She wanted drug rehab. She ended up in the Florida shuffle.

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Brianna Jaynes needed assist for her habit to painkillers and heroin. She ended up trapped in a cycle that centered on operating up large insurance coverage payments and touchdown worthwhile kickbacks — not addressing her drug downside.

In 2015, when Jaynes was 20, she began her rehab search by calling a quantity she discovered via Google. The particular person on the opposite finish of the road promised to get her assist: She’d be high quality, and he or she’d get into among the best habit remedy services within the nation. Jaynes had little expertise with habit remedy, and, in a second of disaster, it was precisely what she needed to listen to.

However what Jaynes didn’t know is that she was talking to a dealer who, regardless of his claims, wasn’t working with the perfect remedy services. As a substitute, she later discovered, he labored with services that had promised him a kickback for sending them sufferers. The services, in flip, would invoice the sufferers’ insurance coverage for 1000’s, if not tens of 1000’s, of {dollars}.

Over the following six months, Jaynes went to greater than a dozen remedy services in South Florida. Many of those locations lacked primary types of remedy; some allowed rampant drug use inside their partitions, together with by employees. In a single case, a employees member bought Jaynes medicine. In others, she was given medicine in change for going to sure services. Jaynes didn’t pay for the services herself, however her insurer, Impartial Well being, paid remedy suppliers greater than $100,000 between December 2015 and Could 2016, in keeping with her insurance coverage data.

Jaynes over time realized it was all improper, she advised me throughout an interview in her residence close to Buffalo, New York. However in Florida, a state that was new to her, and navigating a complicated addiction treatment system she was unfamiliar with, she tried to observe the lead of individuals — these brokers — who appeared to know higher and appeared like they actually had been attempting to assist her. And as an individual hooked on medicine, it was onerous to get away from an setting awash in capsules and heroin, a lot much less get into sustained restoration.

Brianna Jaynes stands for a portrait in her home near Buffalo, New York.

Jaynes’s drug use worsened as she bounced from remedy heart to remedy heart in 2016. “After Florida, I used to be so fucked up mentally,” Jaynes mentioned. “I didn’t give a flying fuck what occurred. I didn’t care.”

Finally, although, Jaynes had sufficient and went again to New York. However the expertise scarred her — main her to additional drug use and crime earlier than she started her full restoration later in 2016. “After Florida, I used to be so fucked up mentally,” Jaynes mentioned. “I didn’t give a flying fuck what occurred. I didn’t care.”

The scheme Jaynes and her then-boyfriend, Shane, had been caught in was so frequent that it now has a reputation: the “Florida shuffle.” On the entrance finish, remedy services in Florida paid brokers to refer sufferers with good insurance coverage, discovering sufferers via 12-step conferences, habit conferences, cellphone hotlines, and online groups and inspiring them to get assist in Florida.

Then the remedy services, a lot of which provided subpar remedy or none in any respect, cashed in themselves by charging the sufferers’ medical health insurance plans. In the meantime, sufferers had been led via a quagmire of remedy services and sober properties with out ever getting actual assist. As Shane, who requested I not use his final identify, advised me, “I used to be utilizing my insurance coverage card as a lodge key.”

The scheme reworked South Florida from the “recovery capital of America” to, as some specialists described it, the nation’s “relapse capital.” Jennifer Napolitano, proprietor of the sober residence Full Circle Restoration (which Jaynes went to), advised me, “It combusted in a single day. Folks had been dying on different individuals’s lawns. Folks had been getting rolled out of automobiles. Folks had been getting rolled in entrance of the hospitals.”

Khary Rigg, a behavioral well being providers researcher on the College of South Florida, argued there was a revenue motive for affected person brokers and remedy services to perpetuate a cycle of drug use: “The monetary incentive is to get them to make use of, have a constructive urine check, then now they’ll return to the remedy heart, and the [broker] or sober residence proprietor will get a kickback from the remedy heart.”

No less than two of the services that Jaynes went to had been shut down by regulation enforcement, partially for brokering and permitting drug use, and at the least eight others closed for unknown causes. And Congress, Florida lawmakers, and native officers have taken some steps to crack down on the shuffle by strengthening legal guidelines towards affected person brokering.

However specialists, advocates, and suppliers argue that the shuffle stays an issue in a lot of Florida, with a number of telling me that officers have to this point solely caught the “low-hanging fruit.” Additionally they warn that the shuffle and affected person brokering extra typically may unfold to other states so long as habit remedy oversight, rules, and their enforcement stay weak nationwide, leaving room for unhealthy actors to take benefit and bilk habit sufferers in disaster for earnings with out offering something near evidence-based care.

