NPR’s Ailsa Chang talks with Mother Jones reporter Julia Lurie about the loosely regulated rehab industry, and how it shuffles people in and out of treatment programs and cashes in on insurance money.

AILSA CHANG, HOST:

Naturally a parent whose child is addicted to opioids would want them in rehab and would want their insurance to cover them for as long as it takes. But for Becki Sarnicky’s son Nick, what seemed like the best way to help him wasn’t.

BECKI SARNICKY: He went through more rehabs than I can count. And I could tell something wasn’t right.

CHANG: It turns out a so-called patient broker was making money off her son, shopping him to different rehab centers, putting him up in hotels in between, supplying him with drugs. Nick was in four rehabs in five weeks, racking up more than $100,000 in insurance charges in that time.

SARNICKY: At one point, I called my insurance. And I asked them to stop paying for the rehab because it wasn’t helping him. It was – he was getting worse every time he went away.

CHANG: Nick died of an overdose in 2017. He was 23. Becki Sarnicky wants more people to know this is happening, which is why she told her story to reporter Julia Lurie for the Mother Jones podcast and magazine. For nine months, Lurie investigated the loosely regulated, lucrative world of addiction treatment.

Welcome.

JULIA LURIE: Thank you so much.

CHANG: So unfortunately, you found in your reporting that Nick’s story is not at all unusual. Can you first explain how these patient brokers work? How do they find and make money off addicts?

LURIE: Sure, absolutely. So there’s this whole sort of cottage industry that’s developed in the murkier parts of the rehab world, where brokers will find people in Facebook support groups, at meetings like Narcotics Anonymous meetings or Alcoholics Anonymous meetings. Sometimes, they’ll just find people on the streets in, say, Southern California or Palm Beach. And they’ll offer perks – say, free rent at a sober home or a few nights at a hotel between rehabs, sometimes even cash.

CHANG: And then at the back end, the broker gets a cut of the insurance money that was paid to the rehab center. That’s how they make money.

LURIE: Yes, exactly. So it’s very easy for patients to then fall into this cycle where they go to rehab for a few days or weeks, you know, as long as insurance will cover it. The rehab collects insurance money. The broker will get a cut of that. The patient will leave and relapse, sometimes with drugs or money that the broker has given them. And then the patient goes back to rehab. And that just happens over and over and over again without the patient ever really getting better.

CHANG: I’m sure there are a lot of people thinking, this has to be illegal, right?

LURIE: Yes. And in fact, it is illegal. Just late last year, Congress passed legislation that prohibits people, namely rehabs or patient brokers, from giving or receiving perks for patients. That said, it’s relatively new legislation. And also, it’s a federal law, so it’s up to federal authorities to really enforce it.

CHANG: Right.

LURIE: So there’s sort of a slow and steady move towards regulating this field and for enforcing those regulations. But in the meantime, you have a lot of patient brokering going on.

CHANG: Not every rehab center, obviously, participates in these kinds of practices. But for those that do, I was amazed reading in your story how little oversight there has been over this industry. I mean, you mentioned California, for example. A counselor just needs to complete nine hours of orientation, and then they’re employable as a rehab counselor.

LURIE: Right, exactly. You know, often, drug policy experts will point out that the basic rules of medicine don’t really seem to apply to addiction treatment. You know, many rehabs don’t employ a single licensed doctor.

CHANG: That’s amazing.

LURIE: Yeah, right. Imagine going into any clinic or hospital and them saying, you know, we don’t have any doctors or nurses on staff here.

CHANG: Right. I mean, how did it even get like that in the first place? Why don’t the rules of medicine apply to addiction treatment?

LURIE: Until very recently, addiction was understood as a moral failing. So it was something that, you know, you did wrong. And you should maybe go to prison or maybe go to a beachy place off the grid, where you can get, quote, unquote, “clean” and then return to your normal life. It’s only very recently that we’ve come to appreciate that addiction is a disease. And, you know, I think that’s happened for a lot of reasons. Our understanding of the brain is a lot better, certainly. The face of addiction has changed as well. You know, the opioid epidemic is…

CHANG: Wider.

LURIE: …A far wider…

CHANG: Yeah.

LURIE: …Drug problem than previous drug epidemics in this country. So, you know, now we’re in this position where we have a historic drug epidemic, and we have this soaring demand for evidence-based treatment. But addiction is really siloed outside of the medical world.

CHANG: So what do you see could be the solution? How do you revamp the industry when it comes to the opioid epidemic?

LURIE: Well, that is a – that’s, like, the million-dollar question (laughter). I think that it’s going to take a lot of things happening simultaneously. I do think that you need higher standards for rehabs. I do think that if you’re going to be a rehab, you should probably have to have a licensed doctor on staff. You should probably have higher regulatory requirements than, like, nail technicians or barbershops, which is not the case currently in a lot of places.

One pretty critical thing that is needed right now is a place where users and their family members and loved ones can go and check out a given rehab. What are the complaints that have been filed against this place? What kind of staff does it have? Some sort of database like that – that would go a very, very long way.

CHANG: Julia Lurie is a reporter for Mother Jones. Her piece on the rehab industry is in the current issue of the magazine. Thank you very much for joining us.

LURIE: Thank you for having me.

(SOUNDBITE OF UOU’S “HANAUTA”)

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