, trying to rebuild himself. But it was his inability to cope with things that he had no control over…”

She thought maybe he started using drugs again this summer after he lost a custody battle over his 4-year-old daughter.

Her son’s ashes were expected to be flown home to Boston for a memorial service after an autopsy. Toxicology tests will take a couple months to come back so it is unknown what drug or drugs killed him.

Patty Solomon doesn’t really care what drug it was, though.

“All I know is he’s never coming home,” she said.

And neither are hundreds of other Orange Countians.

As of Aug. 31, the Orange County Sheriff’s Department had recorded 250 overdose deaths. There were 297 overdose deaths by that same date in 2019. But the coroner’s office is backed up; it has 400 deaths pending review. Assuming at least some of those deaths are overdoses, the 2020 overdose toll is likely higher.

“The number could drastically change, considering we have quite a few cases that have not been concluded,” said Orange County Sheriff’s Sgt. Dennis Breckner.

The total number of overdose deaths in Orange County in all of 2019 was 449.

Patty Solomon spoke with her son the night before his overdose. They both said I love you.

“And I said, ‘Timmy, if you make the right choices, it might be difficult, but the right things will happen.’”

She takes comfort knowing she tried to help him, never gave up on him.

“In my heart we know we did everything we could for him,” she said.

She also finds some comfort in phone calls from her son’s friends who tell her he will be missed.

“I just loved the kid,” said David Williams, who ran a Lake Forest sober living house Solomon once lived in.

Solomon was funny and friendly, but he also had a sad side, a dark cloud passenger.

“I’m that clown,” he said in a 2017 interview. “Remember that clown that’s crying and then he’s happy? I’m that clown.”

One day, after shooting a mix of heroin and meth into his arm behind a Dana Point shopping center, he cataloged all the ways his life had gone bad.

He had attended college, he sobbed, and now here he was collecting cans and bottles for money. He had a toddler daughter living nearby whose life he wanted desperately to be part of. And back home in Boston, he had seven brothers and a mother who he loved and had let down.

Patty Solomon hopes that if anyone takes anything away from her son’s story it’s to not be so quick to judge.

“I don’t think people understand,” she said. “Nobody chooses to be a drug addict. Nobody chooses to be homeless. It’s just awful.”

Earlier this summer Solomon had told his daughter that if she ever missed him she could just look up at the moon and say hello.

The night Solomon died, his mother said she looked up in the sky and saw a full moon.

“I said, ‘Hi Tim. How are ‘ya?’”

Dylan Kai Sarantos, 18. Thought he was taking ecstasy. Died May 8 in Los Angeles.

Alexandra Capelouto, 20. Thought she was taking Percocet. Died Dec. 23 in Temecula.

In a donated ballroom in Columbus, Ohio, parents rose to their feet as their child’s name was read aloud. Many had endured the trauma of discovering their babies’ lifeless bodies.

Jessica Shely Filson, 29. Thought she was doing cocaine. Died Jan. 22 in Redlands. 

Alexander Hastings Neville, 14. Thought he was taking OxyContin. Died June 23 in Aliso Viejo.

By the time all 21 names were read aloud and all the parents were standing, tears streamed down the face of U.S. “drug czar” James W. Carroll, director of the White House Office of National Drug Control Policy. “It was a very powerful moment,” said Michael Gray of Long Island, who organized the national meeting on Oct. 26. “We had to wait for him. He was openly weeping, so he couldn’t speak.”

California was over-represented at this somber gathering of parents on a mission — parents whose children were killed by fentanyl, a cheap synthetic opioid some 50 to 100 times stronger than morphine. These kids were not hard-core addicts, their parents say: Many had just started to experiment, or were celebrating birthdays, or were seeking a thrill or trying to self-medicate a diagnosed mental illness. It only took one pill, one line of “cocaine,” one single incident, to kill them.

The ghastly terminology is “one and done,” and these parents are gently but firmly demanding a reboot of how America understands “accidental overdose deaths.”

“There was nothing accidental about Jessica’s death,” said Steven Filson of San Bernardino. “My daughter, and I would venture to say none of them, intentionally ingested something containing fentanyl. These are not overdoses. These are poisonings.”

Forgotten

Much of the huge spike in “accidental overdose” deaths over the last several years hasn’t been fueled by long-time addicts, these parents and number-crunchers say, but by first-time, intermittent and recreational users — “the largely forgotten constituency.”

They’re the casualties of a paradigm shift that began in 2013, when cheap fentanyl from China began showing up in drugs artfully manufactured in Mexico to masquerade, convincingly, as the real thing. Fentanyl has even been laced into marijuana to punch up the high.

Because it’s so powerful, and in the hands of amateurs, fentanyl turns every instance of drug use into a Russian Roulette with four bullets and two blanks, Gray has said. He calls it a weapon of mass destruction and wants nations that export the chemical sanctioned.

Other aching parents simply want it classified as drug-induced homicide and seek stiffer penalties commensurate with the crime.

There’s one thing they all want while legislation is pondered and drafted and debated: A major campaign to educate youngsters — and their parents — about the killer chemical that can render even the most neophyte experimenter “one and done.”

” ‘Weapon of mass destruction’ is a really huge idea, but no matter what penalties you put on it, fentanyl’s going to be here,” said Amy Neville, mother of 14-year-old Alex, who died in June.

“Everyone in the world that will listen needs to know about fentanyl. It’s killing the long-term drug addicts and the first-time partygoers. It’s taking out anyone and everyone. Parents need to talk about this with their kids and kids need to understand that, if it’s not a prescription with their name on it, they shouldn’t take it. If they’re at a friend’s house and have a headache and the friend says, ‘Hey, I have something for that, try this,” they need to have that worm in their ear: ‘Fentanyl. Oh, wait. Fentanyl.’

“Put that worm in their ear. If I had that in my ear, my son would still be here.”

Gray’s daughter, Amanda Beatrice Rose Gray, 24, struggled with mental illness the last several years of her life. She’d feel an episode coming on and up her prescription of benzodiazapines, “turning off her brain” until it passed, much like a wolfman hiding away during the full moon, her father said. When a new psychiatrist decided to adjust her medications and it wasn’t working, she sought relief elsewhere. “She turned off her brain, permanently,” Gray said.

Amanda Beatrice Rose Gray died on Jan. 11, 2018. Lately, her mother has been yelling at the television. She’ll see a public service announcement for COVID and say, “They could pull those together in six months. Where are my TV commercials? This has been going on for six years. ‘That pill can kill. Don’t snort that powder. If they say they have a prescription and offer you a pill, they’re lying, don’t take it,’ ” said her husband.

Sounding the alarm and educating people is the most important thing right now, San Bernardino parent Filson said.

“There’s people dropping dead every day from all this crap. Something has to be done.”

Action

The parents of the 21 children represented in Ohio last week have thrown themselves into activism. The Nevilles formed the Alexander Neville Foundation, aiming to speak directly to middle and high school kids about unseen dangers and forever consequences. Gray has the Actus Foundation, aiming to change national policy and improve data collection. Filson works with DrugInducedHomicide.org trying to revamp criminal penalties, and the list goes on and on.

“This is not a grief support group,” Gray said. “This is a working group.”

The nearly two dozen parents who gathered in that ballroom last month with the drug czar and Ohio state officials have one very specific goal in mind: Replicate the successes that Candy Lightner had with Mothers Against Drunk Driving to change attitudes, and law, surrounding fentanyl.

