Blue Cross Blue Protect of Oklahoma has filed yet one more lawsuit in opposition to dependancy remedy suppliers in California — whereas reformers complain that California officers merely watch the present with their thumbs caught of their mouths.
The alleged playbook is, but once more, precisely what California outlawed within the wake of the Southern California Information Group’s reporting on this troubled sector (with just a few cherries on high): paying for sufferers, utilizing false info to signal folks up for medical health insurance they aren’t really eligible for, billing insurers for remedy that was by no means offered, refusing to let folks depart after they complained and concentrating on weak members of Native American tribes, based on the go well with.
Named are Asana Restoration and Beachfront Sober Dwelling in Costa Mesa; homeowners Mark and Adam Shandrow; medical director Dr. Christian Small; govt director Jonathan Hagen; and Asana Purchase Promote LLC, the Shandrow firm that owned sober residing properties the place Blue Cross members lived (which offered “free housing to induce patients to receive their ‘outpatient’ treatments with Asana so insurance payments could continue to come in,” the go well with stated).
They billed the insurer for some $71 million and picked up greater than $10 million, based on courtroom paperwork. The insurer is suing them for fraud, negligent misrepresentation, intentional interference with contractual relationships, violations of enterprise {and professional} codes and unjust enrichment.
“Mark Shandrow is no stranger to body brokering and kickbacks,” the go well with stated. “After spending approximately 16 years in real estate, Mark Shandrow co-founded Solid Landings Behavioral Health, a California (substance use disorder) enterprise. … Under Mr. Shandrow’s watch, Solid Landings ended up in bankruptcy after an investigation from the California Department of Insurance and the cessation of insurance payments due to suspicions of kickbacks and body brokering.”
Small, the physician, “actually provided very little, if any, actual services. In reality, he and Asana abused his license to create the appearance that qualified professionals were providing services at Asana,” the go well with stated.
‘Flabbergasted’
Legal professional Matt Lavin stated the parents at Asana are flabbergasted by the “irresponsible, demonstrably false, defamatory” allegations within the go well with.
“It’s wild — we’re still trying to wrap our heads around it,” he stated.
Asana has been in a reimbursement dispute with Blue Cross Blue Protect of Oklahoma over the insurer’s refusal to pay for providers rendered for years, Lavin stated, “and it looks like they’re turning it on its head, trying to get out of reimbursement by filing this suit.”
The allegations learn like a carbon copy of the go well with Blue Cross Blue Protect of Oklahoma lately filed in opposition to different Orange County rehabs, together with South Coast Behavioral Well being and Rad Life Restoration of Costa Mesa, he stated.
Asana is accredited by skilled organizations and in-network “with every single major payer in the country,” Lavin stated. “They’re shocked about this. It seems like this is some kind of reaction to feed into a popular narrative in Orange County of being full of unscrupulous treatment centers. As someone who has worked around health care and behavioral health care, it was an issue, but not Asana. I would send my child there.”
Asana will defend itself — and produce counterclaims for the cash that’s been withheld, he stated. Asana has labored carefully to assist Native American tribes in Oklahoma — a few of whom have written to officers in Oklahoma searching for to interrupt the fee deadlock.
“Starting September 2023, BCBS OK ceased the majority of payments authorized for services provided by Asana Recovery,” wrote Reggie Wassana, governor of the Cheyenne and Arapaho Tribes. “Asana Recovery plays a vital role in providing substance abuse treatment for our Tribal members, particularly when local beds are unavailable. Additionally, the effectiveness of out-of-state treatment for our members has significantly contributed to their recovery and our community’s well-being.”
In Oklahoma, 1 in 5 residents has some type of substance use dysfunction, lawyer Lavin stated, and plenty of of them are Native American. Asana has developed an experience in working with and treating this inhabitants, he stated.
Knowledge from the federal Substance Abuse and Psychological Well being Companies Administration exhibits that Oklahoma had about 165 dependancy remedy amenities treating some 29,000 folks in 2023, with about 730 residential beds. That’s about one mattress for each 5,600 residents.
