LOS ANGELES, August 26, 2024 – In the labyrinth of addiction recovery, where hope and despair often intertwine, a dark and insidious practice known as patient brokering, or “body brokering”, thrives. This unethical, and sometimes deadly, exploitation of individuals seeking help for substance use and mental health disorders has become a malignant undercurrent in the treatment industry. As the opioid crisis continues to claim lives and the demand for treatment rises, the predatory behavior of body brokers represents a gross violation of trust, exploiting some of the most vulnerable members of our society.

The 2022 National Survey on Drug Use and Health by SAMHSA reports that 48.7 million people aged 12 or older (17.3%) had a substance use disorder (SUD) in the past year. This includes 29.5 million with an alcohol use disorder (AUD), 27.2 million with a drug use disorder (DUD), and 8.0 million who experienced both AUD and DUD.

Understanding Body Brokering

Body brokering involves the illicit recruitment of individuals into substance abuse treatment centers, often through deceptive or coercive means, for financial gain. Brokers are paid by treatment centers, usually unethical ones, to deliver patients who bring with them lucrative insurance policies. These brokers often frequent recovery meetings, detox centers, and online forums, preying on individuals such as the homeless, who are at their lowest points. The financial incentives tied to patient recruitment create a perverse system where the focus shifts from patient care to profit margins.

Michael Lynch, CEO and Founder of Stairway Recovery Homes, described the practice in stark terms. “Yes, it’s human trafficking. They call it body brokering. And basically, it’s facilities paying either addicts directly to come into their facilities to fraudulently bill their insurance, or they hire other addicts to prey on other addicts to ultimately pay them to go into their facilities,” said Lynch.

Dr. Neeraj Gandotra, Chief Medical Officer for SAMHSA, highlights that body brokering is most often seen in areas with a high saturation of treatment centers. 

“In particular I think the markets within California and Florida have been named most of the time,” said Dr. Gandotra. 

According to the National Substance Use and Mental Health Services Survey by SAMHSA, the number of addiction treatment facilities in the U.S. has steadily increased over the years. In 2002, there were 13,623 facilities, rising to 17,353 by 2022. California had the highest number of treatment facilities with 1,800, followed by Florida with 1,200, Texas with 950, and New York with 900.

Source: SAMHSA

These markets have become notorious for body brokering, though the practice is not confined to these areas alone. The allure of financial kickbacks creates a dangerous conflict of interest, compromising the integrity of treatment recommendations and patient outcomes.

“In order to go in, you must get high. And, you know, a lot of people don’t make it. They get high thinking that they’re going to go into a facility to get paid, and they end up overdosing and dying,” explains Lynch, highlighting the harrowing consequences of this practice.

The Ethical Dilemma and Its Impact

The consequences of body brokering are devastating. According to the Recovery Research Institute, patients are lured into substandard or fraudulent treatment centers and often receive inadequate care, if any at all. Some are enticed into facilities with promises of free travel, financial incentives, or even drugs—an appalling tactic that exacerbates their addiction. The outcome is predictable: relapses, prolonged suffering, and, in the worst cases, death.

“Any program that engages in paying for leads or offering incentives for referrals raises red flags,” said Dr. Gandotra. “It really does go against the ethics of putting the patient first.”

Noah Fischler, Director of Business Development at Crownview Psychiatric Institute and a victim of body brokering, provides a chilling account of the harm caused.

“They find people that have nothing to live for, have no money, have no income. Family has cut them off. They hear, oh, you can go to treatment, have a bed to sleep in, a roof over their head, and to be fed. That’s like a dream come true for somebody that’s homeless that doesn’t have anything. And then on top of it, when they leave treatment, they’re offered like, oh, here’s $2,500, here’s $3,000, whatever that number is. It’s essentially causing more harm for them because then they’re literally just chasing their next high and how they can attain it,” Fischler described.

The National Library of Medicine identified three major themes in patient brokering: financial enticements, encouragement of substance use, and increased overdose risk. Participants revealed that brokers would pay for plane tickets and offer financial incentives to lure individuals into treatment, aiming to profit from insurance payouts. Some reported being encouraged to use drugs before entering treatment to meet insurance requirements, undermining recovery efforts and increasing the temptation to use. Many participants linked these practices to higher overdose deaths, as brokers often provided drugs, promoted relapse, and created a revolving door of treatment, heightening the risk of overdose after periods of abstinence.

