Hiding in Plain Sight

We all know and chastise patient brokering in the addiction treatment field, but what about the rehabs behind the scenes that keep patient brokers in business?


The ethical issues pervading the addiction treatment industry are well-known and now almost discussed ad nauseam. The addiction treatment field for years has known internally there are major ethics issues taking place but recently it has become news on a wider, more public scale. National media coverage on television and in the newspaper have shed light for the public on the issue. Social media has become a feeding ground for unethical addiction treatment discussions. There now doesn’t seem to be a time when addiction treatment is discussed where ethics isn’t part of the conversation. It should be. This is all for the good. For far too long unethical practices have been taking place within addiction treatment and the constant chatter surrounding the issue can only help to improve things within the field. It gets talked about so much currently, it would almost be hilarious if it wasn’t so infuriating and sad. The fact that addiction treatment centers and other providers need to discuss how ethical they are, or using ethical practices as a selling point to marketing services, is comical; Healthcare providers or other support services dealing with people’s lives should just BE ethical. Unfortunately, that isn’t the reality with addiction treatment.


And almost every discussion regarding ethics in addiction treatment typically comes back to what is the most egregious offense: patient brokering. For the few that may not know what this is, patient brokering is a practice where individuals or organizations receive a referral fee for sending a patient to a treatment center. There can be many examples of patient brokering, but in its most basic form it is when a person gets paid for sending someone to rehab. It is, for all intents and purposes, human trafficking. It is a practice that is clearly unethical, in many cases illegal, and puts a price tag on the heads of those suffering from addiction. Although there may be some outliers (the new person in recovery duped into patient brokering by someone they trust; a person with no experience in the industry being manipulated that they are actually doing God’s work by helping people get to treatment), the truth is that everyone is aware and knows the unethical and illegal practices of patient brokering. People do it because they are willing to sacrifice morals, ethics and principles for the almighty dollar, they manipulate themselves into believing they aren’t doing anything wrong, or quite simply they just don’t care. Brokering patients is unethical, illegal and possibly the biggest unethical practice taking place in addiction treatment. People scream from the rooftops regarding this and how wrong it is…and it is. But might there be something even more sinister, unethical and downright despicable taking place? Because the truth is, patient brokers are not to blame for this practice. They are just as guilty but perhaps, just perhaps, they are not at fault for this continued practice of the human trafficking of those suffering from substance use disorder and addiction. Everyone knows patient brokering is wrong, but perhaps we need to start talking about something else?


Perhaps we need to start talking about, identifying and placing the blame for patient brokering where it belongs: With the addiction treatment centers and rehabs that fund patient brokers and keep them in business.


One of the most frustrating things when discussing ethics within addiction treatment is that on the surface everyone seems to be above board. Ask any rehab what they think about patient brokering or similar unethical practices and they will all tell you the same thing: It’s wrong, unethical, illegal and they would never participate in such a practice. Ask 100 treatment centers if they would ever pay someone for a referral and the ownership of all 100 will no doubt looked shocked, almost hurt that you would ask such a question. “Of course not,” they would say. “We would never do such a thing. We are all about patient care. People that do such a thing should be arrested!” or some facsimile of that response. So the question remains: If that’s the case, then where are all these brokers sending their “clients,” who is paying these patient brokers for referrals, what treatment centers are behind the generic television helplines (another form of patient brokering) and what phantom organization is funding all this unethical behavior if no rehabs engage in such practices?


The truth is that many rehabs and treatment centers participate in these terrible business practices. They pay for patients. It may be via cash to a patient broker or a treatment center placement organization, it may be through “case management” contracts or “marketing contracts”, it may be through generic online web sites meant to present to the consumer as objective but are really landing pages owned by treatment centers to filter patients through their doors or it may be through paying for leads through television helplines that are selling “leads” to treatment centers. Regardless of the method, there are many rehabs that are paying for clients and then turn around to act outraged and disgusted by the unethical behaviors and patient brokering practices taking place within the addiction treatment field. It’s hypocrisy at its highest form. Patient brokering is not on the decline, it’s actually increasing. Why? Because rehabs continually fund the practice by paying for patients in one form or another.


Let’s take a look at such practices through the lens of a different industry and disease, just to get an understanding of how ridiculous, outrageous and egregious it is. Let’s believe for a moment that cancer was treated like addiction in this country. Let’s pretend that hospitals were addiction treatment centers. Think about it. What if hospitals paid for patients in the manner addiction treatment centers do? What if hospitals paid cash to people for referring patients? What if hospitals paid generic helplines to filter “qualified leads”? What if hospitals sent individuals to cancer support groups or grief and loss support groups to coerce family members of cancer victims to send them to a specific hospital if they need treatment? What if hospitals sent out “contracted employees” to steal patients from other hospitals? What if individuals went out and found people suffering from cancer, kept them in a hotel room until they sold them to a hospital, picked them up after treatment and took them to another hotel room to let them smoke, then went and sold them to another hospital because the insurance would cover another treatment stay? Imagine a hospital that would even accept a patient in that scenario from such an individual, without at the least calling the authorities to report it? Sounds rather ridiculous, no? Yet, this happens every day to those suffering from addiction. And every day, rehabs are happily and willingly taking these patients and paying a price-per-head to brokers for the referrals.


Imagine for a second if every treatment center and rehab in the country stopped paying patient brokers. What would happen? There would be no more patient brokering. It would cease to exist. Problem solved.


Unfortunately, although it SHOULD be that simple it just isn’t. Why? Because the almighty dollar holds sway. Because the fear of not getting patients or filling their beds for many rehabs outweigh their ethical responsibility and their moral code. Patient brokering is awful and the rehabs can stop it. The question is, will they? Highly unlikely. Because they’re culpable. The rehabs that pay these body brokers and human traffickers are culpable. The therapists and interventionists that accept kickbacks from treatment centers are culpable. The community organizations that receive referral gifts or fees from facilities are culpable. The treatment centers that continually pay for unscrupulous and questionable marketing and advertising practices are culpable. If the treatment centers stopped engaging in such practices, those practices would disappear. But will they? The answer is probably not, because it is much easier to cast a light on the most obvious, the most egregious culprits as a distraction from having to look inward at their own ethical compass. It is easier to operate out of fear of keeping the doors open than take a stand and stop engaging in such unethical practices that may hurt the bottom line for a time but improve the quality of care for nationwide communities currently dealing with an addiction epidemic. It is easier to find the easiest mark and keep the focus there. The patient brokers need to be stopped! Well, what about the rehabs that keep paying for the individuals sent to them by those patient brokers? Are they not, at the core, even more responsible?


Patient brokering is propelled by the treatment centers that fund the unethical and illegal practice and patient brokering could be stopped if treatment centers stopped the funding. Stop paying for patients. The question is, do people’s lives, patient care and ethical responsibility matter more than the bottom line to many of the treatment center perpetrators? Because this will not stop until the treatment centers themselves say enough is enough.


If you or someone you know is in need of help because of drug and/or alcohol abuse or addiction, please give us a call. Maryland Addiction Recovery Center offers the most comprehensive dual diagnosis addiction treatment in the Mid-Atlantic area. If we aren’t the best fit for you or your loved one, we will take the necessary time to work with you to find a treatment center or provider that better fits your needs. Please give us a call at (410) 773-0500 or email our team at info@marylandaddictionrecovery.com. For more information on all of our drug addiction and alcohol addiction services and recovery resources, please visit our web site at www.marylandaddictionrecovery.com.

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