California, in the meantime, had about 1,500 dependancy remedy amenities treating some 90,000 purchasers, with about 11,100 residential beds, based on the information. That’s about one mattress for each 3,600 residents. It’s price noting, although, that many in California’s dependancy remedy system are from out of state.
Fraud ‘permeates every level’
The Blue Cross Blue Protect go well with stated weak members of an Oklahoma-based Native American tribe with dependancy points have been focused.
One individual, recognized solely as “JC,” was contacted on social media by one other tribe member, KB, who was working for Asana as a “body broker,” the go well with stated.
“KB had previously been a patient at Asana and now was paid kickbacks to track down potential patients and traffic them to California for ‘treatment’ at Asana,” it stated. “Trusting KB and in want of remedy, JC agreed to enroll in Asana and was flown out to California at no cost. Upon arrival at Asana, she was pressured to strip off her garments, hand over her cellphone and all different belongings, and confronted with an settlement to remain at Asana for 90 days, far longer than the utmost 30-days she had been advised previous to arrival.
“Over the subsequent 10 days, JC found the remedy and expertise she had been promised was a lie. She obtained one quick digital session with an unknown particular person, was offered unknown treatment from what gave the impression to be a fellow affected person, and had one ‘treatment session’ that entailed going for a hike.
“After Asana ignored her repeated requests to see an actual therapist and receive real treatment, JC attempted to call her family and leave. Asana refused to let her use her phone. When she then sought to leave, Asana refused to return her phone or belongings and prohibited her from going outside. Eventually, when Asana staff were not watching, JC put what she could in a laundry basket and escaped out the front door.”
Lavin, Asana’s lawyer, stated it’s normal follow within the business to carry a affected person’s belongings in the event that they attempt to depart in opposition to medical recommendation. “The brain is telling them to run away,” he stated. “Every single treatment center has policy of holding things for 48 hours, trying to get people to return so they don’t overdose on the street.”
Throughout JC’s quick keep, Asana submitted claims searching for $4,500 in funds for daily of the keep, “representing that they were providing 24-hour supervised detox treatment,” the go well with stated. “This was obviously false.”
The insurer stated Asana paid kickbacks to physique brokers; paid energetic sufferers for cellphone numbers and “leads” for potential sufferers; focused these potential sufferers with false gross sales pitches concerning the high quality of remedy, perks resembling non-public cooks and the false declare that Asana had “reached an agreement with the state of Oklahoma to provide treatment” though no such settlement existed; and paid sufferers to go away optimistic on-line evaluations “to cover-up the deluge of negative reviews that were flooding online resources,” the go well with stated. One affected person was promised $10,000 if he enrolled in a Blue Cross Blue Protect of Oklahoma plan and attended Asana for a sure size of time, it stated.
Asana’s lawyer, Lavin, stated that the one folks doing outreach are full-time workers. “They don’t have relationships with body brokers,” he stated.
If folks didn’t have good insurance coverage, Asana endeavored to fraudulently enroll them within the Blue Cross Blue Protect of Oklahoma plans, the go well with stated. Asana additionally waived the sufferers’ out-of-pocket prices, which are supposed to guarantee they’ve pores and skin within the sport and are motivated to hunt out probably the most cost-effective remedy and benefit from any remedy they do obtain, it stated.
As soon as enrolled, Asana offered minimal or non-existent remedy, typically overseen by different sufferers or individuals who weren’t licensed or certified, it stated. “Like JC, many sufferers desired to go away after they realized remedy was not forthcoming. As a result of this might thwart the flexibility to invoice insurance coverage, Asana went to appalling lengths to cease affected person departures, resembling: slicing off cellphone entry, refusing to return affected person belongings, and – worst of all – refusing to supply sufferers their wanted drugs.
