
'Body Brokers' Get Kickbacks to Lure People with Addictions to Bad Rehab - Mz
http://www.npr.org/sections/health-shots/2017/08/15/542630442/body-brokers-get-kickbacks-to-lure-people-with-addictions-to-bad-rehab
======
rdtsc
> billed insurance companies for more than $58 million in bogus treatment and
> tests, and recruited addicts with gift cards, drugs and visits to strip
> clubs.

That is a special kind of evil. I hope they are some harsh penalties involved.

I think it is fair to judge a society by how it treats most vulnerable and
marginalized individuals. I don't think we are doing very well there by that
metric.

~~~
ingenuous2
I agree with you. But there are competitive advantages in a cutthroat industry
to being unethical, so over time, it's mostly the bad actors that have the
fattest margins and can make plenty of money before getting caught.

Just like any industry, people accept it because it's just what happens. So
busy being a business owner that you cannot afford to be Sheriff.

~~~
Joeri
You can make this argument for a lot of crimes: bank robberies are lucrative
so over time more and more bad actors will become bank robbers. Except that
doesn't happen because bank robbers are pursued vigorously.

If there's a zero tolerance policy against drugs there should be a zero
tolerance policy against people providing bogus care for drug addicts. Just
like you can judge a society by how it treats its weak, you can judge it by
which crimes it pursues vigorously and which ones it lets slide.

~~~
hueving
>If there's a zero tolerance policy against drugs there should be a zero
tolerance policy against people providing bogus care for drug addicts.

Unlike the bank robbery case, it gets difficult to tell the difference between
incompetence and intentionally crappy care. Nobody accidentally robs a bank
because they were poorly trained.

This makes it harder to have a government policy of charging everyone with a
felony that provided poor care.

------
ada1981
Legalize psychedelic therapies. Specifically iboga.

I watched a friend who was suicidal and an addict a couple months ago enter
into an iboga treatment and the guy hasn't had a smoke or drink since... he
looks like a million bucks.. is hitting the gym and talking about "feeling his
emotions" and is happily in therapy.

This is a dude who has neck tats, was routinely getting into bar fights with
skin heads in NYC and is a vet who had pretty severe PTSD.

Let's legalize treatments that actually work.

~~~
trcollinson
While I am glad this worked for your friend, or seems to be at the moment,
that doesn't actually solve the problem.

The problem that this article is pointing out is actually that rehabilitation
and treatment centers are money making machines and that some owners of those
centers are unscrupulous and unethical at best, and acting completely
criminally at worst. By legalizing new treatments you actually cause the
problem to get worse, not better, especially if those new treatments lack
clinical data and scientific backing. This leaves an open door for desperate
people in need to be seduced into treatments that might not help and will cost
substantial amounts of money.

Many types of treatment do work, and work very well. If someone is in need of
treatment, please, do your homework and research and find those people who can
really help you.

~~~
_lex
Seriously - what types of treatment actually work for people addicted to
drugs?

As far as I know, none of them work ( where working is defined as >50% of
people who complete the treatment course being able to move on to lead a
normal, drug free life). A lot of them do make a ton of noise though, and
several basically lower your expectations from the outset (like AA) - so you
treat addiction as a chronic disease: something you'll never be cured of, and
have to always deal with.

The parent poster seemed to be arguing that iboga can cure addiction. If he's
right, this is a big deal.

~~~
ada1981
My general thesis on this is that "addiction" is really an addiction to
dopamine which is triggered by various other things (drugs, sex, booze, power,
money, shopping, porn, etc). That dopamine release is the nervous systems
attempt to sooth itself when in a state of disregulation.

A healthy nervous system in a healthy environment (with attuned caregivers and
limited traumatic experience) will equipt a person with the neural pathways
(and associated beliefs and behaviors) to regulate their nervous system.

In compromised development, either through lack of attunement or childhood /
early trauma folks don't have the ability to automatically regulate and they
are in a constant state of fight / flight. The dopamine helps to deal with
this temporarily.

Psychedelics, some therapy, and sometimes near death / mystical experiences
(moments of clarity) can offer a window of opportunity in which the ego
loosens its grip enough for the nervous system to relax and for the
subconscious material (traumas) to come to the surface and be released with
the accompanying rewiring of the fight / flight response.

When one experiences reality from an undefended state it is generally such a
pleasurable, rich experience that the desire to use other mechanisms of self-
soothing _organically_ fade away and the cognition and behavior reorient to
healthier more nourishing alternatives.