“The Florida shuffle isn’t the Florida shuffle anymore. It’s simply the shuffle,” John Lehman, a advisor for the analysis company Restoration Outcomes Institute, advised me. “I feel these unhealthy guys are on the lookout for a house. There’s cash to be made right here.”

How the Florida shuffle works

Jaynes had struggled with habit for years. She had respites, notably when she obtained pregnant along with her daughter after which began a profession in nursing. However she gravitated again to opioid painkillers and, finally, heroin. In late 2015, she had sufficient. She known as a hotline, getting led all the way down to Florida — for the primary time — by a affected person dealer.

Jaynes recalled the dealer, who she knew solely as Justin, telling her she wanted a constructive drug check to be admitted: “Go forward and get excessive tonight,” she recalled him saying. “Do no matter you bought to do.”

After a failed stint on the Gardens Wellness Heart Detox in Miami, which is now shut down, she went again to New York. She rapidly relapsed. In January 2016, she obtained Shane, her then-boyfriend, to go along with her for a second attempt.

Brianna Jaynes holds two photographs — one of her sister and her when they were older and another when they were kids.

In 2018, Jaynes misplaced her youthful sister Whitney to a drug overdose. Whitney was 20 years previous.

Over the following 4 months in Florida, Jaynes and Shane had been approached by a number of brokers, who would persuade them to go to remedy services and sober properties across the Miami, Palm Seaside, and Broward County areas by promising money, garments, medicine, and different free stuff. A lot of this was technically unlawful, however the legal guidelines had been barely enforced — so brokers operated within the open on hotlines, in on-line teams, and at 12-step conferences and habit conferences.

In a single case, a dealer directed Jaynes and Shane to Good Future Restoration, a remedy facility in Delray Seaside, by giving the couple heroin and promising money in a while. On the facility, drug use was widespread. Jaynes herself would hop a fence, go to a close-by Western Union to get cash, and purchase heroin. She by no means obtained actual remedy there.

However for the brokers and different individuals guiding the couple via the system, cash was put above all else: By attracting sufferers with some freebies, the brokers may make a revenue from kickbacks — within the lots of or 1000’s of {dollars} — that they obtained from the remedy services and sober properties. Then the services made cash by billing insurance coverage corporations for remedy that generally wasn’t even really provided and drug exams that weren’t mandatory and even checked out.

“I’m failing drug screenings at this place, and they aren’t saying one factor to me,” Jaynes mentioned of Good Future. “I’m getting examined day-after-day to each different day. You’d suppose they’d say one thing.”

Good Future was shut down by law enforcement in 2016, and the proprietor, Daniel Kandler, and other staff had been accused of collaborating in numerous affected person brokering schemes. (Kandler’s legal professional didn’t reply to a request for remark.)

However maybe the worst of the services, Jaynes advised me, was Protected Haven in Miami. Jaynes and Shane had been pushed to the ability in a beat-up automotive pushed by two individuals who had been “clearly excessive out of their minds,” she mentioned. As they stood outdoors of the ability, they had been not sure if they need to even go in. Then, Jaynes mentioned, a tech from Protected Haven got here out and provided to get them heroin, telling them they might come inside after they obtained excessive.

For the tech, it was each private {and professional}, Jaynes defined: “She needed to make the $20 off the lick,” and the couple could possibly be admitted with a constructive drug check.

Jaynes and Shane agreed. However as soon as inside, it was even clearer that the ability wasn’t going to assist them. A former employees member, who spoke to me solely on situation of anonymity, described Protected Haven as a “shitshow.” That very same employees member advised Jaynes, she recalled, that she wanted to get out and discover a place that might really assist her, warning her she’d die at Protected Haven.

Federal regulation enforcement final yr shut down the facility for allegedly allowing drugs and fraud. Based on the Department of Justice, Protected Haven submitted “false and fraudulent claims to medical health insurance plans for habit remedy providers that weren’t supplied as billed and laboratory exams that weren’t medically mandatory.” (Protected Haven’s former homeowners didn’t return requests for remark.)

Jaynes mentioned that she deserved half of the blame for the way issues went down in Florida, telling me that she selected, at some degree, to proceed utilizing medicine. Nonetheless, she argued that, at a naked minimal, remedy services and sober properties are presupposed to attempt to present a drug-free setting for individuals in restoration — and it’s no marvel if individuals relapse when medicine are all over the place.

After three months into her second spherical in Florida, Jaynes determined to provide remedy another trustworthy attempt, calling up services on her personal as a substitute of counting on a dealer. However nothing caught, and he or she returned to New York in Could 2016. Shane quickly adopted.