On May 3, 1980, Lightner’s 13-year-old daughter Cari was walking to a church carnival with a friend when she was struck by a car with such force she was knocked out of her shoes and thrown 125 feet. The driver never stopped. It wasn’t his first time: He had been arrested earlier for another drunk-driving incident. When police told Lightner that the driver probably wouldn’t get much in the way of punishment, Lightner was enraged. “Death caused by drunk drivers is the only socially acceptable form of homicide,” she later told People magazine, channeling her anger and grief into the organization that became Mothers Against Drunk Driving, a national powerhouse pushing awareness and tougher laws across the nation.

“The vision is to be like MADD — there’s no difference with this,” Filson said. “You’re getting killed by a drunk driver or a drug distributor.”

The U.S. pours some $600 billion a year into battling addiction, but Gray fears officials are missing the point. These dollars go toward “legacy” drug policies — treatment and supports for long-term addicts. But that spending completely misses the segment of the population where overdose deaths are increasing most rapidly: Among the non-addicted, non-habitual users, “a population which is not even addressed by the thinking and policies of the old paradigm.”

The Centers for Disease Control maps three waves of opioid overdose deaths:

• The first wave began in the 1990s, with increased prescribing of opioids. Deaths from natural and semi-synthetic opioids have been increasing since at least 1999.
• The second wave began in 2010, with rapid increases in overdose deaths involving heroin.
• The third wave began in 2013, with significant increases in overdose deaths involving synthetic opioids, particularly those involving illicitly manufactured fentanyl.

The market for illicit fentanyl continues to evolve, the CDC said, and the drug can now be found combined with heroin, counterfeit pills, cocaine and marijuana. The carnage is clearly related: All opioid-involved death rates decreased by 2% between 2017 and 2018. Prescription opioid-involved death rates decreased by 13.5%. Heroin-involved death rates decreased by 4%.

But synthetic opioid-involved death rates —fentanyl and its cousins — increased by 10%. All told, nearly a half-million people died from opioid overdoses between 1999 and 2018, the CDC said.

California at risk

Pandemic is only making the landscape bleaker.

In 2013, only 3% of overdose deaths in Los Angeles County involved fentanyl. In 2019, about one-third (32.8 percent) involved fentanyl. In the first seven months of 2020, fentanyl was responsible for nearly half, said Nicole Nishida, spokesperson for the U.S. Drug Enforcement Administration.

Data from the coroner’s office show there were 800 drug-caused deaths in Los Angeles County during the first seven months of 2019. That has leaped by 48 percent in the first seven months of this year — to 1,184, she said.

Nationally, the Overdose Detection Mapping Application Program reports that suspected overdoses rose 18 percent in March, 29 percent in April and 42 percent in May compared to those same months in 2019.

The carnage is particularly grim in California. While China has clamped down on fentanyl exports, the raw ingredients are still being shipped abroad and then manufactured into finished product in Mexico, according to the Brookings Institute. It’s flooding over the border and hitting the Golden State particularly hard: In that Ohio ballroom, eight of the 21 youngsters represented were from California.

The DEA has been cracking down on dealers. On Monday, a San Fernando Valley man was sentenced to 15 years in federal prison for selling fentanyl to a 22-year-old who died 20 minutes after ingesting the drug. Eric Kay, a longtime Angels public relations employee, was charged with conspiracy to distribute fentanyl after star pitcher Tyler Skaggs died last year.

Some parents think the charges should be more like murder and less like selling drugs, and are pushing legislators to that end. But education is the real weapon in this fight. The word needs to get out. People need to understand.

”This crisis-crosses all demographics,” said Filson, who is now raising his granddaughter. “We need education on a national level to wake everyone up. Our kids have to quit dying in this way.”

Updated 9.46 a.m. 11/3/2020 with comment from Gray

The Beverly Hills doctor accused of building a luxurious life on the backs of desperate drug users — and contributing to some of their deaths — has been released from jail after he was diagnosed with COVID-19, despite the strident objections of prosecutors who’ve charged him with 88 felonies and fear he’s a flight risk.

Randy Rosen ran Wellness Wave, a surgical center in Beverly Hills that allegedly paid addicts eager to make a buck to endure unnecessary surgeries, get unnecessary lab tests and receive unnecessary injections for inflated prices, according to Orange County prosecutors.

His “elaborate fraud scheme” reaped some $29 million from insurance companies and employed “body brokers” to lure users for the sham procedures, according to court documents that paint a portrait of unrepentant greed and callous disregard for human suffering.

At risk for complications

In a Dec. 15 court filing, Rosen’s attorney argued that he’s at great risk for complications because of chronic obstructive pulmonary disease, centripetal obesity (excessive marbled fat around the waist), coronary artery disease, high blood pressure and obstructive sleep apnea. “(T)hese multiple risk factors, coupled with Randy Rosen’s age of 57 years, cause (his doctor) great concern for Randy Rosen’s health and well-being,” his attorneys argued.

Prosecutors fought his release, arguing that there’s no legal basis for it, that he poses a significant risk of danger to the community, and that he’s asymptomatic and could be well cared for by the jail medical system even if his condition worsens.

They also noted that he committed the crimes he’s now accused of while out on $300,000 bail in a different criminal case, even though he had promised to commit no crimes. He still has access to millions of dollars in assets and, because he faces more than 80 years in state prison if convicted on all charges, is a flight risk.

In the end, Orange County Superior Court Judge Sheila Hanson concluded that Rosen does have underlying medical conditions and ordered him released to his Los Angeles home — a 9,000-square-foot compound worth some $14 million in the hills of Brentwood — under electronic monitoring for up to 30 days.

He was released Thursday, Dec. 17, the Orange County Sheriff’s Department said. Rosen can’t leave the property unless it’s to go to a doctor or hospital, can’t use the internet except to communicate with his defense team or health care professionals, and “is not to apply for, obtain or use any passport,” the judge’s order said.

‘Theater of the absurd’

“We are watching the theater of the absurd,” Orange County District Attorney Todd Spitzer said in a prepared statement. “The criminal justice system shouldn’t have one set of rules for people who are wealthy and a separate set of rules (for people) who aren’t. Poor people who pose a low risk to society shouldn’t have to sit in jail because they can’t afford to get out while wealthy people who have demonstrated they have no regard for the law or the lives of other human beings and have nothing to lose walk right out the front door of the jail.”

There are 588 COVID-positive inmates in medical isolation right now, said a declaration from C. Hsien Chiang, Orange County’s medical director of Correctional Health Services.

Rosen has pleaded not guilty to 88 felony counts in two separate cases. After a complicated preliminary hearing that lasted more than two months for one of those cases, a judge found there was sufficient evidence to try him. Bail was set at $10 million.

Girlfriend also charged

Liza Vismanos, Rosen’s girlfriend, also is charged with multiple counts of insurance fraud and faces up to 36 years in state prison if convicted. She owned Lotus Laboratories, a toxicology lab in Los Alamitos that allegedly processed and billed for the unnecessary tests Rosen ordered.

Part of Rosen’s scam was to pay addicts to get naltrexone implants, court documents allege. Naltrexone binds to the brain’s opioid receptors, blunting an opioid high, and is designed to be part of a comprehensive program to address addiction, not as a cure in and of itself.

But that’s not how Rosen used it, prosecutors say, instead performing as many as 72 procedures in a single day, with the quickest surgery lasting just one minute. Some parents whose children got the implants, then later died of an overdose, say he’s responsible.

“To me, if you give an addict something like that, they’re just going to do more to get the buzz,” Debbie Berry of Ashland, Missouri, said after Rosen’s arrest last summer. Her son, Brennen, died with a naltrexone implant inside him in February 2018. Two months earlier, Rosen billed $59,000 to Berry’s insurance for the procedure.

“My son thought he had that security blanket in him, that it would save him. And it didn’t.”

Rosen’s trial is scheduled to begin in April.

They were as young as 14, 16, 18. Seeking celebration, relief, escape. Many were inexperienced users who thought they were taking OxyContin, or ecstasy, or cocaine, but were fooled by an even more lethal drug — fentanyl.

