Substance Abuse Treatment And Fraudulent Behavior

Patient First Mentality vs. Head-to-Bed Mentality

Since entering the behavioral health field I have had the great pleasure of sitting down, face-to-face, with some of the most passionate people you could ever meet working within behavioral health services. These individuals are not only highly respected for the behavioral health services they represent, but above all, as I like to say, “they give a damn.” They not only give a damn about getting people well and collaborating with providers offering the same type of enthusiasm and reliable treatment services they are known for, but they are equally transparent and emulate the highest of integrity

The goal of these industry leaders and the companies they represent is to both promote and execute a patient first mentality. By having a patient first mentality, every person being treated within the behavioral health field is to be treated based on their specific or multiple diagnoses and then admitted to a facility that can best work with and heal those diagnoses. The other side of the patient first mentality is the head-to-bed mentality. Under this notion, the goal is to fill beds rather than ensuring that the person filling the bed actually gets the appropriate treatment they need

A good way for people within behavioral health services to gauge whether or not a company has a head-to-bed mentality or patient-first mentality is to ask the question, “what makes your company unique?” I certainly believe what makes Peaks Recovery different is not only our structured care but the culture that we have instilled. We have successfully surrounded our program with talented professionals that have both the education and passion for helping those in recovery. All of our therapists, for example, have completed their CACIII credential or have a master’s level education or higher within this field.

Surrounding our company with not only talented individuals, but individuals that, also, give a damn, creates better outcomes for every young adult entering and exiting our programs. In addition to our clinical team, our extended care model and 24-hour structured level of care is a great format for young adults who have been to many treatment centers prior to us without success. Care within our program is individualized and although we can work with dual diagnoses we are not suited to treat mental health disorders as the primary cause of treatment, we are not suited for a middle-aged or higher populations, and we most certainly are not suited to detox individuals, etc. Our niche is specific and the best outcomes for us are created when clients come to our facility in need our specific level of care.

Cigna Pulls out of Florida Market

Making the above known about our company to detox and residential providers allows them to refer clients best suited for our program as opposed to simply referring a client based on us having an open bed for them. On the flip-side of the patient first, collaborative mentality, however, are the behavioral health programs that express their specific niche and, then, do everything in their power to manipulate clinicians, families, and individuals about the actual level of care and services they provide. In fact, this manipulation or better said, this “fraud” happens everyday and continues to thrive in every single state throughout this country.

For example, depending on the state and area you live in, countless programs do not hire certified clinicians due to lax state requirements. Instead, these programs higher staff whose highest credential is having a few years of sobriety with no education in psychology or counseling, and allowing them to run primary and individual therapy sessions. Equivalently, it would be like a hospital allowing the Nurse Assistant to perform a heart operation. Instead of paying doctors for the operation you end up paying lower salaries while greatly reducing the level of care. The benefactor being the recovery program that saves and, no doubt, pockets hundreds of thousands of dollars that should be going into the cost of professionals required for higher level treatment.

Then you have programs that utilize the disgusting practice of paying clinical staff members money under the table for referring clients to their program. In this view, clients are treated as commodities. Instead of getting clients to an appropriate treatment center, they are being sent to where money is the priority and directed to facilities based on what their insurance can pay rather than the treatment they need.

And, as a final example, there are countless companies who work deals with urine testing facilities to maximize profits off of urine tests. Urine testing is crucial in the behavioral health field to keep clients honest and accountable to their recovery, but when you learn about urine testing facilities paying salary sized wages to recovery programs for guaranteeing, that, their urine screens go to particular urine testing facilities, raises many red flags. Some treatment centers even offer addicts free housing to ensure they have enough bodies to generate millions of dollars from urine tests due to the fact that a single addict can generate 6,000 a month if given the most sophisticated test.

The above three examples are just a sample size of the disheartening practices that happen every single day in this field. It is no wonder, then, why the insurance company Cigna has decided to exit the Florida market place. To be blatant, the self-centered actions of some people across the behavioral health field has contributed to profits, no doubt, but they have successfully created a business model that has made countless other behavioral health providers and insurance providers wary of certain programs, cities, and entire states where services are provided.

The Consequences and need for Education

A few counsequences resulting from this fraudulent behavior are, first, clients and their families are not getting the help they need. Not only are there millions of individuals who cannot access behavioral health services, but the ones who can and who are most vulnerable, whose families are most vulnerable, are being manipulated about which programs offer the most reliable care. The second result of this fraudulent behavior is the lack of trust and stigma being placed on the behavioral health field as seen by Cigna exiting the Florida market. As a result, everyone who owns Cigna health insurance in Florida and who are in need of behavioral health services are about to be entirely shut out from receiving the appropriate services needed for their substance abuse treatment or mental health services.

For those that provide reliable behavioral health services with a patient first mentality, thank you. For those who are apart of the problem, stop, or time will inevitably expose your practices. And for families and individuals of crisis situations who are in need of care I leave you with a few bits of advice: first, when considering a treatment program, look over the company’s website. If the website does not show or detail who their employees are, that’s probably a red flag; second, if you call a company and they do not first address what the needs are for you or your loved one, but first insist that their treatment place is what you need, that’s probably a red flag. After all, how can someone be best for a program if the program does not fully understand the needs of the individual they are serving? And, lastly, if you are looking for a local place within your state and the third party calling center you’ve reached continues to push you to a provider out of state or away from your preferred area, that’s probably a red flag.

In the end, there are many red flags to be aware of and only a few have been listed here. The goal for Peaks Recovery is to collaborate with other treatment providers to ensure that every patient gets both the highest level of care and specific care for their needs. When you remove the fraud and need to fill beds first, we as providers can look to collaborate with each other and create positive outcomes for the people we serve. If you, as a provider, feel the need to “compete” within the business then it’s probably a good sign that you are not collaborating, but working harder to fill beds. However, if you promote the patient-first mentality and emulate integrity, the bed filling part of it all will naturally follow. When we do what is best for the client, everyone wins.