“For other patients, Asana induced them to stay through ’employment,’ during which Asana often continued to bill for insurance, thereby obtaining free labor through insurance payments,” it stated. “Once a patient completed detox treatment, Asana – in conjunction with Beachfront and Asana Buy Sell – provided free housing to induce patients to receive their ‘outpatient’ treatments with Asana so insurance payments could continue to come in.”
Medical health insurance pays for outpatient remedy, however is just not speculated to pay hire or housing prices.
Asana’s modus operandi is just not solely fraudulent, however life-threatening, the go well with stated. “(T)reatment was just a cover for their ultimate prize: money. And they got a lot of it: over $10 million in ill-gotten gains from (Blue Cross Blue Shield of Oklahoma) alone,” the go well with stated. Fraud “permeates every level of the treatment cycle and covers a staggering array of overlapping conduct, including: body brokering, false advertising, fraudulent enrollment, cost-share waivers, fraudulent billing and illegal kickbacks.” The insurer seeks punitive and exemplary damages in an quantity enough to punish Asana — and deter others from participating in comparable conduct.
Asana’s lawyer stated this portrait is fictional. Asana by no means used physique brokers, he stated. It doesn’t have marijuana-friendly sober properties. It by no means offered free housing or transportation. It by no means paid folks to return to remedy. It by no means enrolled anyone in insurance coverage. There have been points within the business, he stated, however Asana is likely one of the good ones.
Critics aren’t stunned
Some reformers, nonetheless, have been asking California regulators to maneuver on Asana for years.
“I have grave concerns regarding Asana Recovery in Costa Mesa … where serious safety violations continue to put lives at risk,” stated a 12-page grievance from Wendy McEntyre of Jarrod’s Regulation to the California Division of Well being Care Companies, which licenses and regulates non-medical dependancy remedy amenities like Asana.
“For over two years, investigations have revealed deeply troubling patterns of abuse, negligence and regulatory violations that continue to this day, while the facility inexplicably remains operational. The necessity for this exhaustive documentation stems from DHCS’s continued pattern of inadequate oversight and apparent willful ignorance of systematic violations…. This institutional failure to acknowledge and act … demonstrates a concerning departure from DHCS’s regulatory responsibilities.”
McEntyre factors to the case of John Jacob McLister, who had a particularly excessive blood alcohol stage when he checked into Asana the morning of April 3, 2021, based on data. He was exhibiting symptoms of acute withdrawal: tremors, nausea, stomach ache, anxiousness, melancholy, irritability, lack of urge for food, headache and restlessness, in addition to current seizure dysfunction, based on a lawsuit filed in 2023.
Safety video exhibits McLister fidgeting as others performed a cube sport just some toes away. He sprawled out on a close-by couch and shortly started to twitch and shake. Nobody took a lot discover. Quickly, the twitching stopped.
Some seven hours after arriving, McLister was useless, the go well with stated. Asana didn’t correctly assess his situation and understand he required a better stage of care; failed to supply treatment to ease the signs of acute alcohol withdrawal; and didn’t adequately monitor him, the go well with charged.
Asana denied the allegations and stated McLister’s demise was his personal fault, and/or “caused by the natural course of a disease.” Nonetheless, the events settled final 12 months, based on courtroom paperwork.
The state discovered nothing to query in its demise investigation and has not but responded to McEntyre’s grievance. We requested to see if it had something to say concerning the lawsuit: “DHCS is unable to comment on active litigation and does not comment on open, ongoing investigations,” a spokesman stated.
Individually, former healthcare technician Keisha Monique Simon filed go well with in opposition to Asana final 12 months, charging it with “a scheme of wage abuse” and a number of violations of labor regulation. Asana denied “each and every allegation” in courtroom paperwork.
Lavin, Asana’s lawyer, stated California’s licensing system has room for enchancment however there’s clearly a necessity for good substance use dysfunction remedy on this nation. “It has affected my family — it affects everybody’s family,” he stated. “The large hospital techniques – they don’t do it. The place are you speculated to go?
“In my experience, people who’ve had cancer generally aren’t opening oncology clinics. But the only population that seems interested in treating this population are a lot of people in recovery.”
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