It cost them their lives.

Fentanyl is a cheap, synthetic opioid — 50 to 100 times stronger than morphine — that’s pouring into California over the Mexican border, masquerading as other drugs and leaving carnage in its wake.

With overdose deaths related to fentanyl surging, state Sen. Pat Bates, R-Laguna Niguel re-introduced a bill on Dec. 15 that would task California’s Attorney General with getting a firmer handle on the problem and crafting coherent solutions.

Modeled after an earlier legislative effort targeting methamphetamine, Senate Bill 75 would require the A.G.’s office to establish and chair a “Southern California Fentanyl Task Force” to enhance law enforcement agency coordination, recommend changes to the law and bring a state-wide caliber of expertise to the issue. It would cover the hard-hit counties of Los Angeles, Orange, Riverside, San Bernardino and San Diego.

“This issue is so widespread that it needs state coordination and implementation over several levels of government to see the effectiveness and results that were attained by other AG task forces,” says a primer on the bill.

It’s a bipartisan effort crafted with Orange County Sheriff Don Barnes and co-authors Assemblymembers Cottie Petrie-Norris, D-Laguna Beach and Marie Waldron, R-Escondido; and Sen. Melissa Melendez, R-Lake Elsinore.

“As a former social worker who once worked in communities ravaged by drugs, (I believe) California must do more to save people from fentanyl-related tragedies,” said Bates in a prepared statement. “A task force would help maximize existing resources and improve communication among various agencies.”

The new bill is the latest incarnation of an idea Bates introduced in March, which was sidelined as the Legislature pivoted to the pandemic. Lawmakers hope to accomplish a major overhaul of the troubled addiction treatment industry next year.

Body count

The pandemic has only pumped up overdose deaths. Consider:

-The U.S. Centers for Disease Control tracked 32,000 deaths from synthetic opioids last year — primarily fentanyl. It’s projecting deaths will leap more than 26% this year, to some 46,000.

-In California, the toll has been grim. There were 104 fentanyl-related overdose deaths in 2014; quadruple that in 2017 (431); and almost quadruple that in 2019 (1,513).  Officials expect fentanyl-related deaths to spike to some 1,900 in the Golden State in 2020.

In Los Angeles County alone, deaths soared from 117 in 2017 to a projected 783 in 2020, Bates said. And it’s not because there’s an exponentially-growing number of hard-core drug addicts; it’s because fentanyl has made its way into recreational drugs bought by occasional, casual users, many parents say.

In 2013, only 3% of overdose deaths in Los Angeles County involved fentanyl. But by last year fentanyl was linked to 32.8% of the county’s overdose deaths, and in the first seven months of 2020 it was nearly 50%, said Nicole Nishida, spokesperson for the U.S. Drug Enforcement Administration.

“Fentanyl continues to pose a substantial risk to our communities,” said Orange County Sheriff Barnes in a prepared statement.

“As a state we must enhance our efforts to reduce the prevalence of this opioid from our communities. The current trend of rising fentanyl-related deaths is unacceptable.”

The victims are not only the users: Cartels increasingly lure young people, often students, to smuggle drugs across the border with promises of money and electronics, officials said. First responders are at risk as well: After police pulled a car over on Dec. 15, in Orange, a man tore open a plastic bag and dumped fentanyl on the ground, spilling it on the shoes and pants of officers and suspects. A small amount of the drug can be lethal.

The Senate has not yet set a hearing date for the bill. Bates has also authored several bills seeking to add fentanyl to the lost of dangerous drugs that are subject to penalty enhancements. Those haven’t been successful, but she plans to keep trying.

Amy Neville’s son Alexander died at age 14 after ingesting fentanyl. She appreciates the effort behind the bill, but wants more.

“If California’s fentanyl crisis was a patient in the ER, I do not think that the doctors would meet in the conference room for four years so they could analyze and determine how to help the patient,” she said by email. “We have hundreds of front line workers already familiar with the problem: coroners, EMTs, firefighters, police, sheriffs, DEA/ICE partners, and civilians. It would not seem hasty to pool these resources and have proposals within six months instead of four years.

“People are dying and lives are being ruined by this scourge and it should be addressed with a similar urgency we have seen in the COVID-19 pandemic. The CDC and local health departments have been extremely responsive to the pandemic, there is no reason that we cannot be just as responsive towards this.”

Updated 12/21/2020 with comment from Amy Neville

The fast-cut trailer to the new movie “Body Brokers” is a dizzying and seductive collage of guns, cash, addiction and prostitutes, punctuated by a nicely dressed man holding a finger to his pursed lips as he says: “Shhhh.”

“Body Brokers” then drops the curtain on what it says is an open secret in the nation’s rehab industry, where drug addicts are reduced to commodities that can be recruited and recycled for big profits, and then kicked to the curb when their insurance runs out. It is a scenario also explored by the Southern California News Group’s 2017 project, “Rehab Riviera.”

Related: Actress Melissa Leo talks ‘Body Brokers’

The movie is not a documentary but it is labeled as being based on actual events.

However, this month, the rehab industry issued a strongly worded letter to the film’s producer and the media, demanding the film carry a different label: “fiction.”

Though they’ve only seen the trailer, the letter, signed by behavioral health and addiction rehab experts from throughout California, say the movie is sensational, irresponsible and likely to scare off addicts who need the services offered by legitimate treatment centers.

The tug-of-war over the independent, low-budget film comes as a handful of California lawmakers step up their war against rogue substance abuse clinics. Two Orange County legislators this year proposed or renewed bills that would force licensed treatment centers to carry insurance coverage and outlaw false advertising — regulations that would be new in the largely unregulated industry.

In her legislative pitch to raise standards in the rehab industry by requiring operators to carry insurance coverage, Assemblywoman Cottie Petrie-Norris, D-Laguna Beach, decried that “fraudsters and scammers” were amok in California’s addiction industry.

And that is the world of director John Swab’s “Body Brokers.”

Swab says he was a street junky for more than a decade, bouncing from detox to detox all over the nation. He says he was brokered — meaning he and his insurance were sold by a third party to a rehab operator — and that he then learned to broker other addicts as part of a multi-billion dollar insurance scam.

Yet, according to the letter from behavioral health experts, Swab’s depiction of that world is wildly exaggerated.

Officials overseeing public addiction treatment programs – which operate in a separate universe from private programs – blasted the filmmaker for “a highly inaccurate” depiction of substance use disorder treatment as driven by greed rather than care.”

Veronica Kelley, director of the San Bernardino County Department of Behavioral Health and president of the County Behavioral Health Directors Association of California, which represents every county in the state, was among those who signed the letter. She said the film doesn’t spell out what she views as stark differences between higher-quality publicly-run programs and commercial, privately-run programs, where anything often goes.

“In the public system, because we’re dealing with taxpayer money, there’s a higher level of accountability,” Kelley said. Public programs, she noted, must not only be licensed by the state and certified by professional organizations, but they’re audited annually by state and federal officials.

She knows both sides. A close relative, she said, sought addiction treatment through the private, commercial system and got caught up in a brokering scenario similar to the transactions depicted in the film.

“What we’re saying in our letter is, this is just one side. People don’t know the difference between the commercial and the public systems. This represents a part of the system that needs to be revamped, absolutely,” Kelley said. “We would love for the commercial side to look more like ours. But the film is generalizing to say that all substance use disorder treatment is predatory.”

Those who want help through the public system can call 800-968-2636, she said.

Kelley’s description, however, is more tempered than the group’s letter, which said the  “irresponsible” focus of the movie could very well cost lives.

Swab said those critics had no right to attack his version of his own life.

