Rehab Clinics Struggle To Provide Care Amid Fraud Crackdown

Drug and alcohol rehabilitation clinics in California are struggling to gain certification following a crackdown on fraud in such facilities, HealthyCal reports. The challenges come amid increased demand for such treatment as more state residents gain health insurance under the Affordable Care Act (DePaul, HealthyCal, 6/1).

Background

Last year, a Center for Investigative Reporting and CNN investigation found evidence of fraudulent billing practices at alcohol and drug treatment clinics in the state.

The California Department of Health Care Services later completed investigations of 66 companies that operate such clinics in the state, resulting in the suspension of Medi-Cal payments to 29 companies operating a total of 83 clinics. Medi-Cal is California's Medicaid program (California Healthline, 8/2/13).

In April, the state Senate Health Committee advanced a measure (SB 1339) that would require criminal background checks for owners or medical directors of rehabilitation clinics participating in the Drug Medi-Cal Treatment Program. Another bill (AB 1644) being considered by the state Legislature would apply a "high risk" classification to all Drug Medi-Cal Treatment Program clinics -- a move that would require stricter screening for employees (California Healthline, 4/25).

Details of Challenges

Rehabilitation service providers -- both new and established -- say that the state DHCS' process for certifying alcohol and drug treatment clinics has been slow following the reports of fraud.

DHCS spokesperson Carol Sloan said the state now requires existing clinics to file for recertification under "new, more stringent" requirements.

Problems Come Amid Increased Demand

The delays could cause patients to have trouble accessing rehabilitation treatment as more residents gain health coverage for such services under the ACA, according to HealthyCal. The health reform law mandates coverage for certain substance use treatment services for Medi-Cal beneficiaries and private health plan policyholders (DePaul, HealthyCal, 6/1).

So far, more than 7,700 California residents have taken advantage of new ACA-mandated coverage for rehabilitation programs for drug use, HealthyCal reports.

For example, Garrett Stenson, program director of Sacramento-based CORE Medical Clinic, said the facility has seen a 5% to 7% increase this year in individuals seeking drug or alcohol treatment.

According to HealthyCal, individuals who misuse prescription painkillers, such as OxyContin and Vicodin, often use heroin as a less expensive substitute (Kempa, HealthyCal, 6/1).

Keith Heinzerling, with the UCLA Center for Behavioral and Addiction Medicine, said the mandated coverage will not be "a real benefit" until there are enough rehabilitation clinics to provide treatment. He added, "There's got to be an increase in capacity of the system to provide services" (DePaul, HealthyCal, 6/1).