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Ep. 049: Insurance Fraud at a Detox: Pled Guilty but Tells a Different Story. You Decide.

In 2014, with the passing of the Affordable Care Act, the treatment industry changed drastically and for what some may define as good as everyone was able to seek drug and alcohol treatment if desired because insurance companies were required to include those services on policies while others defined it as a nightmare as greed took over and fraud became more of the norm.

Treatment programs started seeking out people and offering to purchase insurance by paying for premiums to fill their beds, in some cases these providers would offer financial incentives for coming into their programs by offering cash if they stayed.

Questionable people were opening rehabs because of the money they saw that could be made. Referrers and referral companies began giving financial incentives to people to enter treatment programs as these referrers were charging thousands of dollars to programs for giving them clients.

Safety and ethics was thrown out the window as providers began breaking the law by committing insurance fraud and in some case they were billing for services that weren’t being provided and even charging for people who weren’t even in their program.

I spoke to the DHCS and was informed that unless I can definitively prove it; they could do nothing.

I closed a program in Lake Elsinore because I wasn’t willing to pay for my clients by these dangerous referral companies which almost seemed to be the only way to secure clients to pay the bills to stay open. I was defeated.

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