“We’re flattered people are talking about it,” Swab said. “But this is my truth. I went through this.”

Producer Jeremy Rosen said it would be worse to look the other way.

“It is wildly reckless to ignore this is happening,” Rosen said, although he conceded, “It’s a film, not a documentary. There is some poetic license.”

There have, in fact, been numerous legislative changes to addiction treatment in California in the wake of Southern California News Group’s “Rehab Riviera,” but they were hardly sweeping. Lawmakers acknowledge that the changes they’ve made, so far, have only nibbled at a much greater problem.

Assemblywoman Petrie-Norris says licensed treatment centers and those funded by the government should carry insurance coverage in case patients become prey. But most legislators are reticent to jump into the frey. 

“California regulates anything that moves,” Petrie-Norris said. “But for some reason … it’s been open season for scammers and fraudsters.”

Petrie-Norris has joined forces with state Insurance Commissioner Ricardo Lara to push AB 1158, which would require licensed treatment centers and other clinics that receive government funding to maintain a minimum amount of insurance coverage. Standards of treatment and consumer protections would then be set to qualify for that insurance.

What Lara brings is a statewide enforcement staff of 300 people, enough manpower to enforce basic health rules in the industry — something that currently isn’t part of the state regulatory system.

“There is (now) a total lack of regulation and oversight in this space and people are dying as a result,” Petrie-Norris said.

Another strike at “bad actors” in the rehab world comes from Sen. Pat Bates, R-Laguna Niguel, who reintroduced Senate Bill 434, which would essentially forbid treatment programs from lying.

Hailed by activists as a long-overdue, common-sense measure, Bates’ bill would prohibit false advertising and marketing about such basics as where a center is located – “at the beach” can mean 15 miles away –  and as vital as what services are offered.

Bate’s bill is called Brandon’s Law, after Brandon Nelson. Nelson’s parents were told he was going to a state-of-the-art mental health care program where he’d be closely monitored by a licensed therapist and a psychiatrist. In reality, Nelson wound up in an unlicensed, unregulated “sober living home mental health facility” in San Clemente, where he had a psychotic break and hung himself in  2018.

This is Bates’ third attempt to get the bill enacted. Still, Brandon’s father, Allen, of Santa Monica, remains hopeful.

“It’s obviously disappointing that it wasn’t signed the first time, but we’re certainly in for the long haul,” he said.

The proposal would authorize the California Department of Health Care Services to investigate allegations of misconduct at rehab centers and impose sanctions when warranted.

“If this is passed and enforced, it will bring meaningful change for the consumer,” said David Skonezny, founder of “It’s Time for Ethics in Addiction Treatment,” a private Facebook group of more than 5,600 treatment professionals seeking to raise the bar.

“This is one of the areas where the profession has done a great disservice to the public by misrepresenting itself in ways great and small.”

Skonezny, a substance abuse counselor, has been in the business for years. He said he was prepared to hate the “Body Brokers” movie, but he didn’t.

“The movie is a really accurate look at what happens in the for-profit, privately-funded programs that are lacking in integrity,” he said. “This janky guy running this call center, picking up addicts off the street; a girl turning tricks in a motel to pay for dope for her and her boyfriend, people getting paid off all around – yep. That’s what it looks like.”

Bates agrees. She has been working on the issue for years, and is hopeful the film might finally bring the reality home to her fellow lawmakers, who have been sluggish to act. She’s hoping to organize a screening in Sacramento just for legislators.

“The man who wrote the story lived it,” she said. “It’s hardly fiction.”

The Instagram accounts belonged to “fentanyl_top” and “mass_chemical_drugs” — the 21st century cyber street corners teens visit when looking for an escape, a high, a party.

Amy Neville found those via her smart, curious, 14-year-old son Alex’s account after his death. He bought what he thought was oxycontin from an online dealer and died in his Aliso Viejo bedroom after ingesting what turned out to be fentanyl — a cheap synthetic opioid up to 100 times more powerful than morphine.

The grief-stricken Neville reported the accounts to Instagram — and was stunned when they weren’t immediately removed. They “likely” didn’t go against Instagram’s community guidelines, automated responses said.

It has been nearly a year since Alex died, Today, those particular accounts have vanished. But dozens more like them have popped up on Instagram, on Snapchat and on other social media sites, with names riffing on fentanyl, oxycontin and all manner of illegal drugs — just a click or two away.

“These social media sites are the kids’ playground. We have to make the playground safe,” said Neville. “In the ideal world, the platforms would find these accounts and shut them down. If it’s illegal offline, it needs to be illegal online. Seems like a no-brainer to me, but when there’s billions and billions of dollars at stake, I guess things are different.

“We need to do something,” she said. “People are dying every single day.”

Nationwide protests

On Friday, June 4, protesters demanding that social media giants do more to curb deadly drug sales on their platforms will gather at the Santa Monica headquarters of Snapchat, at the Chinese Pavilion in downtown Riverside and at more than 30 cities across the nation, from Oregon to Ohio and New York to Florida.

It’s the work of volunteers and more than 40 parent-driven nonprofits like the Alexander Neville Foundation and the Association of People Against Lethal Drugs, many of whom are working to stiffen criminal penalties for peddling fentanyl. These are poisoning deaths, not drug overdoses, they say, and need to be treated that way.

“My sister was 20 years old. She died Nov. 7, 2020, after taking a quarter of what she thought was a Xanax, but turned out to be pure fentanyl,” said Victoria Antunez of Riverside.

“People are getting away with selling these deadly pills, and getting away with it because there is no law in California yet. We have to shift people’s ways of thinking and the stigma on death and drugs. It is fentanyl poisoning, not overdose, because each one of the people that we are representing during this rally was blindsided into thinking they were taking something which would’ve been harmless, but because of the fentanyl, they ended up dying.”

Antunez’s sister, Athena Zepeda, was herself an Instagram influencer and an MMA fighter. “Never spoke a bad word about anybody, was always the life of the party and the go-to person for anything,” Antunez said. “We miss her so much.”

Before Athena’s death, the family knew nothing about fentanyl, Antunez said. Now, they’ve connected with more than 100 families in the Riverside area whose lives have been affected by it.

“It is truly an epidemic!” she said.

In February, relationship therapist and TV host Laura Berman’s 16-year-old son Samuel died in his room after taking what was supposed to be Xanax or Percocet, bought from someone he connected with on Snapchat. “My beautiful boy is gone,” she tweeted. “My heart is completely shattered and I am not sure how to keep breathing.”

Taking steps

The list of arrests tied to drug sales on social media is long, including “dealers” busted in Arizona, Pennsylvania, Texas, Tennessee, Indiana  and here in California. Dealers connecting with teens on social media has been documented in countries around the globe.

Media giants say they’ve stepped up their games — and will be doing more.

“For us, nothing is more important than the safety of Snapchatters and we strictly prohibit using Snapchat for drug transactions,” said a company spokesperson by email.

“Drug-related content and activity is firmly against our community guidelines, we aggressively enforce against these violations, and support law enforcement investigations. We try to be as proactive as possible in detecting, preventing and acting on this type of abuse, and are constantly improving our own technology and tools to fight drug dealers and illegal drugs.

“We are also working with parents and safety experts on efforts to raise awareness with Snapchatters about the dangers of fentanyl and other illegal drugs.”

The company said it’s working with experts to further improve its work, including getting regular updates on new terminology, symbols and emojis used to represent and promote drugs; using machine learning tools to improve its ability to find and stop drug transactions; and partnering with dozens of non-profits and “safety partners” in its “Trusted Flagger Program,” which provides them a secure way to report content that violates guidelines and expedites critical safety issues.

