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November 1, 2019 By SmartLight News Desk

“Rehab resorts” recruit patients

Fraudulent claims from rehab facilities that function more as resorts, recruiting patients and even paying commissions for admissions, seems to be a growing trend.

Our past findings have been consistent with recruiting and clearinghouse practices well documented among some rehab centers. In such centers, patient recruiters typically receive payment from the rehab centers for each patient they obtain that generates revenue. Predatory marketing practices often involve a misrepresentation of the services offered and the auctioning of patients through clearinghouses. The clearinghouses route patients to call centers, and once the patient’s insurance is verified the clearing centers act as brokers auctioning off the patients to the highest bidding rehab centers.

“Rehab operators have told the Southern California News Group (which investigated the addiction industry in 2017) that they know it’s wrong to offer money to middlemen in exchange for well-insured patients, but that the practice is so ubiquitous in California they’d have no patients at all if they stuck to the high ground,” according to the piece titled, “Rehab patient brokering is rampant, but it’s hard to stop, industry says,” published in the Orange County Register on May 30, 2018, and written by Teri Sforza, Tony Saavedra and Scott Schewebke.

“Addicts start to see their insurance cards as credit cards, operators said, demanding better food, cell phones, even cash from providers in exchange for staying in treatment. If the provider doesn’t deliver, the addict bolts to a different treatment center that will give him more of what he wants,” the article stated.

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Filed Under: fraud, healthcare

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SmartLight Analytics combines the best inferential analytic models with a team of analytic  and clinical experts to find fraud, waste, and abuse in self-funded employer health care plan claims data.
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