Addiction providers look to alter the industry's growing reputation for fraud

Bad actors forcing some payers to take hard stance on reimbursement
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Providers who specialize in addiction services are scrambling to rehabilitate the industry's image following high-profile fraud cases that have caught the attention of federal regulators and private insurers, according to the Palm Beach Post.

The addiction treatment industry has been marred by multi-million dollar cases, including a well-publicized federal investigation into expensive urine testing claims submitted Millennium Health that culminated in a $256 million settlement. Last year, Cigna announced it was pulling out of the Florida marketplace, citing an increase of fraudulent addiction treatment claims, according to the Post.

At a recent addiction treatment conference in Naples, Florida, Doug Nemecek, M.D., chief medical officer of Cigna's behavioral heath division, indicated Cigna is steering beneficiaries toward in-network providers, and is considering other measures that would minimize the threat of fraudulent claims, such as refusing coverage for out-of-network providers and dropping out-of-area benefits, according to the Post.

On the provider side, the American Society of Addiction Medicine is planning to release new clinical guidelines for urine testing, while others believe self-policing is the key to ushering bad actors out of the system.

Legal experts have said health payers are aggressively investigating addiction treatment services in 2016 with additional requests for medical and billing records. Last year, the father and son owners of Narco Freedom, a drug treatment company based in New York City, were indicted on charges of fraud and money laundering. Months later, a New York Times investigation outlined an ongoing Medicaid scheme involving three-quarter houses throughout the city.

To learn more:
- read the Palm Beach Post article

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