Snapchat recently rolled out a new feature, “Friend Check Up,” reminding Snapchatters to review their friend list to make sure they actually know their contacts, and the company also works with law enforcement to support investigations and can preserve relevant content, the spokesperson said.

Facebook, which owns Instagram, echoed Snapchat.

“We do not allow the sale of illicit drugs on Instagram. It is against our policies to buy, sell or trade non-medical or pharmaceutical drugs on our platform,” a spokesperson said by email.

“We have been focusing on this area for some time, and we are working hard to ensure we keep illicit drug sales off Instagram, while surfacing the communities of support that help those struggling with addiction. We know we have more to do in this area, but we will continue to work with experts and invest in people and technology to keep our community safe.”

Instagram will continue investing in technology to keep illicit drug sales off the platform and connect people with help and resources, the company said. That includes “proactive detection” — tools that can spot images of drugs and signals of intent to sell, such as the posting of phone numbers, prices and user names for other social media accounts.

It also launched a “Get Help Feature,” directing people attempting to purchase illegal substances to the SAMHSA national helpline. But addiction is an issue that affects families throughout the nation and world; no company or government organization can address it alone; and bad actors continually update their tactics and terminology to avoid detection, the company said.

Not enough

Some 90,000 people died of drug overdoses in the 12 months that ended in October, according to data from the U.S. Centers for Disease Control — a spike of 30% in a single year, and the highest tally ever.

Officials say that’s because cheap fentanyl is being dressed up to look like real pharmaceuticals — and is killing people.

Berman has been using her platform to push for a law creating “drug-induced homicide,” which was tabled this year, and to push social media companies to allow parents to track their children’s accounts.

“Currently, #TikTok and #Snapchat do not allow parents to protect their kids on their apps, because they prevent parents from using third-party software to monitor when their child is exposed to dangerous content,” Berman tweeted on June 1.

“These apps are essential to help protect our children…. We have a real opportunity to make the world a safer place for this next generation.”

Parents and kids need to understand that fentanyl is out there, in everything, and that a single pill can kill, said Neville, Alex’s mom.

“This is shaping up to be our deadliest summer,” she said. “I know we’re not going to shut down Snapchat on June 4. But it’s important that Snapchat hear from those of us who have wanted to get loud for a while.”

The Dept. of Justice is filing criminal charges against ten people who run drug and alcohol addiction businesses in Orange County, saying the county has overtaken South Florida as the national epicenter for addiction industry fraud.

“The problem was heavily concentrated, historically, in Miami and South Florida. But with active prosecutions (in Florida) the problems have migrated to Orange County,” Assistant U.S. Attorney Benjamin Barron, chief of the Santa Ana Branch Office, said Thursday, Dec. 16.

The Justice Dept. effort, focused on O.C. and dubbed “The Sober Home Initiative,” is expected to reach others in an industry that, in the county, includes hundreds of licensed rehabs and sober living homes.

“This is the beginning, not the end,” Barron said.

Despite new state laws and local efforts to stamp out abuse in the rehab industry over the last four years, the playbook remains largely the same: Private, for-profit addiction treatment centers hire “body brokers” to find vulnerable addicts with good insurance, then pay those body brokers handsomely so that the rehab can bill the insurance company, often for services that don’t meet a patient’s medical needs or are non-existent.

In addition, addicted people are often paid to remain in treatment, and some rehab centers provide drugs to addicts as a way to re-start the lucrative treatment cycle again and again, officials said.

Arrested Thursday, Dec. 16, were Nick Roshdieh, 51, of Aliso Viejo, and Vincent Bindi, 66, of Laguna Nigel. They owned Crest Recovery LLC, doing business as Truvida Recovery, and were charged in an indictment that alleges conspiracy to pay and receive kickbacks for referrals to clinical treatment facilities and paying kickbacks for referrals to clinical treatment facilities.

Donald Vawter, 30, of Rancho Santa Margarita, an employee of Truvida, also was taken into custody, as was Michael Hislop, 56, of Boston, a patient recruiter, on charges of conspiring to pay and receive kickbacks for referrals.

If convicted, Roshdieh and Bindi would face a maximum total penalty of 65 years in prison, and Vawter and Hislop would face a maximum total penalty of 35 years in prison, prosecutors said.

Attorneys for the accused could not be reached late Thursday.

The sting has been underway for at least 10 months.

In October, the Justice Department indicted Casey Mahoney, 45, of Los Angeles, and Joseph Parkinson, 32, formerly of Costa Mesa, charging both for their roles in an alleged multimillion-dollar addiction treatment kickback scheme.

According to court documents, Mahoney controlled Healing Path Detox LLC in Huntington Beach and Get Real Recovery Inc. in San Juan Capistrano, and allegedly paid some $2.7 million in kickbacks to Parkinson and other patient recruiters in exchange for patient referrals. Mahoney is also facing charges of money laundering charges for allegedly transferring kickback funds to an account held in the name of a patient broker’s mother.

Parkinson, a patient recruiter, also was charged with currency structuring and possession with intent to distribute fentanyl.

If convicted, Mahoney would face a maximum total penalty of 35 years in prison, and Parkinson would face a maximum total penalty of 165 years in prison.

Darius Moore, 28, formerly of Santa Ana, pleaded guilty Dec. 10 to one count of conspiracy to pay and receive kickbacks for referrals and one count of receiving kickbacks. His sentencing is scheduled for May 13, and he faces a maximum of 15 years in prison.

Adrian Gonzalez, 37, of Laguna Hills, pleaded guilty on Aug. 6 to paying kickbacks for referrals. He’s scheduled for sentencing on Jan. 28, and faces a maximum of 10 years in prison. He controlled Stone Ridge Recovery Inc. and Landmark Recovery LLC, and paid at least $1 million in kickbacks to patient recruiters for patient referrals.

Dorian Ballough, 30, formerly of Costa Mesa, pleaded guilty on Nov. 12 to one count of conspiracy to pay and receive kickbacks for referrals and one count of receiving kickbacks for referrals. He’s scheduled to be sentenced on April 8 and faces a maximum 15 years in prison. As a patient recruiter for multiple facilities, he was paid at least $1.8 million, according to court documents.

Kyle Reed, 29, formerly of Huntington Beach, pleaded guilty on Nov. 19 to one count of conspiracy to pay and receive kickbacks for referrals and one count of receiving kickbacks for referrals. He’s scheduled to be sentenced on May 6 and faces a maximum 15 years in prison. He was paid at least $604,474 as a patient recruiter for multiple facilities, according to court documents.

The initiative was made possible by the federal Eliminating Kickbacks in Recovery Act of 2018, a new law that Barron called a powerful new tool to help in prosecutions. It passed in the wake of the Southern California News Group’s probe of fraud, abuse and death in the industry.

“The suspects in this case specifically targeted vulnerable individuals in recovery and sold them as a commodity with no concern for their health or wellbeing,” said California Insurance Commissioner Ricardo Lara in a prepared statement. “Receiving kickbacks for patient referrals endangers lives and has no place in our health care system.”

It was a vicious back-and-forth over who was truly evil — the big bad insurance company, refusing to pay for desperately needed addiction treatment for vulnerable patients? Or the greedy, manipulative treatment provider, milking those vulnerable patients for every last cent it could wring out of their insurers, then kicking them to the curb when benefits ran out?

In the battle between now-defunct Sovereign Health/Dual Diagnosis of San Clemente and insurance giant Health Net, the insurer won. Big.

After a trial that lasted some seven weeks, the jury took about a day to decide that Sovereign/DD and its erstwhile CEO Tonmoy Sharma acted with “malice, oppression or fraud,” and that Health Net proved Sharma violated the Racketeering Influence and Corrupt Organization Act.

Sovereign and Sharma must pay Health Net just shy of $45 million in damages and interest, said the jury in Los Angeles Superior Court, where the case was tried.

