U.S. GOVERNMENT PUBLISHING OFFICE

35–759 WASHINGTON : 2019

EXAMINING ADVERTISING AND MARKETING 

PRACTICES WITHIN THE SUBSTANCE USE 

TREATMENT INDUSTRY 

HEARING 

BEFORE THE

SUBCOMMITTEE ON OVERSIGHT AND 

INVESTIGATIONS 

OF THE

COMMITTEE ON ENERGY AND 

COMMERCE 

HOUSE OF REPRESENTATIVES 

ONE HUNDRED FIFTEENTH CONGRESS 

SECOND SESSION 

JULY 24, 2018 

Serial No. 115–155 

( 

Printed for the use of the Committee on Energy and Commerce 

energycommerce.house.gov 

(II) 

COMMITTEE ON ENERGY AND COMMERCE 

GREG WALDEN, Oregon 

Chairman 

JOE BARTON, Texas 

Vice Chairman 

FRED UPTON, Michigan 

JOHN SHIMKUS, Illinois 

MICHAEL C. BURGESS, Texas 

MARSHA BLACKBURN, Tennessee 

STEVE SCALISE, Louisiana 

ROBERT E. LATTA, Ohio 

CATHY MCMORRIS RODGERS, Washington 

GREGG HARPER, Mississippi 

LEONARD LANCE, New Jersey 

BRETT GUTHRIE, Kentucky 

PETE OLSON, Texas 

DAVID B. MCKINLEY, West Virginia 

ADAM KINZINGER, Illinois 

H. MORGAN GRIFFITH, Virginia 

GUS M. BILIRAKIS, Florida 

BILL JOHNSON, Ohio 

BILLY LONG, Missouri 

LARRY BUCSHON, Indiana 

BILL FLORES, Texas 

SUSAN W. BROOKS, Indiana 

MARKWAYNE MULLIN, Oklahoma 

RICHARD HUDSON, North Carolina 

CHRIS COLLINS, New York 

KEVIN CRAMER, North Dakota 

TIM WALBERG, Michigan 

MIMI WALTERS, California 

RYAN A. COSTELLO, Pennsylvania 

EARL L. ‘‘BUDDY’’ CARTER, Georgia 

JEFF DUNCAN, South Carolina 

FRANK PALLONE, JR., New Jersey 

Ranking Member 

BOBBY L. RUSH, Illinois 

ANNA G. ESHOO, California 

ELIOT L. ENGEL, New York 

GENE GREEN, Texas 

DIANA DEGETTE, Colorado 

MICHAEL F. DOYLE, Pennsylvania 

JANICE D. SCHAKOWSKY, Illinois 

G.K. BUTTERFIELD, North Carolina 

DORIS O. MATSUI, California 

KATHY CASTOR, Florida 

JOHN P. SARBANES, Maryland 

JERRY MCNERNEY, California 

PETER WELCH, Vermont 

BEN RAY LUJA ́ N, New Mexico 

PAUL TONKO, New York 

YVETTE D. CLARKE, New York 

DAVID LOEBSACK, Iowa 

KURT SCHRADER, Oregon 

JOSEPH P. KENNEDY, III, Massachusetts 

TONY CA ́ RDENAS, California 

RAUL RUIZ, California 

SCOTT H. PETERS, California 

DEBBIE DINGELL, Michigan 

SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS

GREGG HARPER, Mississippi 

Chairman 

H. MORGAN GRIFFITH, Virginia 

Vice Chairman 

JOE BARTON, Texas 

MICHAEL C. BURGESS, Texas 

SUSAN W. BROOKS, Indiana 

CHRIS COLLINS, New York 

TIM WALBERG, Michigan 

MIMI WALTERS, California 

RYAN A. COSTELLO, Pennsylvania 

EARL L. ‘‘BUDDY’’ CARTER, Georgia 

GREG WALDEN, Oregon (ex officio) 

DIANA DEGETTE, Colorado 

Ranking Member 

JANICE D. SCHAKOWSKY, Illinois 

KATHY CASTOR, Florida 

PAUL TONKO, New York 

YVETTE D. CLARKE, New York 

RAUL RUIZ, California 

SCOTT H. PETERS, California 

FRANK PALLONE, JR., New Jersey (ex 

officio) 

