Regulatory intervention in the assault on addiction treatment providers in Florida.
This petition had 1,288 supporters
The 1990s began a shift in the human service industry. Complicating the process government began moving away from funding via grants and shifted the burden to a managed care service delivery system initiating significant changes. The Mental Health Parity and Addiction Equity Act (MHPAEA) signed into law by President George W. Bush in 2008 and sponsored by Patrick Kennedy placed mental illness under the umbrella of health insurance, requiring most group health plans to provide coverage for the treatment of mental illness. Followed by the Affordable Care Act (ACA) or, Obamacare coupled with the Opiate epidemic and rapidly, treatment providers began to spring up on a daily basis.
The Recovery Movement further transformed the mental health system by shifting the paradigm of care from traditional medical, psychiatric treatment toward the concept of recovery. The Recovery Movement assessment of a disease rather than a punitive or moral offense also prompted the judicial system to open DUI/DWI, drug, and mental health courts and alter sentencing guidelines. A culmination of the “perfect storm." Insurers do not want to pay, in fact, the insurance industry attacked the laws and lost. Current legislation allows anyone, including someone with no experience, and not excluding individuals recently discharged from treatment to apply and secure a license.
With an onslaught of the Opioid and Opiate Epidemic, the extent to which this country has not seen previously, the opportunity for private behavioral health providers reemerges. This evolution of change created a vast opportunity for profitable business in behavioral health care. Inevitably, when opportunity abounds, the potential and risk of fraud doth exist.
Understandably, health insurance providers remain opposed. While there may exist unskilled treatment entities that apply lower standards of care and perform improper billing, insurance providers are using isolated cases to create a buzz and broadcast unsubstantiated information via the internet and within the recovery community. In a show of force, the FBI has raided only two entities, yet to date, no criminal charges have been filed. In fact, it's been recently reported that one of the two agencies under investigation has resumed legal operation.
Certainly, as with any industry, there are instances of fraudulent activity, but a deliberate attack on the entire human services sector is without merit. Insurers have launched a unilateral offense against all behavioral health care providers. Spearheaded by Legal Counsel, William Welch, II, who was forcibly removed from his previous position with the Department of Justice in 2012 for less than honorable ethics, Cigna has unleashed a blatant assault of epic proportion on treatment providers.
In August 2015, Cigna took the first stab at paralyzing treatment providers in South Florida. The insurance company froze payment on all claims while they audited charts of nearly all "out of network" agencies. These same audits prolonged due to insufficient staffing by Cigna and most of which remain under review by the insurer's SIU department has delayed payment to treatment providers for approximately 6 months.
Florida Statute 65-D-30 requires all addiction treatment providers to abide by the “American Society of Addiction Medicine” (ASAM) criteria for admission to, continued stay and, of course, proper “step-down” for Level Of Care. However, insurers rely on their illegal criteria for care. Under the guise that treatments provided to patients/clients lack "medical necessity", insurers apply unscrupulous internal rules to limit or deny coverage. The strategy is clearly to force agencies to fold or settle claims for pennies on the dollar. Corporate collusion at work. Meanwhile, insurance industry executives enjoy large bonuses. All of which can be corroborated by documentation and any preliminary investigation will show these facts. United Health and Healthnet have now joined the collusive assault.
An epidemic of opioid and opiate is tearing through our communities, and we need to enlist preventative actions before increased damage and deaths occur. There exist limited choices for recovery treatment which are being threatened by corporate THUGs. Our country can not afford to allow insurance providers to win this battle for recovery.
We need to silence the propaganda spread by limited instances of fraudulent activity. Usually, at the level of halfway house providers to paint a picture of fraud and unethical treatment. Furthest from reality, insurance providers are likening the cases as if it were the situation of a 45-year old man who goes to the emergency room complaining of chest pains only to find that his symptoms are due to gas or digestive problems. Imagine if this same individual came to the ER for chest pains and after testing and evaluation, medical professionals determine the patient requires a quadruple heart bypass. But the insurance company will only pay for a single bypass. They deny full treatment allowing the condition to worsen. Consequently, the patient does not get the necessary care vital to saving his life.
The point is, people die every day of opioid and opiate overdose, alcohol abuse and a litany of other substance abuse (medical conditions). These recovery care patients are not traveling to Florida on vacation to enjoy palm trees, and they are not going through withdrawal from too much sugar, their condition is serious and can be life-threatening.
We are facing one of the worst epidemics! However, due to dollars and cents and lack of common sense, insurance corporations are attacking agencies and entities that help save thousands of lives annually!
Join our advocacy for the recovery community in a unified voice against this assault on addiction treatment providers in Florida!
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