New Opioids Bill Addresses Patient Brokering
| Editor’s Note: For payers and policy-makers it can be a challenge to design effective opioid epidemic measures to control the rapid increase of overdoses as program effectiveness data is being accumulated. Staying abreast as to how opioid prescription control policies are evaluated for effectiveness, payers can be more efficient in their policymaking. Click HERE and discuss how BHM helps track claims data for payers. |
The comprehensive opioids bill passed by the Senate and Congress includes a provision to protect opioid use disorder patients from a predatory practice known as patient brokering, according to The Washington Post.
Here are five things to know:
1. Patient brokers are usually third-party entities that recruit patients to addiction treatment centers in return for financial kickbacks from the facilities.
2. Sometimes the patient brokers help uninsured patients enroll in private insurance coverage, paying their premiums until the patients exhaust their benefits. The Washington Post also cited several reports of brokers making drugs readily available to patients so they relapse and search for another provider.
3. Once these patients are in the treatment centers, the facilities make efforts to bill the plans at higher out-of-network rates and submit fraudulent claims to insurers for services.
4. If the opioid bill is signed, it would be a federal offense to provide or receive these types of payments for patients with private coverage. The kickback payments are already illegal under Medicare and Medicaid.
5. Anyone found guilty of these arrangements could face up to 10 years in prison or as much as $200,000 in fines.
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