(III) 

C O N T E N T S 

Page 

Hon. Gregg Harper, a Representative in Congress from the State of Mississippi, opening statement ................................................................................. 1 

Prepared statement .......................................................................................... 3 

Hon. Diana DeGette, a Representative in Congress from the state of Colorado, 

opening statement ................................................................................................ 4 

Prepared statement .......................................................................................... 6 

Hon. Greg Walden, a Representative in Congress from the State of Oregon, 

opening statement ................................................................................................ 7 

Prepared statement .......................................................................................... 8 

Hon. Frank Pallone, Jr., a Representative in Congress from the State of 

New Jersey, opening statement .......................................................................... 10 

Prepared statement .......................................................................................... 11 

WITNESSES

Marvin Ventrell, Executive Director, National Association of Addiction Treatment Providers ..................................................................................................... 13 

Prepared statement .......................................................................................... 15 

Mark Mishek, President and CEO, Hazelden Betty Ford Foundation ............... 26 

Prepared statement .......................................................................................... 28 

Michael Cartwright, Chairman and CEO, American Addiction Centers ............ 38 

Prepared statement .......................................................................................... 40 

Robert Niznik, CEO, Addiction Recovery Now and Niznik Behavioral Health .. 43 

Prepared statement .......................................................................................... 45 

Jason Brian, Founder, Redwood Recovery Solutions and Treatmentcalls.Com . 49 

Prepared statement .......................................................................................... 52 

Kenneth Stoller, Director, Johns Hopkins Hospital Broadway Center for Addiction .................................................................................................................... 56 

Prepared statement .......................................................................................... 58 

SUBMITTED MATERIAL

Subcommittee memorandum .................................................................................. 94 

List of websites, submitted by Ms. DeGette .......................................................... 102 

Letter of July 24, 2018, from the Federal Trade Commission to Members 

of the Committee, submitted by Ms. DeGette ................................................... 105 

(1) 

EXAMINING ADVERTISING AND MARKETING 

PRACTICES WITHIN THE SUBSTANCE USE 

TREATMENT INDUSTRY 

TUESDAY, JULY 24, 2018 

HOUSE OF REPRESENTATIVES, 

SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS, 

COMMITTEE ON ENERGY AND COMMERCE, 

Washington, DC. 

The subcommittee met, pursuant to call, at 10:00 a.m., in room 

2123, Rayburn House Office Building, Hon. Gregg Harper (chairman of the subcommittee) presiding. 

Present: Representatives Harper, Griffith, Burgess, Brooks, Collins, Walberg, Walters, Costello, Carter, Walden (ex officio), 

DeGette, Schakowsky, Castor, Tonko, Clarke, Ruiz, and Pallone (ex 

officio). 

Also Present: Representative Bilirakis. 

Staff Present: Jennifer Barbla, Chief Counsel, Oversight and Investigations; Adam Fromm, Director of Outreach and Coalitions; 

Ali Fulling, Legislative Clerk, Oversight and Investigations, Digital 

Commerce and Consumer Protection; Brighton Haslett, Counsel, 

Oversight and Investigations; Brittany Havens, Professional Staff, 

Oversight and Investigations; Ed Kim, Policy Coordinator, Health; 

Andrea Noble, Fellow, Oversight and Investigations; Jennifer Sherman, Press Secretary; Austin Stonebraker, Press Assistant; Hamlin 

Wade, Special Advisor, External Affairs; Everett Winnick, Director 

of Information Technology; Julie Babayan, Minority Counsel; Jeff 

Carroll, Minority Staff Director; Waverly Gordon, Minority Health 

Counsel; Zach Kahan, Minority Outreach and Member Services Coordinator; Chris Knauer, Minority Oversight Staff Director; 

Jourdan Lewis, Minority Staff Assistant; Miles Lichtman, Minority 

Policy Analyst; Perry Lusk, Minority Government Accountability 

Office Detailee; Kevin McAloon, Minority Professional Staff Member; and C.J. Young, Minority Press Secretary. 

OPENING STATEMENT OF HON. GREGG HARPER, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF MISSISSIPPI 

Mr. HARPER. The subcommittee will come to order. 