Health Net, apparently not eager to gloat, said it wasn’t going to comment on the verdict.

One of Sovereign’s attorneys, Lisa S. Kantor, said this: “We believe that there were multiple reversible errors and that the most significant evidence was kept from the jury. We look forward to obtaining a reversal on appeal.”

That $45 million hit to Sovereign and Sharma breaks down like this: Health Net’s damages for fraud and/or intentional interference amounted to $15.82 million, with a $13.31 million cherry on top awarded for interest. Health Net is due another $15.82 million for the RICO violations, the jury said.

It happens that $15.82 million is how much Sovereign billed for urine and other lab tests that weren’t necessary or even ordered by doctors, according to testimony at trial.

Sovereign, which filed the initial lawsuit against Health Net, got zip.

“Sovereign is not an innocent little lamb,” Health Net attorney Kenneth Julian said during closing arguments. “Sovereign is a ravenous wolf, and it took advantage.”

The fight

Sovereign, once a prominent addiction treatment and behavioral health provider in Southern California and several other states, sued Health Net in 2016 after the insurer refused to pay for treatment already provided to Health Net customers.

Sovereign alleged the insurer “engaged in a disgraceful scheme to enrich themselves by backtracking on their insurance promises to recovering addicts and the mentally ill,” and that its “misconduct is part of a sad pattern of prioritizing dollars over decency.”

Health Net owed Sovereign $55 million for services rendered back then — and, with statutory interest, that ballooned to $80 million and beyond, according to Sovereign’s court filings.

Health Net, of course, has a vastly different perspective.

In a counter-suit, it argued that Sharma and his companies engaged in massive fraud that harmed all consumers. In 2013 — before coverage for addiction treatment was mandated under Obamacare — Health Net paid $251,000 to out-of-network providers like Sovereign. In 2015, it paid them more than $190 million, “an almost 1,000-fold increase in just two years,” it said.

Monthly billings from Sovereign’s companies to Health Net climbed from less than $50,000 to more than $13 million within the span of a single year, Health Net said.

Treatment providers gamed and abused the Affordable Care Act, Health Net said. Sovereign and other clinics “engaged in a sophisticated fraud involving paying kickbacks to ‘buy’ hundreds of patients from teams of brokers, or ‘cappers,’ who find the patients in 12-step programs, AA meetings, homeless shelters and jails, often from outside California, and then ‘sell’ them for cash to the highest-bidding clinic,” its suit said.

“Because the prospective patients typically would not be able to afford private health insurance or the cost-sharing obligations associated with receiving services from an out-of-network provider — and who should therefore be enrolled in state-funded or subsidized health care programs such as Medicaid — the providers, including (Sovereign), offer the patients financial kickbacks and inducements.”

The primary inducement is the offer of free care, Health Net said. Sovereign, and providers like it, signed people up for top-tier insurance policies. Those providers — not the clients — paid the insurance premiums. Then the providers either waived — or paid — the patients’ out-of-pocket deductibles and co-pays, which Health Net said violated the policy terms.

Sovereign and the others recouped their cash outlays by billing massive amounts — often for services that were never rendered, were not medically necessary or were not covered, the counter-suit said.

“This scheme, which involves fraudulently obtaining insurance policies and the submission of thousands of false and fraudulent claims, also raises the costs of healthcare coverage to consumers, who ultimately will have to pay higher insurance premiums.” the insurer argued.

‘Patients as pawns’

Sovereign’s lawyers argued that Health Net was ill-prepared for the mass of claims it would get for addiction treatment and simply decided not to pay them.

The legal process dragged on for years and the insurer had years to investigate, gained access to hundreds of pages of documents, “but at the end, their accusations are based on hearsay, innuendo, gossip,” Sander Dawson said. “They call any obvious mistake part of a fraudulent scheme.”

In the end, Sovereign sought reimbursement for just $10 million of unpaid claims and interest on those claims; it couldn’t collect on the rest because it paid for patients, which is illegal, Health Net told jurors.

Health Net was apparently more convincing to the jury.

“Insurance doesn’t work if a person buys insurance when the fire is coming down the hill, puts in a massive claim for their house that has burned down and then cancels it afterwards,” Health Net attorney Gregory Pimstone said during closing arguments.

“It doesn’t work. The system would collapse … and here we have something even worse than that. It’s not just that they bought the insurance as the fire was coming down the hill and then terminated the insurance after the claim had been put in. But here it’s like the contractor is buying insurance for all the homeowners and saying….’Free insurance for you if you let me rebuild your house so I can submit claims to your insurer for rebuilding your house.’

“Sovereign (gamed) the system. It  defrauded Health Net, and it used its patients as pawns.”

We’ll tell you more about the eye-popping evidence in coming days — which includes a “mop-up” team in India padding medical histories, but sometimes forgetting to change patient names — but the legal proceedings aren’t quite over. There will be a short second phase of the trial in September to consider punitive damages.

Sharma was hoping to use the proceeds from this trial to pay hundreds of Sovereign workers who never got paid as the company was imploding in 2018. Those wage claims are still outstanding.

Sharma, however, has been working with a company, Invictus Health LLC. He has said he advises Invictus and other providers about what they need to do and how they need to do it, but said he had no financial stake in the businesses and they cannot be sued in lieu of Sovereign.

Update 8/2/22 to attribute “ravenous wolf” quote to Kenneth Julian

Read trial transcripts:

2022-07-21 Trial Transcript_Redacted

2022-07-19 Trial Transcript (Closing Arguments)

The surgeon who was accused of building a luxurious life on the backs of often-desperate drug users eager to make a buck — even if it meant enduring unnecessary surgeries, getting unnecessary lab tests and receiving unnecessary injections for inflated prices — pleaded guilty to several charges in two separate cases on Friday, Aug.12, according to court records.

Randy Rosen ran Wellness Wave, a surgical center in Beverly Hills, and girlfriend Liza Vismanos owned Lotus Laboratories, a toxicology lab in Los Alamitos. Over the course of just a few years, they billed health insurance companies some $676 million for medical procedures and tests and collected millions in reimbursements, according to court documents that paint a picture of unrepentant greed and callous disregard for human suffering.

Before landing in the Orange County Jail, they were remodeling a $3.2 million mansion — with “jetliner” views of the Pacific Ocean, Santa Monica mountains and downtown Los Angeles; complete with lap pool and wine cellar — high in the hills of Brentwood. They had high-priced cars, expensive purses and jewelry, eclectic art and bars of silver and gold, prosecutors said in court documents.

Rosen pleaded guilty to several counts of submitting fraudulent insurance claims with an aggravated white collar crime enhancement, while scores of other charges were dismissed. He faces 10 years behind bars, but will get credit for the two years he has already served as the cases progressed through the justice system.

Vismanos pleaded guilty on Friday to insurance fraud and had dozens of charges dismissed. She will face home confinement.

“This is the largest prison sentence for a provider in a California workers’ compensation insurance fraud,” said Orange County District Attorney Todd Spitzer in a prepared statement. “Dr. Rosen used vulnerable sober living patients who were desperately trying to battle their demons as an ATM machine to make a buck. He didn’t care about his patients; he only cared about making as much money as possible.”

Rosen’s time behind bars was itself a source of controversy.

Rosen got COVID-19 in late 2020, and a judge released him to his multi-million dollar home to recuperate, for fear of underlying medical conditions.

Rather than enduring lock-up in Orange County’s main jail, Rosen paid $100 a night to stay at the kinder, gentler Huntington Beach City Jail in 2021, raising questions about justice for the rich, and for everybody else.

Attorneys for Rosen and Vismanos said they’d have no further comment.