Florida was primed for the shuffle

By the point Jaynes left Florida, she had been to at the least 14 remedy services. Ten of them have since shut down. 4 are nonetheless open. Amongst those who stay open, solely Florida Home Expertise in Deerfield Seaside and Full Circle Restoration in Lake Price responded to requests for remark.

Susan Roy, chief technique officer of Florida Home Expertise, advised me her facility disavows affected person brokering. “We actually have a really robust dedication to moral remedy and to a really excessive degree of medical and medical care,” Roy mentioned. “There have been a variety of abuses in our trade. And there was no technique to not be touched by these. And good facilities simply tried to hold along with each other.” (She additionally mentioned Florida Home Expertise follows a medical and scientific mannequin. However the facility doesn’t supply buprenorphine, a medicine that specialists say is a gold standard for opioid addiction treatment.)

Napolitano, of Full Circle Restoration, took the same line: “I delight my profession on serving to appropriate the trade that was exploiting individuals at their most weak and their households. I’m very pleased with the enterprise that I’ve constructed and of the work I’ve obtained to take part in in enhancing it.”

Jaynes, for her half, mentioned Full Circle was the one good facility she went to, as a result of it made her go to 12-step conferences and get a job to “pay lease the suitable manner.”

Brianna Jaynes sits on her porch at her home near Buffalo, New York.

After spending 4 months in at the least 14 totally different remedy facilities in South Florida, Jaynes returned residence to New York, the place she relapsed but once more. Jaynes didn’t start sustained restoration till September 2016, after she was arrested for crimes linked to her drug use.

From Napolitano’s perspective, the shuffle has been horrifying — one which, in her view, was so widespread that even the higher remedy and restoration services would battle to maintain it away.

“Folks would, for lack of a greater phrase, poach shoppers that lived at our home — and it was actually scary and harmful when that was occurring,” she mentioned. “I knew that folks that had been being focused for his or her insurance coverage insurance policies had been being led to a harmful state of affairs, and we’d do our damnedest to get them from going. However $0 every week and utilizing medicine sounds quite a bit higher than $200 every week and having to work a job and work steps and be sober. So it was onerous to compete with that. … We noticed a variety of weak individuals exploited.”

There are causes the shuffle took off in Florida first. The state’s southeast hall was already broadly generally known as the “recovery capital of America.” The nice and cozy climate and good seashores made it inviting to well being care vacationers; as individuals repeatedly advised me, nobody would wish to keep in chilly, dreary Detroit or Buffalo within the winter once they may go to Miami.

“Tablet mills,” which handed out opioid painkillers like sweet and fueled a lot of the preliminary opioid crisis throughout the nation, additionally as soon as thrived in Florida. Many of those locations also used patient brokering, mentioned Rigg, of the College of South Florida: “Tablet mills would pay these people to seek out sufferers, and they might break them off $100 in the event that they introduced in a affected person who’d pay money for the go to, pay money for the capsules.”

However within the early to mid-2010s, Florida cracked down on pill mills. It’s maybe not a coincidence, Rigg argued, that habit remedy services adopted most of the identical ways because the tablet mills shut down.

Within the almost 4 years since Jaynes’s expertise, officers in Florida have taken steps to crack down on the shuffle. Dave Aronberg, the state legal professional in Palm Seaside County, and Al Johnson, head of the native sober residence activity power, have arrested and locked up dozens of unhealthy actors within the remedy trade. The state, with the assist of the sober residence activity power, has enacted new legal guidelines to stiffen penalties and enhance enforcement for current legal guidelines towards affected person brokering. The feds have gotten concerned, taking the lead particularly on instances of fraud, like Protected Haven’s.

“We’re very pleased with our work down right here,” Aronberg advised me. “I consider our regulation enforcement efforts, our sober properties activity power, has develop into a mannequin for the remainder of the nation.”

Others are much less enthusiastic. On and off the document, suppliers and activists mentioned that there are nonetheless main issues in Florida. For one, Aronberg’s jurisdiction is restricted to Palm Seaside County — and as Jaynes and Shane skilled, the shuffle encompasses services in Broward County and Miami, too.

Even in Palm Seaside County, some brokers have been pushed additional underground however are nonetheless actively recruiting sufferers for remedy facilities and sober properties. And the duty power still meets bimonthly and regularly announces new arrests, suggesting that the issue is ongoing.

“It’s nonetheless a significant downside,” Rigg mentioned. “I don’t suppose that is going to be going away anytime quickly except there’s one thing slightly extra complete.”