Today, the subcommittee holds a hearing entitled examining, advertising, and marketing practices within the substance abuse 

treatment industry. This hearing builds on the subcommittee’s extensive work over the past 4 years examining the causes and scope 

2 

of the opioid epidemic including ways to effectively treat individuals with a substance use disorder. 

The opioid epidemic continues to ravish our nation. According to 

the Centers for Disease Control approximately, 2.1 million Americans over the age of 12 suffer from an opioid use disorder. Meanwhile, the number of Americans dying from opioid overdoses has 

increased in recent years to 115 deaths per day. 

As the opioid epidemic continues to take its toll, the demand for 

treatment has dramatically increased. According to the Substance 

Abuse and Mental Health Services Administration, the number of 

treatment facility admissions for opiate use increased 58 percent 

from 2005 through 2015. With rising demand, the number of treatment facilities has also grown. However, the increased demand for 

treatment and attendant proliferation of treatment facilities has 

raised a number of concerns about practices within the industry. 

Our December hearing examined ‘‘patient brokering,’’ the practice of recruiting individuals with a substance use disorder and luring them to treatment facilities and sober living homes, often in 

other States, in return for financial kickbacks. We also heard testimony about the problems stemming from the dramatic surge and 

substance use disorder treatment facilities including practices employed by businesses known generally as ‘‘call aggregators.’’ These 

practices incentivize profit over the recovery and well-being of the 

individual seeking treatment. 

The information we learned at the hearing in December, along 

with additional reports and research that the Committee conducted, led us to dig deeper into these marketing and advertising 

practices within the drug treatment industry. 

If you compare how one seeks care for a substance use disorder 

to how one would seek care for any other illness or disease, the differences are staggering. For example, if you aren’t feeling well, 

most people would go to their primary care physician, or if it’s an 

emergency, the ER, and that doctor is likely to refer you to another 

doctor or specialist, depending upon what’s wrong. Here, individual 

seeking treatment for themselves or loved one often turn to the 

Internet to find resources to guide them in choosing a treatment 

center. One study found that 61 percent of people who went to 

rehab used the Internet to find treatment. Such online searches 

can prove overwhelming. Patients are often at the mercy of what 

they find online with little or no guidance from a medical professional. 

Many treatment-focused websites advertise hotlines that purport 

to direct individuals to a trained professional that can help the individual assess what treatment facilities will best meet their needs. 

These call centers may appear to be unaffiliated third-party referral services, but they are often either owned and operated by treatment facilities or are paid by facilities to refer calls. While some 

centers disclose their relationship with treatment facilities, others 

may engage in deceptive marketing tactics to hide them. Moreover, 

these call centers are often staffed by sales representatives rather 

than medical professionals. In some cases, the individual staffing 

the company’s call center receive a bonus each month based on the 

number of callers that are successfully admitted into one company’s 

facilities. 

3 

In some of the worst cases, call aggregators, or call centers, may 

refer patients to facilities that don’t meet their needs based on a 

financial arrangement. And once patients enter treatment, they 

may be vulnerable to exploitation by unscrupulous business owners. 

Concerns raised about deceptive advertising and marketing practice have already led to action. For example, several States have 

passed legislation, the National Association For Addiction Treatment Providers updated its code of ethics, and Google placed a temporary restriction of online advertising by treatment providers due 

to misleading experiences among rehabilitation treatment centers. 

As the opioid epidemic continues to claim lives, it is vital that 

we ensure individuals seeking treatment for themselves or loved 

ones are able to find treatment that best meets their needs without 

being misled by those who would prioritize financial gain over saving lives. 

We thank our panel of witnesses for joining us this morning. I 

hope that today’s hearing will shed light on how we can combat deceptive marketing practices while protecting legitimate treatment 

centers and the individuals desperately seeking their care. 

We thank you for appearing before the subcommittee today, and 

we will look forward to hearing your testimony shortly. 

At this time, the chair will recognizes the ranking member of 

this subcommittee Ms. DeGette for 5 minutes for the purposes of 

an opening statement. 

