Thanks to social media, ethics is making a comeback in the addiction treatment field.  One doesn’t have to look far to find an industry Facebook group or an article on Linkedin that is exposing the greed and justification driven lack of ethics that has infiltrated our field like a virus.  Worse yet, are the illegal activities that are driving many corners of the field. 

I have been in the field myself since the late 90’s, after sobering up as a teenager.  That places me in a unique situation, in that I am at about the 20-year mark for experience in our field, but I am still young enough to have the energy to remain actively outspoken.  This isn’t to say that there aren’t many of my elders who aren’t passionate, but c’mon guys, you and I both know most of you don’t have the time or energy for this fight anymore.  You saw this in the 80’s, and a touch of it in the 90’s, and here we are again.  You already brought us back a time or two, it’s time for my generation of counselors, therapists, physicians, and like-minded entrepreneurs to bring it back.

Having started as direct care staff (I was a nurse’s aid for a state-run medical detox in Rhode Island), I know that those of us in the trenches aren’t the ones who are taking kickbacks from laboratories, or engaging in illegal patient placement scams.  We don’t have the time or access to the resources to engage in this kind of behavior.  Frankly, most of us are extremely well meaning and either took a major pay cut to enter the field, or we are just getting on our feet and trying to do some good in the world, because we are in the first few years of recovery ourselves.  I know the latter was my story. 

With all of that said, we know what the deal is on the front lines.  We see the writing on the wall.  We didn’t fall off the turnip truck.  A lot of us engaged in shady stuff when we were out using, if we are recovering, or as professionals we have worked with enough people who have that we are not naïve.  In my experience, most people inherently don’t feel good about it when they see it, but they also just don’t know what to do.  They are afraid to lose their jobs.  They are afraid no one will listen.  Worse yet, they are afraid that if they blow the whistle they are going to be branded as a trouble maker and rendered unemployable.  This is unfortunate because in some respects the front lines are the folks in the field who can be the most influential to the field, if the movement we create is toward the ethical treatment of those we treat.  People with substance use disorders are dying in record numbers and to take advantage of this national epidemic is not only deplorable, it guarantees a special place in hell for those who are perpetuating it. 

“What can I do?”

I am so glad you asked. 

Unreported crimes can’t be prosecuted.  Unprosecuted crimes continue.  It is as simple as that.  We have to be brave. We have to put aside our fears for the greater good, and we have to do the right thing.  I assure you that if you lose your job because of this, there will be five ethical programs willing to give you a shot.  This isn’t the same kind of business you were in before.  The true people and clinicians in the field, the ones who will be here when the almighty dollar moves its influence to another field, we get it.  We are the ones who are going to be here when the dust settles.  We were always here and we will continue to be.  We get excited about moral counselors and techs who are trying to do the right thing.  It’s what we as clinical supervisors are trying to instill in those we develop.  Have faith in us.  We won’t let you down. 

I am going to list some websites where fraud and illegal activity should be reported, along with some ideas of what you can report to each entity.  All of them will allow some form of anonymous reporting, but it is always better when there is a verifiable report on record. 

Illegal or Unethical Facility Issues in California

This is the State of California’s Department of Healthcare Services.  They license all detoxification, residential (RTC), day treatment (PHP), and certify intensive outpatient programs (IOP).  They look into complaints on all of these facility types.  They also will look into sober living homes that should be certified or licensed as treatment programs but are not.  If they provide treatment services at the sober living home such as counseling, psychotherapy (group or individual), medical services, or other professional services, they are operating a residential treatment center without a license.  If they bill insurance companies for the care taking place in the home, it is almost always a sure sign they are not a sober living home and should be licensed. 

Some examples of things to report to DHHS:

  • Hiding clients or “stacking clients”.  Residential treatment centers that are set up in a house nearly always have a six bed limit attached to their license.  If they are “stacking” people by hiding beds or paying people to stay in hotels or the residences of staff members, they should be reported.  There are licenses for RTC that can increase this amount but they are difficult to get and rare.  Actual hospitals and skilled nursing facilities do not have this type of census restriction for their facilities and may have many more beds. 
  • Detoxing people in a sober living home. This is unsafe, illegal, and potentially fatal for the client.
  • A facility looking the other way while a counselor engages in predatory behaviors with clients such as sexual or financial relationships.  Watching a client go through treatment only to open a business 3 months later with a treatment center owner or employee is an example of this.  I would hope I don’t have to explain the sexually inappropriate part of this, but since I will regret it if I don’t; ANY SEXUAL CONTACT WITH A PATIENT IS UNETHICAL AND ILLEGAL AND SHOULD BE REPORTED IMMEDIATELY, BOTH TO THE COUNSELOR’S BOARD AND, IN THIS CASE, TO THE STATE.  Sorry about the yelling.  Some people are dense.  Not you, just some people, and I need them to hear too.   