For Jaynes, the trauma of the Florida shuffle — not simply the failure and hopelessness of the remedy she sought, however abuse and disrespect for different those who she witnessed — set again her restoration for months after she left Florida. When she went again to New York, she relapsed once more; this time, she dedicated crimes, together with fraud and theft, to get cash to purchase medicine.

By September 2016, police caught as much as Jaynes, arresting her. She was positioned in drug courtroom later that yr, getting habit remedy in New York. She stopped utilizing medicine, and the courts largely dropped the costs towards her. She accomplished a licensed nursing program, finishing above a 90 percent average. In the present day, she works full-time as a nurse at Chautauqua Nursing and Rehabilitation Heart.

The shuffle isn’t an issue unique to Florida

Whereas Florida was the primary to get nationwide consideration for its downside, most of the components that produced the Florida shuffle are nationwide issues. Aronberg, the state legal professional, mentioned that his workplace has fielded calls from different states asking for assist — and a few, like California and Arizona, have been motivated to alter their legal guidelines.

One California group, Advocates for Accountable Remedy, argued that the shuffle is hitting the realm in and round Los Angeles, notably Orange County and Malibu. Laurie Girand, a member of the group, mentioned her group has tried to attract consideration to the difficulty, however not sufficient has been achieved but. Her group maintains on its website an extended checklist of issues at remedy services and sober properties, starting from crimes to violence to drug overdoses.

In 2017, the Orange County Register reported that brokers in California would “troll Alcoholics Nameless conferences, homeless camps and drug courts to seek out individuals they’ll ship to rehab — for kickbacks from the facilities. Usually, once they have a prospect, brokers will name a number of rehab facilities and search aggressive bids. Highest bidder will get the enterprise.” This is able to feed what locals name the “rehab riviera.” Whereas state lawmakers have made some changes, Girand argued the adjustments haven’t been enough.

The shuffle “is completely occurring in different states” moreover Florida, Girand mentioned, citing instances she’d heard of in California, Pennsylvania, and Massachusetts. “It’s just about anyplace the place a legal can open a facility and name it one thing that it’s not and due to this fact get an earnings stream from insurance coverage.”

One downside: In most states, habit remedy stays underregulated. As one instance, remedy services typically don’t want even a single medically licensed skilled on employees. The shortage of oversight permits shady, unqualified remedy facilities to open up store with little to no supervision.

On the identical time, there have been concerted efforts to get insurers to pay for extra habit remedy. However partially as a result of insurers have refused to pay for remedy for therefore lengthy, they haven’t developed requirements for habit remedy — and frequently don’t know if what they’re paying for is any good.

With the opioid disaster within the background, all of this has created a state of affairs during which unhealthy rehabs and sober properties can simply reap the benefits of sufferers and households in determined want of care. The Florida shuffle took off after federal parity legal guidelines and the Reasonably priced Care Act concurrently expanded entry to medical health insurance and required well being plans to extra totally cowl habit remedy. Jaynes and Shane had been capable of keep on their mother and father’ medical health insurance because of the regulation’s requirement that they cowl kids till they flip 26.

However Richard Frank, a well being economist at Harvard centered on psychological well being and habit providers, cautioned towards blaming the shuffle’s progress on expanded entry to insurance coverage.

Insurance coverage protection and higher regulation are two separate points, he mentioned, and it’s essential not “to carry hostage one for the opposite.” In his view, efforts to broaden entry to well being care, together with habit care, must proceed; in spite of everything, federal data reveals that just one in 10 individuals with a drug use dysfunction will get into specialty remedy, partially because of lack of entry. Individually, he mentioned, regulators and well being insurers also needs to do rather more to carry habit remedy packages accountable — ensuring they provide evidence-based care and observe well being outcomes.

For many years, habit remedy within the US has averted the federal government rules and insurance-enforced accountability measures which are outstanding in the remainder of well being care. Remedy modalities with little to no proof behind them, like confrontational approaches or equine therapy, have been allowed to flourish, whereas evidence-based care, like medications for addiction, is broadly rejected. A standard quip I heard as I reported this piece is that each one it takes to open a sober residence in many of the US is to hold up an indication at your entrance door claiming to be a sober residence.

And though regulators and insurers carefully observe outcomes in conventional well being care services and use these outcomes to resolve what remedy is working and value paying for, the vast majority of remedy services within the US don’t observe even essentially the most primary outcomes of their approaches on a constant foundation — making accountability tough if not unattainable.

“A part of [insurers’] job is enjoying the unpopular function and saying ‘no,’” Frank advised me. “The problem is that in some instances ‘no’ is totally justified and we must be supportive of that, and in different instances ‘no’ is principally a manner of eliminating individuals and that’s uncool. Ensuring that we’re vigilant in distinguishing between these two is a crucial public coverage job.”

