WASHINGTON D.C. – As he and other lawmakers grilled representatives from the addiction recovery industry Tuesday, the Congressman from Georgia seemed to grow incredulous.
“So you have a list of companies that you refer people to?” Rep. Buddy Carter, R-Georgia, asked Jason Brian, founder and owner of TreatmentCalls.com and Redwood Recovery Solutions, two Florida-based companies that market treatment centers to people addicted to drugs or alcohol.
“What are the qualifications for a company to be on that list?”
Brian sat stiffly in his chair and began to answer, “Licensed by the state…”
Carter cut him off: “Do you take into consideration outcomes?” Do you ask those companies (what percentage of patients achieve sobriety) before you put them on your list?”
“No,” Brian said.
“So the outcomes have nothing to do with it,” Carter noted. “You’re just on the list.”
And so it went Tuesday as members of the U.S. House subcommittee investigating addiction treatment in America grilled providers and marketers about advertising practices. It was the latest hearing in a bi-partisan probe of an industry that many lawmakers believe should be subject to tougher federal oversight in order to curtail widespread consumer and insurance fraud.
Some executives pointed out that their industry — which includes a beachhead in Southern California known as the Rehab Riviera, with more than 1,100 centers in Los Angeles, Riverside, San Bernardino and Orange counties — is particularly needed during the national opioid crisis. They also noted that regulation varies widely from state to state.
“We have people dying in the streets,” said Michael T. Cartwright, chairman and CEO of American Addiction Centers. “We really need to do something about this. We want to see consistency regarding the quality of care and licensure standards. It’s completely different from state to state. In California, you can detox in six-bed houses. In other (states), it has to be done in hospitals. We should have standardization.”
And because there is no agreed upon standard definition of what quality care is, and isn’t, there’s no ability to rank facilities on quality, and no easy way for consumers to get information, noted Rep. Gus Bilirakis, R-Florida.
Most information about addiction treatment is provided via Internet advertising, where overstatement, misstatement and outright fraud abound, lawmakers said. Several witnesses implored the federal government to raise the bar.
“To ensure ethical, quality care for all who seek help for addiction, we believe it is time to establish quality standards,” said Mark Mishek, president and CEO of the Hazelden Betty Ford Foundation.
“Congress needs to assist… Reforms ought to bolster state licensure requirements; accreditation standards; clinician education qualifications; and access to comprehensive, evidence-based care and support that is coordinated and integrated with the rest of the healthcare system.
Kenneth Stoller, director of the Johns Hopkins Hospital Broadway Center for Addiction, said there are five elements to high quality treatment. Effective centers use clinically appropriate medications (methadone, buprenorphine and naltrexone for opiate disorder; naltrexone, disulfiram and acamprosate for alcohol disorder). They combine medications with counseling or psychotherapy that is delivered by skilled, experienced staff. And they use behavioral therapies that motivate positive change and incorporate objective measures of treatment response as well as so-called wrap-around services (including supportive housing and vocational rehabilitation, among others) to help patients achieve long-term sobriety.
“A big concern that this committee has is in ensuring that, when an individual is looking for treatment, they know what to look for, and what things to avoid,” said Rep. Bilirakis of Florida. “I want to make it clear and less complicated for the consumer.”
On average, 115 Americans die every day from opioid-involved overdoses, said Rep. Gregg Harper, R-Mississippi. The demand for treatment has increased greatly in recent years, with admissions for opiate use growing 58 percent between 2005 and 2015.
That growing demand has spawned a large and complex treatment industry that Harper and others said is largely unregulated at the federal level.
The Congressional probe comes in the wake of a Southern California News Group investigation of the “Rehab Riviera.” The SCNG probe found that unscrupulous operators can turn a single drug addict or alcoholic into huge profit, often without providing much in the way of recovery. Offers of free travel and treatment “scholarships” lure addicts from other states to Southern California, where those addicts then are signed up for health insurance, often under false pretenses. Treatment centers pay the premiums and then bill insurance companies for services — a slight-of-hand that can put hundreds of thousands of dollars into the operator’s pocket.
Often, when the insurance runs dry, those addicts wind up on Southern California streets, destitute and still addicted. Sometimes addicts die in the care of non-medical centers that would not be allowed to open in other states.
“Without more accountability, our field will continue evolving into a sector where success is predicated not on whether patients get well and families heal, but on the size of your advertising budget, website analytics, search engine optimization and call center tactics,” said Mishek.
“The lack of transparency, on top of minimal quality standards in the industry, puts patients at risk. These kinds of practices certainly would not be tolerated in any other area of healthcare,” he said. “In too many cases, people who need help are instead being harmed.”Updated 7/25 with comment from Mishek