[The prepared statement of Mr. Harper follows:] 

PREPARED STATEMENT OF HON. GREGG HARPER

The Subcommittee will come to order. Today the Subcommittee holds a hearing 

entitled ‘‘Examining Advertising and Marketing Practices within the Substance Use 

Treatment Industry.’’ This hearing builds on the Subcommittee’s extensive work 

over the past four years examining the causes and scope of the opioid epidemic, including ways to effectively treat individuals with a substance use disorder. 

The opioid epidemic continues to ravage our nation. According to the Centers for 

Disease Control, approximately 2.1 million Americans over the age of 12 suffer from 

an opioid use disorder. Meanwhile, the number of Americans dying from opioid 

overdoses has increased in recent years to 115 deaths each day. 

As the opioid epidemic continues to take its toll, the demand for treatment has 

dramatically increased. According to the Substance Abuse and Mental Health Services Administration, the number of treatment facility admissions for opiate use increased 58 percent between 2005 and 2015. With rising demand, the number of 

treatment facilities has also grown. However, the increased demand for treatment 

and attendant proliferation of treatment facilities have raised a number of concerns 

about practices within the industry. 

Our December hearing examined ‘‘patient brokering,’’ the practice of recruiting individuals with a substance use disorder and luring them to treatment facilities and 

sober living homes, often in other states, in return for financial kickbacks. We also 

heard testimony about the problems stemming from the dramatic surge in substance use disorder treatment facilities, including practices employed by businesses 

known generally as ‘‘call aggregators.’’ These practices incentivize profit over the recovery and well-being of the individual seeking treatment. 

The information we learned at the hearing in December, along with additional reports and research that the Committee conducted, led us to dig deeper into these 

marketing and advertising practices within the drug treatment industry. 

If you compare how one seeks care for a substance use disorder to how one would 

seek care for any other illness or disease, the difference is staggering. For example, 

if you aren’t feeling well most people would go to their primary care doctor or if it’s 

an emergency, the ER, and that doctor is likely to refer you to another doctor or 

specialist depending on what’s wrong. Here, individuals seeking treatment for themselves or a loved one often turn to the internet to find resources to guide them in 

4 

choosing a treatment center—one study found that 61 percent of people who went 

to rehab used the internet to find treatment. Such online searches can prove overwhelming, patients are often at the mercy of what they find online with little or 

no guidance from a medical professional. 

Many treatment-focused websites advertise hotlines that purport to direct individuals to a trained professional that can help the individual assess what treatment 

facility will best meet their needs. These call centers may appear to be unaffiliated 

third-party referral services, but they are often either owned and operated by treatment facilities or are paid by facilities to refer calls. While some centers disclose 

their relationship with treatment facilities, others may engage in deceptive marketing tactics to hide them. Moreover, these call centers are often staffed by sales 

representatives rather than medical professionals. In some cases, the individuals 

staffing the company’s call center receive a bonus each month based on the number 

of callers that are successfully admitted into one of the company’s facilities. 

In some of the worst cases, call aggregators or call centers may refer patients to 

facilities that don’t meet their needs based on a financial arrangement and once patients enter treatment they may be vulnerable to exploitation by unscrupulous business owners. 

Concerns raised about deceptive advertising and marketing practices have already 

led to action. For example, several states have passed legislation, the National Association for Addiction Treatment Providers updated its code of ethics, and Google 

placed a temporary restriction of online advertising by treatment providers due to 

‘‘misleading experiences among rehabilitation treatment centers.’’ 

As the opioid epidemic continues to claim lives, it is vital that we ensure individuals seeking treatment for themselves or loved ones are able to find treatment that 

best meets their needs without being misled by those who would prioritize financial 

gain over saving lives. 

We thank our panel of witnesses for joining us this morning. I hope that today’s 

hearing will shed light on how we can combat deceptive marketing practices while 

protecting legitimate treatment centers and the individuals desperately seeking 

their care. 

We thank you for appearing before the Subcommittee today and look forward to 

hearing your testimony. 

OPENING STATEMENT OF HON. DIANA DEGETTE, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF COLORADO 

Ms. DEGETTE. Thank you very much, Mr. Chairman. 