Insurers are conscious of this downside, teaming up with the advocacy organization Shatterproof to develop better standards for addiction care.

There’s additionally a dearth of analysis on habit remedy and what really works, particularly for addiction to stimulants. So long as that’s true, fraudsters and even well-intentioned however misguided actors will be capable to pop up, promising miracle cures and coverings, mentioned Sherry Glied, a well being economist and the dean of New York College’s Robert F. Wagner Graduate College of Public Service.

“A part of the explanation that we stopped having as many bogus most cancers remedies is that we obtained higher at treating most cancers. When you get higher at treating most cancers, there’s much less incentive for individuals to go search magic remedies as a result of they’ve given up on every little thing else,” Glied advised me. “We’re not there but on substance use and psychological well being. So there’s a variety of house for charlatans to return in with all types of loopy issues. And individuals are determined.”

Jaynes’s earlier insurer, Impartial Well being, declined to touch upon the Florida shuffle, saying it wanted “to make sure the integrity of present [Special Investigations Unit] investigations.” Shane’s former insurer, Empire Blue Cross Blue Defend, didn’t reply to a request for remark concerning the Florida shuffle.

Cathryn Donaldson, a spokesperson for America’s Well being Insurance coverage Plans, advised me in a press release that “insurance coverage suppliers are extraordinarily involved about what the trade typically refers to as ‘physique brokers’ who goal and exploit weak people by concentrating on insurance coverage corporations to invoice for remedy and exams which will or might not be clinically acceptable or really even be supplied.” Insurers, she mentioned, are working with regulators, policymakers, and remedy suppliers to handle the difficulty.

To cease the shuffle from spreading, advocates demand reform

It’s unclear what, if something, will get lawmakers to behave on this situation. Congress handed a strengthened anti-kickback law in 2018 as a part of broader opioid legislation. Past that, advocates — together with addiction treatment providers themselves — have called for extra regulation on and oversight of habit remedy services, notably those who obtain federal funds.

“One, it entails higher licensing. Two, it entails higher accreditation. Three, it entails higher measurement of efficiency,” Frank, of Harvard, mentioned. “After which 4, it additionally means while you put these first three issues into place, and folks depart from them, you might have critical penalties in consequence.”

However the remedy trade has resisted such efforts, and lawmakers have but to make strikes towards considerably extra regulation.

Wanting ahead, Jaynes mentioned she hopes to transition to a profession in habit restoration and remedy, however continues to pay attention to issues within the trade like these she skilled in Florida.

Brianna Jaynes stands in her kitchen in her home near Buffalo, New York.

Jaynes launched Breaking Chains: The Whitney Mission on YouTube to interview individuals in restoration after her sister, Whitney, died in 2018, following a years-long battle with habit. Jaynes additionally plans to develop into a restoration coach.

Whereas we had been speaking in her residence, she obtained a cellphone name. Declining to take the decision, she remarked, “I feel that’s a affected person brokering man.” She defined that as she’s achieved extra work in habit restoration, she’s tried to keep away from associations with remedy services — out of concern they may attempt to loop her into some form of shuffle-like scheme. However she often nonetheless will get a shady name or electronic mail.

Nonetheless, she’s attempting to enhance issues. In 2018, her sister, Whitney, died of a drug overdose. Within the aftermath, Jaynes launched Breaking Chains: The Whitney Project on YouTube to interview individuals in restoration and share their tales extra broadly. She’s additionally an expert public speaker, centered on habit. And he or she plans to start out a job as a restoration coach later this yr.

For her, it’s about righting among the wrongs she noticed in Florida. Nevertheless it’s additionally, she added, a bit therapeutic.

“It’s a must to discover one thing that you simply love greater than medicine. You’ll love medicine greater than you’re keen on something in your life,” Jaynes mentioned. “When you give your self that means in the intervening time, it doesn’t make you so centered on anything.”


We wish to hear from you

We’re shining a light-weight on the issues with the habit remedy system in America and the way they’re affecting individuals, financially and in any other case, day-after-day. Please assist our reporting on the excessive price of habit rehab by sharing your story with us. It’s also possible to sign up for our email newsletter to get updates on the mission.

In the event you or somebody wants habit remedy, you may search assist on-line at FindTreatment.gov or by cellphone at 1-800-662-4357. In the event you want extra data, Vox put together a guide for how to find good addiction treatment.


Images by Libby March, an impartial documentary and editorial photographer, primarily based partly in Buffalo, New York, and partly in Michigan’s Higher Peninsula.

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