Right now there are thousands of drug-addicted West Virginians in what are called “MAT” programs. “MAT” stands for Medication Assisted Treatment, more commonly known as suboxone treatment.
There are 71 of these clinics across the state, regulated by the Department of Health and Human Resources. But some clinics are accused of exploiting their patients.
When addicts walk into a suboxone or methadone clinic, they are trying to get clean and get their lives back on track. But some are finding, they just can’t afford it.
Elizabeth Crawford has been a counselor for 25 years. She was excited when Dr. Anwar Abdeen offered her a job at his suboxone clinic Absolute Care.
“I felt like I was getting through to them. The patients loved me and I loved them. They would tell me that they feel like no one cared about them until I came,” Crawford told 13 News.
But on Crawford’s first day, a patient said she was concerned about the cost of required counseling.
“She said to me, she said, ‘I just had to pay you $300’ and I said ‘beg your pardon?’ She said ‘well I’m broke I don’t have anymore money and l just paid you $300’,” Crawford recalled.
Crawford thought her patient was confused, but as the weeks went on, other patients said the same thing. Crawford connected us with patients who were too scared to show their faces on camera. Most are on Medicaid, and it’s being billed every month. But they said, they still have to pay cash up front.
In a statement to 13 News a spokesman with West Virginia’s Medicaid program says all portion of MAT are already covered by Medicaid.
“The doctor visit, assessment and evaluation, counseling, drug testing, and medication are covered and reimbursed through WV Medicaid. There are no required services that are not reimbursable through Medicaid.”
So we confronted the Absolute Care Clinic. Dr. Abdeen denied repeated requests for interview or comment. Then we went to the clinic.
“I have channel 13 news standing in front of your office getting ready to film your building with an expose that’s going to hit the news this evening about the insurance fraud going on at your clinic,” An office manager could be heard saying on the phone to Dr. Abdeen. Our camera caught the phone call when we asked why the clinic was billing patients for a service they are already being paid for.
Crawford said her patients also reported double-billing at Solutions Recovery in Williamson. Though no one from the clinic responded to our repeated calls for an interview, a viewer shared a recording of a phone call from last week:
“We charge $350 a month, is that going to be a problem for you? The insurance will pay for your medicine and it will pay for the doctor visit. We still require a $350 fee for the counseling and drug testing,” a manager can be heard telling the potential patient.
West Virginia Medicaid says counseling and drug testing are already covered, “There are no required services that are not reimbursable through Medicaid.”
The Office of Health Facility Licensure or Certification, in charge of overseeing these clinics, told us cash payments are only allowed if a patient’s insurance is denied, they don’t have insurance or the patient tells a clinic not to bill insurance.
9 CSR 12-8.2. “Payments for services rendered may be made either by Medicare, West Virginia Medicaid, private insurance, or by cash as described in this rule.”
8.2.a. “Prior to directly billing a patient for any MAT treatment, the OBMAT program shall document in the patient’s record the receipt of any rejection of prior authorization, rejection of a submitted claim, or written denial from a patient’s insurer, Medicare or West Virginia Medicaid denying coverage for opioid treatment. The OBMAT program shall also clearly document in the patient’s record if the patient has no insurance or has voluntarily and with full knowledge of the financial obligations, including all treatment costs, requested a claim not be submitted to their insurer, Medicare or West Virginia Medicaid. When any instance described in this sections regarding direct billing and acceptance occurs, the OBMAT program shall clearly document in the patient’s record the rationale and medical necessity for acceptance into the program.”
Crawford said many patients are on a fixed income or work minimum wage jobs, she’s heard dozens of heartbreaking stories from patients.
“They were bathing in the creek because they had no other place to go, they had no home, their car was their home. they’ve been betrayed, they’ve been betrayed big time,” Crawford explained.
Crawford said she’s reached out to the DHHR’s Inspector General, the U.S. Attorney’s Office and Governor’s Office, but the clinics remain open. She’s concerned this is happening at other clinics as well.
A spokesman for West Virginia’s Medicaid Program says, “The doctor visit, assessment and evaluation, counseling, drug testing, and medication are covered and reimbursed through WV Medicaid. There are no required services that are not reimbursable through Medicaid.”
If you are a patient at a clinic where you believe you’re being charged twice for services, send us an email or message.