Families often encounter behavioral health in a moment of fear. A child is unraveling. A partner is disappearing into relapse. A parent is terrified that the next call will be the hospital, jail, or morgue. That urgency creates a market in which bad actors can exploit need, confusion, and time pressure.
Healthcare fraud in mental health and substance use disorder treatment is not just a billing problem. It is also a clinical harm problem that distorts placement decisions, damages outcomes, and turns human beings into revenue units.
This blog focuses on the fraud patterns that show up again and again: patient brokering, misleading marketing, call centers that sell leads like an auction, urine drug testing schemes, fee splitting, and predatory recruitment inside support groups and online parent communities. It also covers the legal guardrails that exist and what families can do right now to protect themselves.
The Core Concept: Money That Follows Bodies
In ethical care, referrals are driven by clinical fit: diagnosis, risk, acuity, safety needs, family system, and the level of care that matches the moment.
In fraudulent care, referrals are driven by money: the primary focus is on who pays the broker, the marketer, the “coach,” the “placement helper,” the call center, or the testing pipeline.
That is why patient brokering is so corrosive. It quietly replaces clinical judgment with financial incentive. Florida State Attorney, Dave Aronberg, has documented how this plays out in the addiction treatment marketplace, including the ways relapse can be financially incentivized when payment systems reward churn over recovery (Aronberg, Campbell, Fighting the Florida Shuffle, Indigo River Publishing; Aronberg author page).
Patient Brokering: The Referral That Is Really a Kickback
Patient brokering is the practice of paying or receiving something of value in exchange for steering a person to a particular provider, facility, recovery residence, or laboratory.
Florida’s patient brokering statute makes it unlawful to offer, pay, solicit, or receive remuneration for referrals to or from a health care provider or facility, with specified exceptions and penalties (Fla. Stat. § 817.505).
At the federal level, the problem is also addressed through multiple laws, including the Eliminating Kickbacks in Recovery Act, which criminalizes certain referral payments tied to recovery homes, clinical treatment facilities, and laboratories in connection with services covered by a health care benefit program (18 U.S.C. § 220).
When a family hires someone or is referred to a helper who is secretly compensated by a treatment center, the family is not receiving independent guidance. They are being routed through a financial channel. The clinical consequence is predictable: placement drifts toward what pays, not what fits.
Misleading Marketing: “The Best Place” Is the Place That Bought the Click
Behavioral health marketing has a long history of deception, but the digital era supercharged it. The most common patterns include:
- Websites that look like neutral directories but are actually paid funnels
- Search ads that impersonate reputable providers
- “Helpline” phone numbers that are actually lead brokers
- False claims about specialties, outcomes, accreditation, or staff credentials
In 2025, the Federal Trade Commission announced a settlement involving a Florida-based substance use disorder treatment clinic over allegations of deceptive search advertising and telemarketing that impersonated other providers, along with monetary relief and bans on impersonation and deceptive advertising.
When families are scared, they click the first result, and fraudsters know that. They build a front door that looks clinical and compassionate, then route the person to whoever is paying for that call today.
Call Centers That “Auction” People
Many call centers operate on a lead sale model. The person calling thinks they are speaking to a counselor or an intake team at a specific facility. In reality, they are speaking to a sales operation that can route them anywhere based on reimbursement and margin.
This is where families hear the line, “this is the best facility.” But the hidden truth can be that this is the highest payer at this hour.
Even when a placement is not outright fraudulent, a conflicted referral source is still unsafe, because it undermines informed consent. Families cannot consent to a plan if they are not told who is being paid and by whom.
Urine Drug Testing Schemes: When the Test Becomes the Business Model
Urine drug testing is clinically useful when it is medically necessary, appropriately selected, and integrated into a treatment plan. Fraud enters when testing becomes a profit engine that is disconnected from clinical need.
Common tactics include:
- Standing orders for high frequency testing regardless of presentation
- Expensive panels when simpler testing would do
- Billing practices that maximize reimbursement rather than clinical utility
- Free items or inducements offered to referral sources in exchange for lab volume
The Department of Justice has repeatedly pursued False Claims Act matters tied to medically unnecessary urine drug testing and improper inducements, including a 2024 settlement involving allegations of unnecessary testing and providing items to physicians tied to referrals.
Older but still instructive, the DOJ also announced a large settlement tied to allegations of unnecessary urine drug testing billed to federal programs.
This matters to families, because testing fraud can reshape care. Programs may structure the entire “treatment day” around billable tests rather than therapy, psychiatry, family work, and stabilization.
Fee Splitting: The Quiet Corruption Behind the Scenes
Fee splitting is the practice of dividing revenue or paying commissions for referrals. Sometimes it is disguised as “marketing services,” “consulting,” “per call fees,” “case management,” or “transport coordination.” The label changes, but the function remains the same.