Mr. Chairman, throughout the several years that we have been 

holding a series of hearings in this subcommittee and other subcommittees of the Energy and Commerce Committee, one of the 

themes that has emerged is that families need good information 

about the types of treatments that are available. And also we’ve 

heard from the medical experts that evidence-based treatment, including medication-assisted treatment is the most effective means 

for overcoming opioid use disorders. 

But this is echoing what your concern is. Not all facilities provide 

that treatment. Some facilities make only vague promises about 

the effectiveness of various treatment models they offer. And in addition, when you’re finding your facility online, most patients will 

have no idea if the facilities that they’re identifying would have the 

types of treatment that would actually work in dealing with this 

opioid crisis. 

We’ve been seeing through this committee’s investigation that 

we’ve got nefarious or unqualified actors out there who are taking 

advantage of those who are suffering in order to capitalize on this 

condition. 

Last year, this subcommittee had a hearing where we heard 

about individuals known as ‘‘patient brokers’’ who profit from reVerDate Nov 24 2008 12:09 Apr 10, 2019 Jkt 037690 PO 00000 Frm 00008 Fmt 6633 Sfmt 6633 U:\MY DOCS\HEARINGS 115\HEARINGS\115-155 CHRIS
5 

cruiting patients with opioid addiction and then send them to dubious treatment centers in other States. 

We have heard that the operators of many of these centers sometimes have no training or expertise in drug treatment and once the 

patients arrive, they may receive substandard or no care at all. 

And then in December, the subcommittee heard from law enforcement officials in States that were affected by these schemes. 

They testified about the wide variation and the quality of care 

provided at some of the facilities and how we lack sufficient national standards. 

Now, today, we’re looking at another feature of the opioid epidemic that shows the challenges patients with opioid use disorder 

currently face. And that is, how the treatment providers advertise, 

market, or locate prospective patients seeking treatment and guide 

them to appropriate treatment. 

In other words, are patients prioritized when it comes to finding 

and directing those seeking care for opioid use disorders and for 

those patients who are the target of aggressive marketing practices, how should they evaluate a possible treatment facility for its 

effectiveness? 

As you noted, Mr. Chairman, this committee has seen reports of 

call centers that sell customer referrals to treatment providers. 

Some also hide the fact that they’re making referrals for a fee or 

that the call centers actually owned by the same company that 

owns the treatment center. 

We’ve also seen aggressive advertising and marketing strategies 

by treatment facilities such as websites and 1–800 numbers that do 

not clearly disclose who a patient is contacting or where they’re 

being referred. And some facilities try to lure in patients with 

promises of luxurious treatment such as daily yoga sessions and 

free housing. And I think that the experts who are here today will 

tell you that things like daily yoga sessions, while they might be 

great for a spa, are not going to cure opioid addiction. 

So how pervasive are these problems in the industry, and how 

many of these practices, like having multiple websites or purchasing calls in bulk, actually provide the treatment that helps 

people recover? 

So for today’s discussion, here is what I’m looking to hear from 

the witnesses: What are good practices when it comes to marketing 

treatment services and what are dubious practices? 

We need to hear whether there are certain quality indicators patients should look for when seeking a treatment and just as important, are there certain red flags that indicate questionable services? 

In other words, Mr. Chairman, opioid use disorder and its treatment is complicated enough for any prospective patient to navigate. 

We need to make sure that existing practices are not making it 

more difficult for people seeking treatment by obscuring what’s 

really being provided and what they need to treat their addiction. 

And so we need to find out how treatment providers find patients, educate them, and then guide them into appropriate treatment. 

I look forward to hearing from all of the witnesses about these 

issues, and I yield back. 

[The prepared statement of Ms. DeGette follows:] 

6 

PREPARED STATEMENT OF HON. DIANA DEGETTE

Thank you, Mr. Chairman. 

We have all heard the statistics about the opioid crisis: the thousands who die 

each year, and millions more who are suffering from addiction. 

But through this committee’s investigation, we have seen another side of this crisis: some nefarious or unqualified actors are taking advantage of those who are suffering, out of the desire to capitalize on their condition. 

As the Committee learned last year, some individuals known as ‘‘patient brokers’’ 

profit from recruiting patients with opioid addiction, and then send them to dubious 

treatment centers in other states. We heard that the operators of many of these centers sometimes have no training or expertise in drug treatment, and once the patients arrive, they may receive sub-standard or no care at all. 

