Insurance fraud at Best Drug Rehab and A Forever Recovery?

[source]

Tony Ortega has a nice new article about the Michigan Scientology empire:

http://tonyortega.org/2013/11/06/more-questions-about-scientology-drug-rehab-and-insurance-this-time-in-michigan/

Some highlights included taking the client to the bar to get drunk so they could bill more for insurance

Sean Blevins is 42 and today lives in Florida. But he grew up in Alabama, and was transferred to Michigan by the company that had employed him for more than 20 years. His company was supportive when he developed a drinking problem — he’s never done drugs, he says — and he looked for a place to dry out. His sister did a search on the Internet, and suggested that he try a place in Battle Creek called A Forever Recovery. Before he could enroll there, however, he was told that he needed to go through a short medical detoxification program at another facility called Tranquility Detox. This requirement was for insurance reasons, he was told. He didn’t have the $20,000 for his treatment, but he was told that if he went through the medical detox, his insurance would cover his costs.

“They gave us all something to drink,” he tells us. After they picked him up, on the way to the facility he was taken to a bar to get him good and drunk. “You have to fail the breathalyzer. I blew a 2.2 or something. I was pretty inebriated.” He then spent five days at Tranquility Detox, where he was put on phenobarbital, which “zombified” him, he says.

And then a nice section about billing insurance for Scientology training routines:

“That’s when the Scientology brainwashing started,” Sean Blevins says about his stay at Best Drug Rehab. “Staring contests. Bullbaiting. Walking people into walls, the whole thing.” He didn’t care for it, but he stuck it out from July 30 to early October, 2012. “They tried to push me toward Scientology, but I wasn’t interested.”

Also, he was surprised to find later how much he’d been charged. “It was supposed to be free, but it wasn’t free. I told them I still had COBRA insurance, but I couldn’t pay my premiums. They told me they’d make my insurance premiums so they could get me the most out of my policy,” he says.

Eventually, between his stay at A Forever Recovery, his two short stints at Tranquility Detox, and his tenure at Best Drug Rehab, his insurance policy was billed to the tune of $190,000. Records show that his insurance company actually paid just under $70,000 on those claims.

Apparently Per Wickstrom has found an amazing way to profit off of Scientology.  To actually walk into a Scientology Org and pay for training routines and the life improvement courses is somewhere less than $2000.  Apparently Best Drug Rehabiliation and/or A Forever Recovery is billing close to $200,000 for the same thing.

Sounds like Georgia all over again.

I wonder how they are going to justify that "staring at someone for 2 hours" is actually a therapy that has an associated billing code.

And I wonder who the licensed therapist is who is signing off on it?  Or should I say "soon to be ex-licensed therapist".

[mefree]

I hope the insurance fraud cases go somewhere. This criminal enterprise has been operating for far too long and harming people who need real treatment.

[Suppressive Person]

I hope the insurance fraud cases go somewhere. This criminal enterprise has been operating for far too long and harming people who need real treatment.

I think this could be it for Wickstrom.  This is proof positive of insurance fraud and if the authorities start digging they will find a consistent pattern.  Wickstrom and company have defrauded them for millions over the years.

And what other treatment center do you know that would ever cost/charge such an amount?  ( Except maybe some Hollywood star hideaway).

I hope Ortega shares some of charges and services they billed .

I also hope Blevin's insurance company pays a physical visit to BDR to see the substandard care they paid for.

I am also upset with CARF. They are complicit in all this.  They have received numerous complaints, yet fail to act.  I have concluded they are nothing more than a certificate mill.

[AnonLover]

I am also upset with CARF. They are complicit in all this.  They have received numerous complaints, yet fail to act.  I have concluded they are nothing more than a certificate mill.

^^This. CARF should be targeted for more exposure and held accountable in the public opinion arena imo. When you do a Google search for What is Carf? the first several pages are nothing but positives, impressive affiliations and claims of them being the "gold standard" program.