Illegal Client Procurement (AKA: Body Brokering) or Insurance Fraud

Body Brokering: In healthcare, the referral or placement of a patient for a fee is illegal and certainly unethical. While this may be common practice in other fields such as financial services, in healthcare we simply do not do it.  Ever.   Because lives are at stake, we should always refer a patient to a facility or provider that, in our best estimation, gives them the most ideal opportunity to succeed.  Whenever I make a referral, I look at clinical specialties and experience of a facility and its staff, patient age, cultural aspects, minority status, other diagnoses, and resource profile, among many other significant factors. 

This one seems to be the one people really do not know what to do with, and it may be the most straightforward in some respects.  These are illegal activities and could be reported to the police department itself, but that usually isn’t the best route for this, as the local police really would just hand it over to the county district attorney’s office.  The county district attorney’s office actually has investigation units specific to healthcare fraud.  They are not limited to alcohol and drug treatment and are often looking at everything from worker’s compensation fraud cases to fraud with elder care.  They also have an interest in our field.  Depending on the county you are in, some of them have a very specific interest in this, and for good reason.  No one in this continuum of issues is too small either.  Even the vulture who sits at AA meetings and offers addicts money to get on insurance and go to their center is of interest to these guys, because that guy will roll over in a heartbeat on the people making the real money on this type of activity.  He/she is usually a kid (often who was or is a client of that very facility) and they often think they are just “being of service”.  They often don’t even know they are committing an egregious crime or easily justify it because of the “helping” aspect of what they are doing.  Once they are in the rabbit hole and their own greed starts in, we see some of the more nefarious activities like paying people to get high so they meet admission criteria, but that isn’t usually where this starts. 

Insurance Fraud: Insurance fraud is anything that attempts to obtain payment or increased payment through dishonest or exaggerated claims from an insurance company or payer entity.  I often hear the argument against the all-powerful insurance companies as a justification for a lot of things, but it isn’t worth the detriment to the field.  Sure, you may get this guy a few extra days by lying on a utilization review, or you might be able to scholarship a woman because you did some extra billing under an unrelated code, but in the end this hurts years worth of patients.  Abuse is nearly always followed by regulation, and believe me when I say that the boutique treatment center you are working for is not going to be the one lobbying congress or the state assembly when those regulations are passed.  It will be the major insurance carriers with heaps of evidence to support their claims, and to deny yours. 

Los Angeles County District Attorney-Healthcare Fraud

211 West Temple Street
Suite 1000
Los Angeles, CA 90012

Phone: (213) 257-2350

Orange County District Attorney

401 Civic Center Drive West, P.O. Box 808
Santa Ana, CA 92701
PHONE: (714) 834-3600

San Diego County District Attorney

Hall of Justice
330 W. Broadway
San Diego, CA 92101

Insurance Fraud Hotline 800-315-7672

FAX: 619-237-1351

Riverside County District Attorney

Multiple addresses:

San Bernardino County District Attorney

Multiple locations:

This article is short and to the point. I intended it to cover some of the most regularly occurring issues out there.  I know there are a lot more issues going on.  The websites listed here are a good place to start, even if you have an issue outside of the ones listed.  If the person is an individual that is engaging in unethical or illegal activity, then their own licensing board or certification board is a good place to start.  If what they are doing is on a grander scale than that, I would also look toward criminal prosecution and the district attorney’s offices.  They can at least tell you where to go, if not to them. 

The condensed version of all of this is that we got into this to do the right thing and to help another man or woman out.  We didn’t get into it to make a killing.  People are dying without our help, they don’t have to die because of it.  If you read this far, it says a lot about who you are and I am guessing doing the right thing is your calling.  Don’t shirk away from who you really were intended to be.  The support is here for you.  Most of us are very supportive and will point you in the right direction if you do the right thing and there is a temporary backlash.  If you are even moderately competent, it won’t be an issue in the future.  There is plenty of honest work out there to be done and we want honest people to do it. 

Author: James “Kansas” Cafferty, LMFT is a psychotherapist and founder of True North Recovery Services, an intensive outpatient program located in Encinitas, CA. He also serves as a Commissioner to the National Certification Commission of Addiction Professionals at NAADAC. 

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