This past December, the subcommittee heard from law enforcement officials in 

States affected by these schemes. They testified about the wide variation in the 

quality of care provided at some facilities, and how we lack consistent standards. 

Today we are examining another feature of the opioid epidemic that again shows 

some of the challenges patients with opioid use disorder currently face. And that 

is how treatment providers advertise, market, or locate prospective patients seeking 

treatment and guide them to appropriate treatment. 

In other words, are patients prioritized when it comes to finding and directing 

those seeking care for opioid use disorders? And for those patients who are the target of aggressive marketing practices, how should they evaluate a possible treatment facility for its effectiveness? 

This Committee has seen reports of call centers, for example, that sell customer 

referrals to treatment providers. Some also hide the fact that they are making referrals for a fee, or that the call center is owned by the same company that owns the 

treatment center. 

We have also seen aggressive advertising and marketing strategies by treatment 

facilities, such as websites and 1–800 numbers that do not clearly disclose who a 

patient is contacting or where they’re being referred. Some facilities also try to lure 

in patients with promises of luxurious treatment, such as daily yoga sessions and 

free housing. 

How pervasive are these problems in the industry, and how do many of these 

practices—such as having multiple websites or purchasing calls in bulk—actually 

help individuals recover? 

For today’s discussion, the witnesses need to articulate what they regard as good 

practices when it comes to marketing treatment services, and what they regard as 

dubious practices. Also, are there certain quality indicators that patients should look 

for when seeking a treatment option? As importantly, are there certain red flags 

that indicate questionable services? 

In other words, Mr. Chairman, opioid use disorder and its treatment is complicated enough for any prospective patient to navigate. We must make sure that 

existing practices are not making it harder for those seeking treatment by obscuring 

what’s really being provided and what they need to treat their addiction. 

So today we have questions regarding how treatment providers find patients, educate them, and then guide them into appropriate treatment. 

The witnesses today can articulate how they do these things before referring or 

accepting a patient. And hopefully, they will also describe how pervasive certain 

questionable tactics are regarding treatment offerings. 

Mr. Chairman, one of the themes that has emerged in our years-long examination 

of the opioid crisis is that families need much better information about the types 

of treatment available. 

This Committee has long heard from the medical experts that evidence-based 

treatment- including medication-assisted treatment-is the most effective method for 

overcoming opioid use disorder. But not all facilities provide that treatment, and 

some make vague promises about the effectiveness of the various treatment models 

they offer. 

Our witnesses today can provide a benchmark of what they regard as quality 

treatment, and how that compares to some of the questionable treatment facilities 

we have seen reports about. This is critical because if patients don’t know what to 

look for when they are seeking care, it is even easier for bad actors to take advantage of them. 

Mr. Chairman, the effects of the opioid crisis will be with us for decades. It is 

going to take a monumental effort by the medical community, public health agencies, Congress, and this Committee to climb out. That will be challenging enough. 

But in the process, we cannot let bad or ineffective actors make the problem even 

worse. 

7 

I hope this Committee can shed some light on these problems and provide the 

tools and resources for people to get the treatment they need. 

I yield back. 

Mr. HARPER. The gentlewoman yields back. 

The chair will now recognize the chairman of the full committee, 

Greg Walden for the purposes of his opening statement. 

OPENING STATEMENT OF HON. GREG WALDEN, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF OREGON 

Mr. WALDEN. Thank you very much, Mr. Chairman. I appreciate 

you holding this hearing. 

I want to thank our witnesses for being here today to inform our 

work. 

Today’s hearing follows up on our year-long bipartisan investigation to patient brokering and the fraud and abuse within the substance use disorder treatment industry. 

Beginning in April of 2014, this subcommittee commenced a comprehensive examination into the causes of the opioid epidemic, the 

impact it’s had on Americans and explored possible solutions to enable greater access to effective evidence-based treatment for substance use disorders. 

The House, as you know, recently passed H.R. 6. This is the Support For Patients and Communities Act, which includes 70 provisions, largely from this committee, that seek to address a number 

of issues within the opioid epidemic. But our work here is not done. 