This is likely fodder for a new a thread dedicated to brainstorming up ideas & tactics for applying pressure to CARF, but that "gold standard" untarnished reputation is NOT a good thing to let stand unchallenged. Or another way to look at this is that the certification program is a potential weak link - CARF is a lot more likely to change the policies and/or take action if a shit stain appears on their public image than the Narconon rehabs are because they can't change - a scam is scam.

The most powerful counter to a bad situation that has a certain buffer around it is to flip the enabler factor into a disabling tactic. CARF is the enabler. And as such, they should share in the blame and shame for what is happening.

[source]

There is a lot of confusion about insurance vs private pay.

A treatment center can sell its services for any amount they want, but can't necessarily bill insurance for the same.  In other words, you could have a rehab that the private pay cost is $1,000,000 per month.  However, they are limited in the maximum amount that they can bill insurance for, usually per service.  In other words a residential daily rate might be capped at $1300 per day, one on one therapy might be $200 per hour, etc.

If you add everything up that becomes your actual price for service via insurance.  In other words, the billable rate becomes $40,000.   Now, you can go down in that amount via sliding fee scale, but you can't go up.  You can't say "hey this insurance pays a lot more so we'll charge $100,000 for the services we normally bill out for less".  But if you have a client whose insurance only pays $30k and you want them to come in, you can "discount" their program $10k.  Where most programs profit, is that their program doesn't really cost $40k per month,  to be profitable they only need $20k.  So they hit insurance for the $40k but only expect less than that.

Is it possible to bill out via insurance for $100k a month?  No way.

Even a dual diagnosis program couldn't do it.  And considering that most of the BDR program can't be billed under any codes since they are not therapeutic, overseen by licensed clinicians, etc, if anyone digs BDR will probably be scrutinized pretty heavily.

Now we look at some other things including massage therapy, chiropractic services, etc.  you aren't really allowed to start combining these things and billing for them within a residential drug rehab setting.

Where the fraud really is is in the amount they are billing and whether or not the services billed are actually reflected.  In addition it is considered fraud to intentionally recommend more expensive services so that you profit more. A hospital can't recommend you stay overnight for every bump and bruise even though they would profit more.

It will be fascinating to see if this ever gets scrutinized.  I would imagine that only a handful of hours per day at BDR could actually be billed to insurance. 

[BigBeard]

Having new clients get drunk to get them into detox, and then billing insurance companies for the "detox", is straight up fraud that should result in jail time.

[Suppressive Person]

Big Beard and Source - you are both correct.  And getting people drunk before they enter is fraud enough much less this 200k insurance billing. That is why I hope Mr. Blevins will allow Tony O to post the charges.

After the initial detox phase ( which is usually the most expensive and why Wickstrom wants everyone to be detoxed) a treatment center really only has a daily room and board and program charge. The daily "therapy" and use of facility resources is included in the daily rate. Only unusual additional charges such as medication, individual therapy with a state LICENSED therapist, or physician consultation could be billed separately.

There is NO WAY they delivered 200k worth of service to Mr. Blevins over the course of 2 admissions. NO WAY.

And the getting people drunk before entering is their standard m.o.  It is indeed fraud because it is tantamount to the ER breaking your other leg so they can x-ray and cast them both.

[Suppressive Person]

Also AmonLover - I agree whole heartedly about a new thread and exposure of CARF in the public arena. They are "non-inspective" and they allow their certification clients to "define their own success".  Give me a break. 

They are churning for dollars just as much as Wickstrom. They have no real interest in patient safety or quality standards.

[mefree]

They are churning for dollars just as much as Wickstrom. They have no real interest in patient safety or quality standards.

Yep. They have received several letters and nada.

[ethercat]

My feeling, too, is that CARF is only interested in money, but unfortunately some states accept CARF certification in lieu of other, better, types of certifications.

If you do a search here for "CARF": http://forum.reachingforthetippingpoint.net/index.php?action=search
there are a number of threads where CARF has been discussed.  I don't have the time right now to do it, but if someone wanted to go through them and compile the most important info into a new thread, we could investigate and turn the spotlight on them.

If faced with a loss of income if they don't turn the spotlight off, they might straighten up and amend their requirements.

