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Member Research & Reports

Member Research & Reports

BU: What Does Opioid Use Disorder Treatment Fraud Look Like?

As the opioid crisis has grown, so too has the number of opioid use disorder treatment programs. But in this widely unregulated treatment system, some “sober homes” and other programs prove to be scams, taking on patients to milk insurance without providing real treatment.

Insurers may not be able to look across national data to find the telltale signs of this kind of fraud, but Boston University School of Public Health (BUSPH) researchers can, with help from a top former federal healthcare regulator, a Washington, DC-based law and consulting firm, and some undercover “mystery shoppers.”

Together with support from the Laura and John Arnold Foundation, part of Arnold Ventures, four professors from the Department of Health Law, Policy & Management at BUSPH are working on a two-year project to identify insurance claims patterns that point to substance use disorder treatment scams; they will then build a tool for insurers and regulators to understand just how big the problem is, and how to stop it. Law and consulting firm Faegre Baker Daniels and insurers will then test the model by having mystery shoppers contact the potentially fraudulent programs, posing as people interested in treatment.

“This problem affects everybody,” says Dr. Melissa Garrido, research associate professor of health law, policy & management at BUSPH, and the lead researcher on the study. “The fraud wasn’t targeted at the general public, but the general public suffers from it.”