Newly addicted individuals are especially vulnerable to these manipulative tactics, making it extremely difficult to resist such offers when their logical thinking is impaired by addiction. 

 “As an addict myself, I do remember what it was like when I first was getting clean. And every hour I wanted to leave, every hour I wanted to get high. Just sitting in my seat and staying another day was so hard. These predators… talk to new addicts that are newly getting clean,” said Lynch.

Fischler shared the personal struggles he faced when he became trapped in the cycle of body brokering.

 “So, I mean, just from my experience, having that much money in my pocket after 21 days, my head had still not come out of my a**, excuse my language, but I was still in the obsession of wanting to get that next high and not knowing where that would take me. Granted, I didn’t go all out the first time out of treatment. It was still causing more harm than good,” said Fischler.

The treatment industry itself is not immune to the fallout from these practices. Reputable centers, that strive to provide ethical and effective care, face the stigma and mistrust bred by the actions of unethical operators. For individuals with Substance Use Disorder (SUD) and their families, navigating the treatment landscape becomes a minefield, where the fear of being exploited is as pervasive as the hope for recovery.

Hai Nguyen, COO of Arision Treatment Center, underscores the systemic nature of the body brokering problem, describing it as a severe ethical violation with dangerous implications for those struggling with addiction.

 “In my own terms, I would call it attempted murder,” Nguyen stated. He further explained, “There’s a clear distinction between patient brokering and prioritizing clinical support. It’s about what comes first, business or clinical care. It’s very clear when someone is engaging in body brokering.”

The Recovery Research Institute defines “addiction tourism” as a practice where brokers receive financial incentives to send patients out of state for treatment. This often involves unethical practices such as hijacking online business listings by unaffiliated parties and misrepresenting services and credentials by treatment facilities. This can lead to a violation of patient privacy, insurance over-billing, and fraud.

Legislative Measures and Protections

Recent legislative efforts have aimed to combat the issue of body brokering and enhance protections for individuals seeking substance use disorder treatment. Senate Bill No. 349, also known as the California Ethical Treatment for Persons with Substance Use Disorder Act, was approved by Governor Gavin Newsom on April 13, 2022, and represents a significant step forward in addressing these concerns.

The bill introduces several key provisions designed to safeguard clients and their families. Among its main features, SB 349 prohibits the referral of individuals to substance use disorder treatment facilities in exchange for anything of value, such as kickbacks or other financial incentives. This builds on existing regulations that already bar such practices but strengthens enforcement and accountability.

SB 349 mandates that treatment providers adopt a client bill of rights, making it available to all clients and prospective clients. This bill of rights is intended to ensure transparency and uphold the dignity of those seeking treatment. Additionally, the bill requires treatment providers to maintain detailed records of referrals to or from recovery residences, thereby increasing oversight and accountability.

Penalties for violations under SB 349 include civil fines of up to $20,000 per infraction, and the Attorney General, district attorneys, and other relevant officials are authorized to bring claims for declaratory relief or recover civil penalties. The Department of Health Care Services is also empowered to investigate allegations and enforce compliance, including the suspension or revocation of licenses and certifications for violators.

Senate Bill No. 1228, enacted on September 26, 2018, focuses on regulating referral practices within licensed facilities. The bill prohibits the giving or receiving of remuneration for referrals by such facilities, their owners, and employees, to eliminate conflicts of interest and safeguard individuals seeking treatment. To enforce these provisions, the bill grants the Department of Health Care Services the authority to investigate violations, impose penalties, and suspend or revoke licenses and certifications. 

These legislative measures are a critical component in the broader fight against body brokering, aiming to restore integrity and ensure that treatment providers prioritize the well-being of their clients over financial gain.

Measures to Combat Body Brokering

Addressing the scourge of body brokering requires a multifaceted approach, involving tighter regulations, enhanced monitoring, and a commitment to ethical standards across the industry. Several strategies can be implemented to halt this practice and protect those seeking help.

Regulatory Oversight and Enforcement

Stricter regulations and robust enforcement mechanisms are crucial in curbing body brokering. The California Ethical Treatment for Persons with Substance Use Disorder Act represents a significant advancement in this regard, but similar legislation should be adopted nationwide to create a uniform standard of ethical practice.