These experiences and therapy combined with a healthy environment and
relationships that support the honest expression of emotion (ie, not co-
dependent) can rapidly support healing.

The basic idea is that traumas are trapped in the somatic system and that
altered states of consciousness combined with the right context can allow for
an unfolding and healing of the underlying issues.

Depending on the underlying issue and severity of the defense structures folks
may find help with various psychedelic substance from MDMA, Iboga, LSD,
Mushroom or Ayahuasca.

We also have seen great result using Holotropic Breathwork which was developed
as a legal alternative to LSD Psychotherapy.

This is essentially the same process I used to heal from bipolar, as I began
to see bipolar as an "addiction" to states of depression and mania as a
protective, adaptive response.

It's also the process I now use with my clients and the underlying philosophy
that I bring to the communities that support.

If anyone is interested, there is a new book out (published anonymously) that
documents accounts of a number of people who have been helped by an
underground MDMA therapy practice. (Not specific to substance addiction, but
includes some accounts.)

[https://smile.amazon.com/Trust-Surrender-Receive-Release-
Tra...](https://smile.amazon.com/Trust-Surrender-Receive-Release-
Trauma/dp/1619617382/ref=sr_1_1?ie=UTF8&qid=1502907574&sr=8-1&keywords=trust+surrender+receive)

------
exogeny
I'm not trying to flippant, I really don't know: how much of this specific
case is caused by our completely byzantine and backwards health care system?
Or is this more of a case of terrible people, well, being terrible?

I would wager this sort of thing is beyond unheard of in a country that has
both centralized, state-run healthcare and a progressive attitude towards
addiction.

~~~
55555
These are drug addicts who largely don't have any savings. They are extremely
cash poor. But they are "worth money" because each body can be used to bill an
insurance company for outrageous amounts (which, one way or another, we all
pay). Without an extremely flawed insurance industry this wouldn't be
possible. How else could you make lots of money from people who don't have
any?

------
unixhero
Guys. I discovered a sinister rehab clinic in Portugal after an online cry for
help was discussed on the Reddit Bureau Of Investigation (yes, it's a real
thing, /r/rbi ).

It was mentioned that after being "admitted" they were held there against
their will.

The treatment method was to "break the patient down" and then "build it back
up".

This clinic is the one which was mentioned.
[http://novavidarecovery.com](http://novavidarecovery.com)

~~~
icebraining
Unfortunately, as a Portuguese, that wouldn't surprise me. Do you have a link
to the Reddit thread?

~~~
unixhero
[https://www.reddit.com/r/RBI/comments/5utmaz/my_girlfriend_j...](https://www.reddit.com/r/RBI/comments/5utmaz/my_girlfriend_just_called_me_in_panic_to_come_get/)

~~~
icebraining
Thanks. She's young, which fits the profile of the "rehab" houses known to be
essentially milking State subsidies while treating the patients as cattle. The
girl I knew who spent a few months in one of these could only call her
parents, and usually not in privacy.

A local news article claims they also treat airline pilots, which should be
harder to mistreat, but that was two years ago.

Unfortunately there aren't many leads. It's hard to denounce these places
without an inside witness.

------
hn_throwaway_99
I'm not particularly religious, or superstitious, but I have to believe there
is a special place in hell for those that would prey on the sick like this.

~~~
alexanderstears
There's a special place on Earth too: private beaches.

------
cperciva
Why don't the insurance companies get together and blacklist the "bad" rehab
facilities? I mean, insurance companies want their patients to get off drugs,
so that they stop costing money, right?

~~~
Mz
Having worked in insurance, my guess is this would be illegal.

They do share information via state regulators (insurance commissioner or
state department of insurance) regarding actual fraud once it is proven.
Proving fraud requires significant investigation. You have to have more going
on than a high rate of recidivism for patients wrestling with addiction for
them to accuse you of fraud.

~~~
inetknght
So if this fraud is too "low scale" to be worth fighting, imagine how much
_profitable_ fraud exists...

~~~
Mz
When I worked at Aflac, they claimed that insurance fraud costs every man,
woman and child in the US more than $1000 a year.

------
javajosh
Glad to see this problem getting visibility. I worked briefly for a rebilling
company that specialized in rehab centers in SoCal. With the right billing
codes, those places could pull incredible incomes.

