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Paul Zimmerman
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Showing 8 posts in Substance Abuse & Sober Living Facilities.

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Under the Microscope: Substance Abuse Patient ReferralsĀ 

Governor Brown just signed Senate Bill 1228 into law, implementing Health & Safety Code §§11831.6 and 11831.7. The move directly impacts marketing practices within the world of substance abuse treatment. (Read More)

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Federal Legislation Expected on Sober Living Homes

Sober living homes offer drug- and alcohol-free, cooperative living arrangements for people in the process of recovery from addiction. Rapid growth within the sector as well as increased media attention due to some recurring concerns expressed by frustrated communities, have led many states and municipalities to rethink their approach to substance abuse treatment and explore new modes of regulation. Now, federal legislators have said that they will intervene. (Read More)

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Drug Treatment Centers Must Walk a Fine Line With Respect to Marketing

A recent New York Times article entitled “How Staten Island’s Drug Problem Made It a Target for Poaching Patients,” details how recruiters for treatment centers as near as Long Island and upstate New York, and as far away as Arizona, California and Florida are soliciting recovering addicts from addiction treatment centers on Staten Island to leave and go to other centers. Recruiters allegedly find addicts, or in some cases even call patients while they are receiving treatment from other centers, and offer them money to seek treatment at a different facility. They also routinely pay for these individuals to travel to a new treatment center, where presumably they are enrolled and the marketer is paid a fee. This story brings to national attention an issue that has been building within the behavioral health community for years. (Read More)

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SoCal Sober Living Homes Face an Array of Regulatory and Zoning Obstacles

The subject of residential sober living homes and other treatment centers located in residential neighborhoods continues to attract substantial media attention in Southern California. The topic has become a lightning rod within many Southern California coastal communities. Arguments over residential treatment centers have recently evolved into litigation as the issue continues to spur local regulatory challenges and incite great passion. The effect that these cases may ultimately have on state law and city zoning codes remains in flux, all while the state considers various proposed bills on the topic, including AB 2255 and AB 2403. For owners and providers in the sober living and residential treatment space, the time is now to ensure strict compliance with applicable licensing requirements and zoning laws. To play fast and loose with local and state regulations is to invite dire consequences. (Read More)

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Health Net Payments Trickle in to Addiction Treatment Centers as CA Regulators Investigate Insurer

As we have previously detailed, Health Net began directing a great deal of attention toward addiction treatment providers in early 2016. The payor (which has subsequently been acquired by Centene Corp.) started aggressively monitoring and investigating claims from substance abuse treatment facilities, and then dramatically expanded its attestation requests to smaller providers. Among other things, Health Net scrutinized referral practices, the medical necessity of services, and whether providers were waiving out-of-pocket payments from patients. Providers throughout California, as well as states like Arizona, Nevada and Texas, received attestation requests regardless of whether Health Net had any specific evidence of fraud and abuse. At the same time, providers found that Health Net payments stopped completely, including payments for previously-submitted claims that pre-dated the attestation letters.  Now, while some providers are beginning to receive reimbursements from Health Net, the California Department of Insurance (CDI) has reportedly opened an inquiry into the improper withholding of payments. (Read More)

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CA State Legislature Clamps Down on Residential Treatment Centers

The existence of residential sober living homes and other treatment centers located in residential neighborhoods has recently attracted the attention of many media outlets and has become a hot button topic on both sides of the argument. The California State Assembly’s Health Committee has now approved two separate bills which would impose stricter regulations on these facilities. (Read More)

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Health Net Deepens Investigation of Addiction Treatment Centers

As noted in a blog posted earlier this year, addiction treatment providers have been receiving an increased number of requests from payors seeking a range of medical and billing records and other documentation concerning the provision of substance abuse treatment and related services. Several major payors have begun aggressively monitoring and investigating claims, and now Health Net has separated itself from the pack by dramatically expanding its attestation requests to smaller providers. While there are, no doubt, some bad actors in the addiction treatment community, it appears that health insurers are cracking down hard on all providers in an effort to ferret out allegedly fraudulent practices. (Read More)

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Alexander Raths © 123RF.com

Health Net And Other Payers Ramp Up Audits Against Addiction Treatment Providers

Over the past several months, we have seen a tremendous amount of payer attention directed at addiction treatment providers. Payers are sending increasing numbers of requests seeking a range of medical records, billing records and other documentation concerning the provision of substance abuse treatment and related services, with several major payers seeming to aggressively investigate providers’ claims. Payer requests range from commonplace medical record requests, on the one hand, to requests for information about patient residency and co-payment obligations on the other, and have included requests for facility licenses, state and county certifications, and CLIA certificates. (Read more)