“I refuse to allow these body brokers to traffic human beings as part of a thinly disguised plot to strike it rich,” D.A. Spitzer said. “People battling addiction and the people who love them are looking for a lifeline to help save them. Dr. Rosen not only grabbed the lifeline out of their hands, he billed the insurance companies to do it.”

This article has been updated with response from attorneys and sentencing detail

“Medically supervised!” boast so many addiction treatment centers — even though they’re explicitly “non-medical.”

Matthew Maniace died in a Lake Arrowhead detox that said it was “clinically supervised” and offered “around-the-clock medical supervision.” So did Terri Darling and James Dugas. In a paranoid delirium, Henry Richard Lehr bolted from a Newport Beach detox that provided “incidental medical services” and broke into a nearby home, where he was shot and killed by the terrified resident inside.

It’s easy to mistake mental health and addiction treatment centers for actual medical facilities in California. But they are not staffed 24/7 by doctors (and are not allowed to be). They’re typically situated in tract houses in residential neighborhoods, and the most stringent medical requirement may be the full-time presence of someone who knows CPR.

Enter Senate Bill 1665 by Sen. Pat Bates, R-Laguna Niguel — an attempt to untangle the pretzel logic of non-medical facilities crowing about their medical services, or exaggerating staffers’ credentials, or promising prescription-drug-level services when no one on staff is licensed to prescribe drugs. It was signed into law by Gov. Gavin Newsom on on Monday, Aug. 22.

No bull

It refines Brandon’s Law, the Bates bill signed by Newsom last year, which prohibits addiction treatment and mental health providers from misrepresenting or making blatantly false claims about the services they offer or where they’re located. That was a long-fought victory for Bates and Nelson’s family, and its meaning seemed crystal clear.

But some operators have tried to skirt it using sophistry, Bates said.

Thus the new law, which expressly forbids drug or alcohol programs from making false or misleading statements about medical treatments or services offered.

“We’re thrilled we got that signed by the governor,” Bates said. But perhaps not so thrilled that every burp and gurgle of what seems obvious and ethical must be explicitly spelled out.

Bates’ intent has always been clear and simple: She doesn’t want people in crisis over addiction and mental health issues to be bamboozled. She doesn’t want them to be misled about what kind of help they’ll be getting. She doesn’t want operators to exaggerate or lie to snag a client. It can be a matter of life and death.

Phantom care

Brandon Nelson had suffered a debilitating psychotic break and was promised the finest care at now-defunct Sovereign Health: He’d be closely monitored by a licensed therapist, and a psychiatrist, and would get group and other forms of therapy, his parents were told.

But Nelson wound up in an unlicensed “sober living home mental health facility” run by Sovereign, didn’t get the hospital-prescribed drugs he needed on time, was left unattended and used his sweatpants to hang himself from the sprinkler system. He was 26 when he died in 2018.

This reporter, who has spent the past five years chronicling the tragic flaws in California’s private-pay, insurance-money-fueled, addiction treatment system, naively thought that Brandon’s Law would stop non-medical facilities from claiming to provide medical supervision. But alas.

There are hundreds of officially non-medical addiction treatment and mental health facilities licensed to provide “incidental medical services” by the California Department of Health Care Services. They are not allowed to provide primary medical care, but can obtain medical histories, monitor patients’ health to determine if emergency care is needed, oversee patients’ self-administered medications.

These IMS facilities typically have a contractual relationship with a doctor, who will look over patient paperwork within 72 hours of admission.

Of course, the first days of detox are the most dangerous. Lehr and Maniace and Darling were dead before 72 hours had passed.

Still, DHCS said that these non-medical facilities did not run afoul of Brandon’s Law by claiming they offer medical supervision.

No hyperbole

The new law will provide penalties — such as loss of license — to dissuade operators from hyperbole, like claiming the staff marriage and family therapist is a certified addiction counselor and the like.

Enforcement action, as always, must begin with a complaint to DHCS (details on how to file complaints here).

The interpretation and enforcement will, of course, fall to the DHCS folks themselves. We asked if the new law will stop rehabs with IMS designations (and without!) from claiming they’re medically supervised.

State officials couldn’t tell us yay or nay by deadline. But Bates said that that’s clearly her intent. If more legislation is required, she’ll do what she can to make that happen — even as term limits mean her time in the state Senate will come to a close this year.

“Families should be assured their loved ones are properly cared for as they begin their journey to recovery,” Bates said in a statement. “Now that SB 1165 is law, I am hopeful more people will feel confident enough to enter treatment and overcome their addiction.”

I will be dropping my daughter off for her freshman year of college in less than two weeks. I am a quivering, gelatinous mass of maternal angst. But I, along with the rest of California, got an assist this week from our lawmakers that will help ease (some of) my fears — and may help keep kids like my daughter alive.

On Monday, Aug. 29, Gov. Gavin Newsom signed into law a bill by Assemblymember Laurie Davies, R-Laguna Niguel, legalizing the possession of those funky kits that test pills et al. for the presence of deadly fentanyl, as well as strips that screen drinks for “date rape” drugs like ketamine and gamma-hydroxybutyric acid.

Until now, they fell under the definition of “illegal drug paraphernalia” and were officially verboten in the Golden State.

The new law, Assembly Bill 1598, “is an innovative step in California’s ongoing battle to rid our neighborhoods of dangerous drugs and actually get addicted users the help they need,” Davies said by email Tuesday during the final, frenetic days of the Legislative session.

“Legalizing testing equipment for drugs like fentanyl or ketamine … can empower parents, school officials and law enforcement to have these products readily available to ensure if there are drugs found, we can prevent accidental overdoses and deaths,” she said.

“This measure is a common-sense approach to improve harm-reduction strategies and certify drugs on our streets are not unknowingly laced with more dangerous chemicals.”

Harm reduction

This logical, welcome-to-the-real-world approach acknowledges that some level of drug use is inevitable.

And rather than trying to achieve total abstinence — impossible, as a little experiment called Prohibition clearly illustrated — it seeks to reduce bad outcomes, say our friends at the National Institutes on Drug Abuse, part of the National Institutes of Health.

“Persuasive evidence” from around the world has shown that harm reduction greatly reduces the morbidity and mortality associated with risky health behaviors, NIH said.

Products like test strips clearly save lives, Davies has said. In 2019, research institute RTI International found that 43% of drug users reconsidered after test strips found fentanyl in pills or powder masquerading as something else.

“We must increase the tools in our tool belt to prevent accidental overdoses and deaths,” she said in analyses of the bill. “One way to do this is to reform our ‘drug paraphernalia’ laws to not criminalize life-saving products and technologies.”

The Orange County Board of Supervisors endorsed Davies’ bill after holding its own hearing on the fentanyl crisis, and supporters included the California Consortium of Addiction Programs and Professionals, California Attorneys for Criminal Justice, addiction medicine specialists and more than a dozen police and sheriff’s groups.

But alas, this session’s major harm reduction bill — allowing safe injection pilot sites in Los Angeles, Oakland and San Francisco — was vetoed by Newsom (even though, as a candidate in 2018, he said he was “very, very open” to the idea). He worried that they might “induce a world of unintended consequences” — including, some have suggested, providing ammunition to opponents if he pursues higher office.

There’s always next year. There’s an argument to be made that civilized societies don’t let their most vulnerable members do dangerous narcotics on sidewalks and then let them die on the streets.

Equipped

Meantime, our what-to-bring-to-college list just got longer.

The law is so new that we’re not going to be able to amble into the local drug store (or head shop) and buy test kits immediately, but we expect that’s not terribly far off.