At the federal level, the Anti-Kickback Statute prohibits knowingly and willfully offering, paying, soliciting, or receiving remuneration to induce or reward referrals for items or services payable by federal health care programs (42 U.S.C. § 1320a 7b(b)). EKRA extends the concept into an all-payer context for referrals involving recovery homes, treatment facilities, and laboratories, which is especially relevant in commercially insured addiction treatment markets (18 U.S.C. § 220).
Families should hear this plainly: if someone is being paid by the facility to recommend that facility, the family is not getting independent advice.
Predatory Recruitment in Support Groups and Online Parent Communities
One of the most painful realities is that exploitation can occur in spaces that are supposed to be safe, such as meetings, support groups, and online parent forums.
Predators show up where people are desperate, then offer certainty, shortcuts, and “inside connections.” Sometimes they present as a recovered success story. Sometimes the pose as a parent advocate. Sometimes they present as a “consultant.” The hook is trust, but the monetization is referral.
This is not only unethical, but it can also be criminal, depending on the structure and the jurisdiction. However, even when it falls into gray zones, it is clinically dangerous because it steers families away from comprehensive assessment and toward a single monetized pipeline.
Why This Harms Outcomes: Misplacement Is Not a Small Error
Placement is not a preference. It is a clinical intervention. When financial incentives drive placement, predictable harms follow:
- Wrong level of care, either too low to keep someone safe or too high to maximize billing
- Fractured continuity, with repeated transfers and churn
- Delayed stabilization and increased relapse risk
- Erosion of family trust and burnout
- Increased overdose risk when people are cycled through unstable settings
Academic literature on fraud, waste, and abuse in substance use disorder treatment notes unethical practices such as unnecessary testing and upcoding, which highlights how financial distortion can infiltrate care delivery.
What Families Can Do Right Now: A Due Diligence Script
Ask these questions, and insist on clear answers in writing when possible:
- Are you affiliated with or paid by any treatment center, lab, recovery residence, transport company, or marketing network?
- Do you receive referral fees, per-call payments, marketing fees, free services, or anything of value tied to where my loved one goes?
- Who exactly will provide the clinical assessment, what is their license, and can it be verified?
- What level of care are you recommending and why, based on what criteria?
- If you are recommending a facility, can you name at least two alternative options and explain why you are not recommending them?
- Will you provide an itemized estimate of costs and what insurance is expected to cover?
- How do you handle urine drug testing: frequency, medical necessity rationale, and the existing lab relationship exists?
If a person gets defensive about transparency, pressures you to make a decision immediately, or refuses to disclose financial relationships, treat that as a red flag, not a personality quirk.
What Ethical Systems Look Like
Ethical referral and ethical marketing are simple in principle. They:
- Disclose conflicts of interest clearly
- Separate clinical recommendations from financial gain
- Use evidence informed placement criteria
- Avoid kickback-driven relationships with labs and call centers
- Prioritize continuity, family engagement, and outcomes, not churn
Dave Aronberg’s work is valuable here because it describes how systems can be designed to reward the wrong behaviors and how policy blind spots can unintentionally incentivize relapse over recovery when oversight is weak.
The Standard Should Be Dignity, Not Deals
If you are a parent or spouse seeking help, you are not a lead. Your loved one is not a body. You are navigating a medical and psychological crisis, and you deserve truth. Fraud in this space is uniquely cruel because it preys on hope. It takes the moment a family is most willing to trust and turns that trust into revenue. The antidote is transparency, enforcement, and a cultural shift inside behavioral health. Most importantly, clinical fit must be the only acceptable reason for a referral.
Sources:
- Aronberg, Dave, and Campbell, David R. Fighting the Florida Shuffle: The Inside Story of Corruption in the Addiction Treatment Industry. Indigo River Publishing, 2025.
- Eliminating Kickbacks in Recovery Act. 18 U.S.C. § 220.
- Florida Statutes. Patient brokering prohibited. Fla. Stat. § 817.505 (2025).
- Federal Trade Commission. “Evoke Wellness to Pay $1.9 Million to Settle FTC Claims…” June 10, 2025.
- Federal Trade Commission. “Enforcing the Opioid Addiction Recovery Fraud Prevention Act…” June 11, 2025.
- U.S. Department of Justice. “Precision Toxicology Agrees to Pay $27M to Resolve Allegations…” Oct 2, 2024.
- U.S. Department of Justice. “Reference Laboratory, Pain Clinic, and Two Individuals Agree to Pay $41 Million…” Apr 15, 2020.
- U.S. Department of Health and Human Services Office of Inspector General. “Fraud & Abuse Laws.” Anti Kickback Statute overview.
- Garrido, M M, et al. “Detecting fraud, waste, and abuse in substance use disorder treatment.” 2022.
