Legislation was announced March 7 that would ban the practice of patient brokering schemes in Delaware.
The passage of SB 32 will prevent the abuse and substandard treatment of Delawareans seeking critical care for substance use disorders and will save millions of dollars in fraudulent medical claims.
“Delawareans seeking help for their addiction, or any health-related issues, should not have to fear exploitation and mistreatment by those looking to capitalize on their disease. That ends now,” said Lt. Gov. Bethany Hall-Long. “This legislation will protect those seeking treatment and ensure they get the quality care they deserve.”
Patient brokering schemes occur when a medical provider or someone associated with a medical provider pays a third party entity to deliver patients to their practice, often in exchange for financial kickbacks. In Delaware, this type of fraudulent enrollment has created hundreds of false claims and millions of dollars in wrongful medical payouts. SB 32 would impose a civil fine of up to $10,000 for those engaging in patient brokering schemes.
“We need to do everything we can to ensure that people battling addiction get the best treatment possible,” said Sen. Darius Brown, D-Wilmington. “The Patient Brokering Bill will help us do that while also reducing insurance fraud and protecting this vulnerable population from being taken advantage of. It is good health care policy that also provides strong consumer protection, which is why I would like to thank our partners in the health care and insurance industries for supporting this legislation.”
“This practice targets the most vulnerable among us: those who are struggling with the disease of addiction and simply trying to find care. Patient needs are being exploited to further fraud and ballooning healthcare costs. That’s unacceptable,” said Rep. David Bentz, prime House sponsor of SB 32. “By addressing this problem we will free up funds to help those in need and protect vulnerable individuals from this predatory practice.”
Highmark Blue Cross Blue Shield estimates a loss of $113,000 every time someone is enrolled in treatment due to a patient-brokering scheme. More importantly, patient brokering schemes prey on some of the most vulnerable, including many individuals struggling with addiction.
"For several years, Highmark has identified and combatted the issues associated with the act of patient brokering in the drug and alcohol treatment industry,” said Kurt Spear, vice president of financial investigations and provider review at Highmark BCBSD. “Those suffering from addiction are recruited and are merely a paycheck to those that financially benefit from their fraudulent enrollment in insurance plans and subsequent, often questionable, treatment. The recruited individuals are often left at risk for relapse and stranded away from home when the promise of their premium payments or
‘treatment scholarships’ are then left unpaid. Legislation making the act of patient brokering illegal increases the efforts of insurers like Highmark to protect their members’ well-being and to stop the flow of money to those involved in the acts."