The committee continues to conduct its proper oversight, because 

our Nation is far from seeing the end of the opioid epidemic and 

its tragic and deadly effects. 

In December, the subcommittee held a hearing examining the patient brokering and addiction treatment fraud where concerns were 

raised about deceptive and sometimes predatory advertising and 

marketing practices within the treatment industry. 

In addition, we’ve read news reports, spoken to treatment facilities, doctors, associations and stakeholders within the industry, but 

most importantly, we’ve heard from individuals, their loved ones, 

who have faced some of these aggressive and deceptive advertising 

practices. In fact, in my own district out in Oregon, a father named 

Mike told me about the troubling experience he had when his son 

was seeking treatment for addiction. The recovery center that his 

son went to was located in another State. And he said it seemed 

more interested in cashing the check than actually caring for his 

son. 

As the committee dove deeper into the advertising and marketing 

practices within this industry, we found a Pandora’s box of online 

advertisement, websites, phone numbers, lead generators, call centers, and television commercials. In some cases an individual or 

company may own dozens and dozens of websites, and some of 

these websites contain different 1–800 numbers, despite all being 

owned by the same person were all leading to the same treatment 

company. 

Some websites and television commercials used pretty forceful 

language, such as, ‘‘Call now, don’t wait any longer,’’ ‘‘Get the help 

you need,’’ ‘‘Talk to someone who cares,’’ ‘‘End your addiction now,’’ 

or ‘‘For immediate treatment help.’’ One individual the committee 

8 

spoke with shared that the person on the other end of the phone 

went on to say, ‘‘if you don’t get your kid here now, your kid will 

die.’’ 

Further, some of the websites and advertisements purport to 

offer the ‘‘best’’ treatment in the country or claim high success 

rates to lure patients to their facilities. This all sounds great. We 

don’t know what those statements are based upon. For example, 

does that mean someone successfully enrolled in the treatment, 

completed treatment, that they are still maintaining their sobriety 

one year later? What does success mean, and how do you measure 

it? These are the types of questions that individuals and their loved 

ones should be able to find answers for when they search their 

treatment that best meets their needs. 

These advertising practices lead to reputable and quality treatment. That’s great. That’s what we hope for. But deceptive practices can have consequences, whether it’s online advertisements, 

websites, 1–800 numbers, or television commercials, individuals 

and their loved ones should be able to expect transparency, know 

who answers the phone or responds to an inquiry when they reach 

out for help. Individuals who call treatment hotlines are often in 

times of crisis and they had need help fast and from someone that 

can be trusted. They have a right to know what facilities they’re 

calling and the type of treatment that facility offers so they can decide whether it’s the right treatment for them or their loved one. 

So today’s hearing will help bring much-needed attention to this 

issue, help us understand the scope of advertising and marketing 

practices within the treatment issue. Our hope is a thoughtful discussion will help us establish a baseline for best practices, help inform individuals or loved ones about how to seek treatment that 

best meets their needs. 

And I would yield the balance of the time to the chairman of the 

Subcommittee of Health, Dr. Burgess. 

[The prepared statement of Mr. Walden follows:] 

PREPARED STATEMENT OF HON. GREG WALDEN

Thank you, Mr. Chairman, for holding this hearing. Today’s hearing follows up 

on a year-long bipartisan investigation into patient brokering and the fraud and 

abuse within the substance use disorder treatment industry. 

Beginning in April 2014, this subcommittee commenced a comprehensive examination into the causes of the opioid epidemic, the impact it’s had on Americans, and 

explored possible solutions to enable greater access to effective, evidence-based 

treatment for substance use disorders. 

The House recently passed H.R. 6, the SUPPORT for Patients and Communities 

Act, which includes 70 provisions—largely from this committee—that seek to address a number of issues within the opioid crisis. But our work here is not done 

and the committee continues to conduct oversight because our country is far from 

seeing the end of the opioid epidemic and its tragic effects. 

In December, this subcommittee held a hearing examining patient brokering and 

addiction treatment fraud where concerns were raised about deceptive and sometimes predatory advertising and marketing practices within the treatment industry. 