------
sgwealti
How fucking evil and cold hearted do you have to be to take advantage of
addicts. I'm losing faith in humanity.

~~~
ams6110
Humanity is the same as it's always been. There have always been those who
will take advantage of whomever they can.

~~~
thinkfurther
I doubt that. Early humans had to cooperate and share. They couldn't afford
this parasitism. We still can't afford it, but for most individuals it's
easier to just let it go rather than to follow them to their nest and smoke
them out.

~~~
WalterSear
Most early humans cooperated and shared because they spent their entire lives
surrounded by the same a few hundred people.

It's the same today. We still cooperate and share with about a few hundred
closest people, and for everyone else, we have capitalism. Whenever the two
meet, we shock-horror a bit about the callousness of others, and then we go
back to treating everyone outside our Dunbar number as an object to extract
resources from.

I don't want to suggest that it's biologically inevitable, but that we aren't
going to overcome it until we start recognizing the blind spots in our
cognition and empathy.

~~~
thinkfurther
> Most early humans cooperated and shared because they spent their entire
> lives surrounded by the same a few hundred people.

That and, as far as I understand, when they went hunting, only a few get
lucky, and those couldn't eat all the meat themselves before it spoiled.

------
fapjacks
Meanwhile, the addiction rehab industry is lobbying _hard_ to make kratom
illegal on the state level. Make no mistake, they are sociopaths preying on
addicts that will do and say anything to keep them addicted.

------
tcj_phx
A year and a half ago I had to call emergency services to revive my friend.
She'd gotten herself a court order for mental health treatment, and the mental
health professionals thought she'd benefit from getting addicted to
benzodiazepine anxiety drugs too. She'd only wanted the benzo "as needed", but
they made her take the full dose every day. After 6 weeks the helpful effect
of the benzo wore off, leaving her with just another addiction. She ordered
heroin from her street pharmacist to get her through the benzo withdrawal. I
later learned from a HN comment that benzos increase the potency of opiates,
so they don't actually go well together...

The firefighters did more for my friend with their Naloxone than any of the
mental health professionals. Her drinking was under control for about two
weeks. Then the naloxone wore off...

I think the fundamental problem with current approaches to
addiction/rehabilitation is that they mostly view addicts as having had a
'moral failure' in choosing to use 'recreational drugs'. ~80% of rehab
facilities use some version of the 12-step program, which is helpful for
~10-15% of people who are addicted to something.

I've observed some cases of alcoholism too. It's not very different from
street drugs, except every corner store has their vice.

About five years ago someone figured out that the brains of alcoholics switch
to running on acetate, one of the breakdown products of ethanol. Alcoholism is
basically a metabolic problem, as far as I can tell. I found an article by an
alternative medicine heretic ~3 years ago that said nerve tissue can run on
coconut oil too. I've heard a tablespoon really does help with alcohol
cravings.

IMHO, it's much more productive to view addiction as self-medicating physical
and mental anguish. People who are emotionally stable tend to not get hooked.

I was just transcribing the videos my friend made of us frying donuts (in
coconut oil), taken two weeks before her first hospitalization. She was doing
very well, then she ran out of alcohol & the professionals got hold of her...

A very smart woman I know once said, _" When a person feels safe,_ the false
ego goes away." Helping people to feel safe is the most important part of all
effective drug rehabilitations. Sometimes people need access to their drug of
choice to feel safe. It's much better to give them pharmaceutical-grade drugs
[1], and wait for them to age out of their addiction, than to train them to be
helpless in jail, or help them to feel like failures in a 12-step-based "drug
rehab".

[1]
[https://news.ycombinator.com/item?id=14782416](https://news.ycombinator.com/item?id=14782416)
\- Switzerland gives their most hopeless heroin addicts access to
pharmaceutical-grade heroin.

~~~
ThrustVectoring
>~80% of rehab facilities use some version of the 12-step program, which is
helpful for ~10-15% of people who are addicted to something.

I'd say 12-step is closer to "takes credit for the ~10-15% of people who'd
beat their addictions anyways".

~~~
webnrrd2k
I'm not against 12-step programs, and I have a lot of friends in 12-step
programs. Just some observations... the programs certainly have some problems.
There is a very high rate of relapse, for one thing. The religious aspects a
bit hard to swallow, too.

The things that concern me the most, however, is, well, it's weird, but I've
seen this happen a few times... Friends who had moderate problems with alcohol
and/or drugs go into 12-step programs. They seem to over-identify with the
social side and really want to belong, but feel that they haven't had a bad
enough bottom, so they go out again but really go overboard in an effort to
_prove_ that they belong. I've seen some otherwise sane people go on some
crazy, nearly life-ending binges.