[aegerprimo]

Good info, good research! I had no idea about the legitimacy of CARF and its accreditation.

[BigBeard]

To be fair, one more time, CARF never wanted to be in the drug rehab accreditation business to begin with. CARF was in the business of certifying Physical and Mental Health (Life Skills) Rehab facilities. Some of which fell under the auspices of SAMSHA, and involved government contracts.

There were some changes to the requirements for certifying Drug Rehabs that fell under SAMSHA, so they needed someone to do the certifying. Apparently someone in SAMSHA decided a rehab is a rehab, and dropped it on CARF, since they were already doing govt contract work. When CARF protested they didn't have the expertise, there were basically told to get it, or lose the contract work they already had.

So CARF went out looking for expertise in drug rehab, and the answer to their proverbial prayers showed up in the form of one William Kent McGregor. You know, the William Kent McGregor with family ties to NN Arrowhead he never told CARF about when he was assigned to do the survey on NN AH. And who went to work for NN AH after leaving CARF.

As embarrassing as it might have been for themselves, should CARF have started pulling accreditations when McGregor's conflict of interests came out? You bet. But this wouldn't be the first time a company went with CYA mode, instead of doing the right thing. In fact, in a perfect world they probably should have told SAMSHA what to do with the government contracts when they were being pressured into taking on drug rehabs.

So yes, CARF's hands are not clean in this, but William Kent McGregor has a lot to answer for in this mess too. In some ways a lot more than CARF, because he (and Cof$/NN) deliberately set out to get into the position he held, hiding his major conflict of interest for narCONon's advantage in the process.

[Suppressive Person]

This is great information Big Beard.  Thanks so much for posting.

I have been tackling the CARF issue as it relates to BDR/AFR and came across the Willam Kent McGregor and Narconon Arrowhead issue.  I was unclear on some of it and your explanation has been very enlightening to me.

But may I ask how you know that information? i.e.  I am trying to find out who surveyed AFR and BDR.  I cannot get any of certification filing paperwork so my only options have been written correspondence to CARF which they respond to with cookie cutter answers about their process.

I also know that CARF has received many patient complaints about these facilities and they are aware of current investigations,   but they have still failed to act, or suspend certification.

Do you have any input on why they still certify AFR/BDR under these circumstances?

[BigBeard]

CARF, and the question of whether they were a Cof$ front or not, came up way, way, back, before RFTTP existed. I started digging, more as part of the front group search than specifically related to narCONon, and somewhere in my digging I came across a mention of SAMSHA. Digging into SAMSHA is where I found the info on the contracts for Physical Rehab and Mental (Life Skills) Rehab accreditation, long before they got into the Drug Rehab side of things.
And the more I dug, the more it became obvious CARF was pressured into taking on Drug Rehab by SAMSHA. I recall a small article in one of the business rags mentioning CARF wasn't real happy about taking it on.

The William Kent McGregor link didn't pop until after after the narCONon mess really started taking on a life of it's own. But once it did, it became real obvious there was a major conflict of interest where he and CARF were concernced. And he, and Cof$/NN, went out of their way to keep it under wraps.

I can speculate on why CARF hasn't pulled their certifications, but that's all it would be is speculation. It could be embarassment about being scammed by WmKMcG/NN, and not wanting to admit it. Or it may be for legal reasons. Or it could relate to the SAMSHA contracts in some way. I suspect the only way we'll find out is when they get dragged into a law suit or criminal action related to their NN accreditations.

[BigBeard]

Sorry to follow up my one post, but there is one other point I forgot to mention.

In spite of narCONon implying otherwise, CARF does NOT accreditate the entire program. I'll have to dig it out, but I believe only the initial portion of the program falls under CARF's accreditation, and the vitamin/sauna/TR's by another name routines are not part of the portion they look at.

It may be they don't pull their accreditation because, as frustrating as it is, NN may be meeting the requirements for what they are looking at.

If so, you'd think CARF would at least smack NN down for implying their acceditation covers more than it does. Thus misleading potential clients.