Accrediting bodies like the Joint Commission and the Commission on Accreditation of Rehabilitation Facilities (CARF) should also play a more proactive role in monitoring facilities for compliance with ethical standards. While accreditation provides some level of oversight, it is not foolproof. 

“Accreditation only ensures minimum standards have been met… but it’s still better than nothing,” said Dr. Gandotra.

Enhanced Transparency and Patient Education

Transparency is a powerful tool in the fight against body brokering. Treatment facilities should be required to disclose their financial arrangements, including any payments made for patient referrals. Patients and their families need access to clear, accurate information about the services offered, the costs involved, and the facility’s track record.

Ash Vardanyan, CEO of the Los Angeles County Addiction Treatment Center, describes his commitment to communication with clients and their loved ones. 

“I understand how frightening it can be for a parent or loved one to send someone into treatment without knowing the details or if it’s legitimate. Families just want their loved ones to get better, so we really need to improve our communication with both clients and their families,” said Vardanyan.

The article, Patient Brokering: How to Identify and Report Addiction Treatment Fraud, explains how education is equally important. Patients and their families must be equipped with the knowledge to recognize the signs of body brokering. This includes understanding the tactics used by brokers, such as offering free services, manipulating insurance information, or providing misleading information about treatment outcomes. Community organizations, advocacy groups, and healthcare providers can play a pivotal role in disseminating this information.

“I always aim to keep both the families and the clients involved throughout the entire process. I’ve seen too many clients arrive with prepaid cards or a lot of cash from programs they were paid to go to, and often their families had no idea where they were sending them,” explained  Vardanyan.

Lynch highlights the dangers of falling into the body brokering trap. 

“Some predator will come up and tell them, ‘Hey, do you want to get paid to go to treatment?’ And they’re like, sure, because they were thinking about getting high anyway. And so, they will go, and they get paid and they leave again to get high. To get paid again to get high. And they’re just going through the circuit… And then ultimately, what ends up happening to most, usually the one that had been body brokered starts offering to other addicts in places the same thing. And that victim turns into the predator,” Lynch explained.

Collaboration Among Law Enforcement, Healthcare Providers, and Community Organizations

Combatting body brokering requires a collaborative effort across various sectors. A study by The National Library of Medicine emphasizes that law enforcement agencies must work closely with healthcare providers and community organizations to identify and shut down unethical operations. This includes investigating facilities suspected of engaging in body brokering, as well as prosecuting those responsible for exploiting vulnerable individuals.

Healthcare providers, particularly those in the addiction treatment field, have a responsibility to adhere to the highest ethical standards and report any suspicious activities. By fostering a culture of accountability, the industry can begin to weed out the bad actors and restore trust in the system.

Community organizations, such as DHCS, can serve as watchdogs, raising awareness about unethical practices and advocating for stronger protections for patients. These organizations can also provide support and guidance to individuals seeking treatment, helping them navigate the complex and often confusing landscape of addiction recovery.

The Role of Ethical Treatment Providers

Ethical treatment providers must be at the forefront of the battle against body brokering. These providers should adopt rigorous screening processes to ensure that referrals are made based on clinical needs, not financial incentives. Employing licensed clinicians to handle admissions and patient care decisions can help mitigate the risk of unethical practices.

“It’s incumbent upon us as a treatment industry to make sure that we are not involved in this practice,” stated Dr. Gandotra. “We need to be vigilant in our efforts to protect the individuals we serve and to hold ourselves accountable.”

Ensuring Integrity in Addiction Treatment

The fight against body brokering is a fight for the soul of the addiction treatment industry. As long as profit is placed above patient care, vulnerable individuals will continue to be exploited, and the promise of recovery will remain out of reach for many.  Legislative efforts like Senate Bill No. 349 and Senate Bill No. 1228 represent a crucial step in addressing this issue, but continued vigilance and action are necessary to protect the most vulnerable among us. 

By implementing stricter regulations, enhancing transparency, and fostering collaboration among law enforcement, healthcare providers, and community organizations, we can begin to dismantle the body brokering network and protect those who are seeking a path to recovery.

As we move forward, let us not lose sight of the real purpose behind addiction treatment: to heal, to support, and to restore hope. The fight against body brokering is not just about closing down corrupt operations; it is about ensuring that every person seeking help receives the care and compassion they deserve.