Also, AA seems to stunt people in a weird way... They seems that they think AA
is a total solution to all their life's problems, and so they often go on for
years with some difficult psychological problems. Depression, anger issues,
ADHD, etc... stuff that would be much better addressed by modern medicine.
Maybe it's the similar to many religions, in that once you've got God, all
your problems will be fixed by prayer and devotion.

Even after all that, I think 12-step programs can be a great thing for a lot
of people. It depends a lot on the person, and the groups around them.

------
qq66
I would like to see the organizers of these scams executed, and given the
nature of their crimes and their victims, I do not personally believe that
this would be cruel or unusual punishment. I know that the Supreme Court would
disagree with me.

------
maxxxxx
There was a thing on NPR a while ago about billions paid to scam therapy
centers. They would prescribe useless therapies to people with chronic back
problems and other injuries. Without quality control this happens in every
industry.

~~~
enraged_camel
>>There was a thing on NPR a while ago about billions paid to scam therapy
centers. They would prescribe useless therapies to people with chronic back
problems and other injuries.

So... chiropractic?

~~~
BenjiWiebe
Funny, I've had very good luck with chiropractors. And no, she actually has
never told me to come back.

------
Mtinie
In theory, it should be straightforward to validate if a halfway house is
legit or not. Professional help offered generates fees through insurance
charges which means income for the businesses that can be traced...

...so why am I so cynical about being optimistic for an actual consumer-
beneficial outcome in cases like these?

~~~
ingenuous2
It turns out, it's very hard to determine "legit" or not. Standard of care has
not permeated much of the AA/NA [edit: treatment] culture. This is a heavily
stigmatized group of people who frequently do not have the response reactions
you or I might.

Insurance companies like scans from MRI tests, not reports written from mental
health consultants.

These are some of our most vulnerable people. We need to take care of them.
It's less competitive as a business to do so.

[edit - like much of mental health issues, 'success' is difficult to define,
so outcome based measurement is difficult.]

~~~
Mtinie
Thank you for the response.

In your opinion, in the facilities such as those discussed in the article and
ones like them, would physical inspections address the more egregious cases?
Are run down facilities, lack of sanitation, etc., enough to add a location
(and operators) to an interstate "do not process insurance claims" blacklist?
More regulation isn't the answer for everything, certainly, but as you stated,
we are talking about exceptionally vulnerable people.

Or is the stigma of addiction and mental health issues the root cause? Would
this type of regulatory pressure be DOA because regulators, as people
themselves, often believe addiction is a moral failing and not a health
consideration?

~~~
ams6110
Who would do the inspecting? How do you qualify them? Who pays for it? How do
you prevent bribes/payoffs?

------
nanis
This is the tip of the iceberg generated by mandated coverage of addiction
treatments.

~~~
cguess
What are you trying to say? That insurance companies shouldn't have to cover
drug treatments? Perhaps, instead, this is an issue with lack of regulation
and inspection. Fund treatment, but also fund inspections and required
standards (which it seems, according top the article, is finally happening).
It's not like health insurance companies don't want to see the treatment work,
they make their money when their patients are healthy.

~~~
njarboe
Under ACA insurance companies must spend 80% of of premium dollars on claims
and activities to improve health care quality. 85% in large markets. Sort of
like the cost-plus system in defense spending. The company % take remains the
same so there is incentive to increase the amount spent. Just jack up the
premiums.

~~~
robbiemitchell
I disagree. The incentive is to spend as little as possible on the remaining
%, because sick people already cost a ton as it is.

Most insurance revenue comes from non-ACA employer plans, which don't have
this requirement.

~~~
vidarh
It is a general problem with "cost plus" type arrangements though, that really
always ought to have clauses to explicitly reward cost-cutting (by letting the
provider keep a portion) and sound investments towards better care.

------
amelius
Solution: legalization.

~~~
kazagistar
That doesn't solve the need for a safe place where people with destructive
addiction to recover. If anything it would make it more important. Hoe do you
imagine it would help?

~~~
amelius
It would help because there would be no incentive to get these people addicted
(again).

------
josephpmay
Basically the plot of Inherent Vice (the move at least)

------
chefandy
Been going on in Boston for a few years.

~~~
eropple
Can you substantiate this? I have some friends who would be interested in this
if you can.

