The system that we have setup for drug rehab has failed
There is nothing more obvious that heroin addicts have a price tag over their head than this Inquirer look into how Philly drug rehab clinics are losing their clients to treatment centers in Florida.
There were signs that something was wrong with the treatment industry before this story appeared. Heroin junkies just in Philly alone are often poached between rehab centers in the region and group home providers who direct where those addicts go. The one trait in common is that all the providers involved rely on Pennsylvania Medicaid. As the number of patients continues to rise, so has the demand for billing against procedures that Medicaid routinely pays out. This has led to heroin patients having a price tag over their heads as providers dig into their profit margin to preserve and expand their patient rolls.
Recovery house operators are being slipped payments as large as $400 a month just to keep a junkie linked to a dedicated Medicaid-billing treatment facility. Those treatment facilities are sending those payments under the table.
Along the EL between Somerset Station and Margaret-Orthodox lies another bespoke housing system that relies on another form of state assistance: SNAP benefits. Each flophouse near the Market-Frankford Line has opioid addicts as their primary tenant. Some of them without any means of paying the room for rent but are on the SNAP program surrender their ACCESS cards to the caretaker who works in tandem with a participating bodega. The bodega then runs up non-existent cold food purchases and hands the card back.
The waste goes beyond just drugs
Even outside the realm of drug treatment Medicaid billing fraud is rampant. Just Friday a Federal jury spent only 4 hours in deliberations and issued a swift verdict against Renee Tartaglione, former CEO of the Juniata Mental Health Clinic on 53 counts for improperly billing Pennsylvania Medicaid, money laundering and then pocketing the money to keep up her lifestyle and that of her disgraced husband Carlos Matos, who is a ward leader in Norris Square.
The trial itself triggered a special election in the Pennsylvania House of Representatives for the 197th District. This was because former state representative Leslie Acosta and her mother Sandy Acosta were participating in the fraud. During the special election Leslie Acosta pushed for another Medicaid billing doctor, Frederick Ramirez as her replacement. Ramirez once faced accusations of running a pill mill and during that investigation he was charged with perjury. Ramirez also has another toe in the charter school industry as he is on the board of ASPIRA, which runs schools in the barrio. ASPIRA is itself facing an FBI probe.
Republicans don’t see a path forward for further expansion of Medicaid
An unfortunate turn for heroin addicts and Medicaid billers looms: the state resources that will be diverted to drug treatment are going to be limited if we’re talking about cash. Medicaid has to pay for a lot more medical procedures than just the services related to drug treatment. With demand in claims for other medical services not abating, the war over patients only looks to get worse. The source of worry will be forthcoming caps in Congressional spending on continued Medicaid expansion. Pennsylvania will be forced to shoulder that burden and it will result in curtailment of program expansion in the state.
Most Medicaid providers see the vice grip on the horizon. How much it will tighten is a mystery. As the heroin crisis expands but the money to fight it doesn’t, it should make it obvious that the waste and fraud inherent in the system that is allowing Medicaid providers to bid on patients in a Kensington-style black market needs to cease.
Where are state regulators? Apparently they are non-existent or asleep as the trend of “pimping out” formed right under their noses. This started more than 6 years ago, even before Purdue Pharmaceuticals reformulated the binding agents in Oxycontin that sent so many oxycontin abusers off to heroin.
It would also help if Harrisburg’s health regulator was also located here, in Kensington, where the East Coast’s largest heroin market is and so are the locations of a large proportion of medical providers who are billing Pennsylvania Medicaid. We also need the services of the Pennsylvania Auditor General to find and discontinue payment to terrible providers and relocate that spending to performing drug treatment providers who are playing by the rulebook and need the opportunity to expand.
This is our state and federal income tax money we’re talking about, here. Shouldn’t we demand that it be spent wisely to help the most amount of people in the best manner available?