In the meantime, since these kits are legal in many other states, they can be purchased online. I bought 10 fentanyl test strips and 10 date rape drink test strips which should arrive in time to be tucked into the luggage before drop-off day — which will provide me with yet another opportunity to lecture her about how a single pill can pack enough fentanyl to kill, and how she should never drink from a glass that she hasn’t poured herself or one that she left unattended for even a minute.

She’s a good kid. She’s never gotten into real trouble. Her nose curled in disgust every time I tried to order her a glass of champagne on a recent vacation to Paris (where the legal drinking age is 18). It’s not a terrible world. There are so many good people in it. But there are also some wicked ones, and I want her to have every possible tool at her disposal to keep the bad at bay.

Mother = control freak. I realize she may never, ever use these tools — like she’ll probably never, ever use the nifty screaming alarm with special flash feature I bought for her key chain — but she’ll have them. And I think that makes both of us feel better.

When you lose a child, the what-ifs can be paralyzing. Juli Shamash is part of an unfortunately robust army that’s channeling that agony into change, to spare others from ever having to endure it.

Her son, Tyler, was 19 when he overdosed at a sober-living facility in Beverlywood in 2018. It turns out that the drugs Tyler took contained deadly fentanyl — a single sugar packet of the stuff is enough to kill 500 people — but he was never screened for fentanyl at the emergency room.

“Had it been common practice to do a separate tox screen for fentanyl back in October of 2018, Tyler may still be alive today,” Shamash said by email.

Enter Tyler’s Law, authored by Sen. Melissa Melendez, R-Lake Elsinore, and signed by Gov. Gavin Newsom on Aug. 22. It simply requires a general acute care hospital to include fentanyl testing in its urine drug screenings, and takes effect Jan 1.

“We are confident that this bill will save lives and spare others from the heartache of losing a loved one,” Shamash said.

Folks are surprised to learn that routine drug screens don’t always capture fentanyl use, and many of those who take it never meant to — instead thinking they bought legit prescription pills such as Xanax or Oxycodone. Fentanyl is in just about every street drug as well, from methamphetamine to cocaine.

Shamash, of Los Angeles, is working with an emergency physician from San Diego to make routine ER screening for fentanyl standard in every state. It can convince people to carry naloxone, alert friends who may be using, ditch suspect pills (which can now be legally tested for fentanyl in California) and motivate them to seek help. It can also help law enforcement prosecute drug dealers and help outpatient clinics with data, Shamash said.

Tyler was a brilliant kid who could fix anything, but he struggled with anxiety and couldn’t see his own worth. He wanted so very much to fit in. His family spent hundreds of thousands of dollars sending him to wilderness programs and boarding schools, private treatment programs and sober living homes.

He got the money to buy the drugs that killed him from a “friend” who brokered him to a program in Laguna Hills that accepted Tyler’s insurance — and received $2,000 for his troubles, Shamash said. Tyler got a cut of the take.

Shamash — and a coalition of more than 50 groups including the California Hospital Association, California Medical Association, county health directors, public safety officials and family-based organizations — wants to forge a new path forward on addiction treatment and behavioral health issues. Clearly, with more than 100,000 drug-related deaths in a single year, it’s desperately needed.

The governor’s new CARE courts, which would compel people with serious mental health issues into care and housing, may be part of that change. Be Well Orange County is one of the programs that’s getting it right, according to the coalition, Behavioral Health Action.

One of the important takeaways: “If you’re in the public behavioral health system because you don’t have insurance, or you’re in Medicaid, you have a better chance of getting recovery-based treatment than you do in a private program,” said Steve Fields, the Progress Foundation’s executive director, when the coalition’s new Blueprint for Behavioral Health was unveiled last year.

Shamash wishes she had known that when her son was struggling. But a story told, she has said, is a life saved.

The Beverly Hills doctor accused of building a luxurious life on the backs of desperate drug users — and contributing to some of their deaths — has been released from jail after he was diagnosed with COVID-19, despite the strident objections of prosecutors who’ve charged him with 88 felonies and fear he’s a flight risk.

Randy Rosen ran Wellness Wave, a surgical center in Beverly Hills that allegedly paid addicts eager to make a buck to endure unnecessary surgeries, get unnecessary lab tests and receive unnecessary injections for inflated prices, according to Orange County prosecutors.

His “elaborate fraud scheme” reaped some $29 million from insurance companies and employed “body brokers” to lure users for the sham procedures, according to court documents that paint a portrait of unrepentant greed and callous disregard for human suffering.

At risk for complications

In a Dec. 15 court filing, Rosen’s attorney argued that he’s at great risk for complications because of chronic obstructive pulmonary disease, centripetal obesity (excessive marbled fat around the waist), coronary artery disease, high blood pressure and obstructive sleep apnea. “(T)hese multiple risk factors, coupled with Randy Rosen’s age of 57 years, cause (his doctor) great concern for Randy Rosen’s health and well-being,” his attorneys argued.

Prosecutors fought his release, arguing that there’s no legal basis for it, that he poses a significant risk of danger to the community, and that he’s asymptomatic and could be well cared for by the jail medical system even if his condition worsens.

They also noted that he committed the crimes he’s now accused of while out on $300,000 bail in a different criminal case, even though he had promised to commit no crimes. He still has access to millions of dollars in assets and, because he faces more than 80 years in state prison if convicted on all charges, is a flight risk.

In the end, Orange County Superior Court Judge Sheila Hanson concluded that Rosen does have underlying medical conditions and ordered him released to his Los Angeles home — a 9,000-square-foot compound worth some $14 million in the hills of Brentwood — under electronic monitoring for up to 30 days.

He was released Thursday, Dec. 17, the Orange County Sheriff’s Department said. Rosen can’t leave the property unless it’s to go to a doctor or hospital, can’t use the internet except to communicate with his defense team or health care professionals, and “is not to apply for, obtain or use any passport,” the judge’s order said.

‘Theater of the absurd’

“We are watching the theater of the absurd,” Orange County District Attorney Todd Spitzer said in a prepared statement. “The criminal justice system shouldn’t have one set of rules for people who are wealthy and a separate set of rules (for people) who aren’t. Poor people who pose a low risk to society shouldn’t have to sit in jail because they can’t afford to get out while wealthy people who have demonstrated they have no regard for the law or the lives of other human beings and have nothing to lose walk right out the front door of the jail.”

There are 588 COVID-positive inmates in medical isolation right now, said a declaration from C. Hsien Chiang, Orange County’s medical director of Correctional Health Services.

Rosen has pleaded not guilty to 88 felony counts in two separate cases. After a complicated preliminary hearing that lasted more than two months for one of those cases, a judge found there was sufficient evidence to try him. Bail was set at $10 million.

Girlfriend also charged

Liza Vismanos, Rosen’s girlfriend, also is charged with multiple counts of insurance fraud and faces up to 36 years in state prison if convicted. She owned Lotus Laboratories, a toxicology lab in Los Alamitos that allegedly processed and billed for the unnecessary tests Rosen ordered.

Part of Rosen’s scam was to pay addicts to get naltrexone implants, court documents allege. Naltrexone binds to the brain’s opioid receptors, blunting an opioid high, and is designed to be part of a comprehensive program to address addiction, not as a cure in and of itself.

But that’s not how Rosen used it, prosecutors say, instead performing as many as 72 procedures in a single day, with the quickest surgery lasting just one minute. Some parents whose children got the implants, then later died of an overdose, say he’s responsible.

“To me, if you give an addict something like that, they’re just going to do more to get the buzz,” Debbie Berry of Ashland, Missouri, said after Rosen’s arrest last summer. Her son, Brennen, died with a naltrexone implant inside him in February 2018. Two months earlier, Rosen billed $59,000 to Berry’s insurance for the procedure.

“My son thought he had that security blanket in him, that it would save him. And it didn’t.”

Rosen’s trial is scheduled to begin in April.