In addition, we’ve read news reports, spoken to treatment facilities, doctors, associations, and stakeholders within the industry, but most importantly, we’ve heard 

from individuals and their loved ones who have faced some of these aggressive and 

deceptive advertising practices. In my district in Oregon, a father named Mike told 

me about the troubling experience he had when his son was seeking treatment for 

addiction. The recovery center was located in another stated and seemed more interested in cashing a check rather than caring for his son. 

9 

As the committee dove deeper into the advertising and marketing practices within 

this industry we found a Pandora’s box of online advertisements, websites, phone 

numbers, lead generators, call centers, and television commercials. In some cases, 

an individual or company may own dozens and dozens of websites, and some of 

these websites contain different 1–800 numbers, despite all being owned by the 

same person or all leading to the same treatment company. 

Some websites and television commercials use forceful language, such as: ‘‘Call 

now,’’ ‘‘don’t wait any longer,’’ ‘‘get the help you need,’’ ‘‘talk to someone who cares,’’ 

‘‘end your addiction now,’’ or ‘‘for immediate treatment help.’’ One individual the 

committee spoke with shared that the person on the other end of the phone went 

as far to say, ‘‘if you don’t get your kid here now, your kid will die.’’ 

Further, some of the websites and advertisements purport to offer the ‘‘best’’ 

treatment in the country or claim high success rates to lure patients to their facilities. This all sounds great, but we don’t know what those statements are based on. 

For example, does that mean someone successfully enrolled in treatment, completed 

treatment, that they are still maintaining their sobriety one year later? What does 

success mean and how do you measure it? These are the types of questions that individuals and their loved ones should be able to find answers for when they search 

for treatment that best meets their needs. 

If these advertising practices lead to reputable and quality treatment, that’s 

great. But, these deceptive practices can have consequences. Whether it’s online advertisements, websites, 1–800 numbers, or television commercials—individuals and 

their loved ones should be able to expect transparency and know who answers the 

phone or responds to an inquiry when they reach out for help. Individuals who call 

treatment hotlines are often in a time of crisis and they need help fast and from 

someone they can trust. They have a right to know what facility they are calling 

and the type of treatment that facility offers so they can decide whether it is the 

right treatment for them or their loved one. 

Today’s hearing will help bring much needed attention to this issue and help us 

understand the scope of advertising and marketing practices within the treatment 

industry. Our hope is that a thoughtful discussion will help us establish a baseline 

for best practices and help inform individuals and their loved ones about how to 

seek treatment that best meets their needs. 

I welcome our witnesses and look forward to their testimony. 

Mr. BURGESS. I thank the chairman for yielding. And the chairman makes an important point. H.R. 6 did pass through this committee and, indeed, on the floor of the House. And we do call on 

the Senate, the other body, to take that up. 

This is not the first hearing we’ve had on this subject. Last December, we did have a hearing, and we heard from the assistant 

attorney general from the Massachusetts attorney general’s office, 

Eric Gold, was his name. And he provided for us three recommendations on the evaluation and solution for the problems that 

are existing at sober homes. 

He said we need additional resources for Federal, State and local 

law enforcement. OK, that’s covered in H.R. 6. Second, patients 

need transparency into the quality of addiction treatment of the 

providers nationwide. I agree with that. I’m not sure we’re there. 

And the third thing: We need to ensure that patients with substance use disorder have access to the treatment they need and we 

do not unintentionally limit access. And that is an important point 

as well. 

Additionally, we heard from a panel of family members who had 

been affected by family members who had problems with opioid addiction. And one of the statements of one of the witnesses really 

stands out. 

She said, ‘‘the intent, of course, was not to kill Jaime, but to keep 

him in the system and continue to abuse his insurance.’’ 

10 

Those are pretty apocryphal words, and I hope we get to explore 

some more of that. Mr. Chairman, thank you for the indulgence, 

and I yield back Mr. Walden’s time. 

Mr. HARPER. The gentleman yields back. The chair will now recognize the ranking member of the full committee, Mr. Pallone, for 

5 minutes. 

OPENING STATEMENT OF HON. FRANK PALLONE, JR., A REPRESENTATIVE IN CONGRESS FROM THE STATE OF NEW JERSEY 

Mr. PALLONE. Thank you, Mr. Chairman. 

The opioid epidemic continues to devastate families and communities around the Nation. We still have a long way to go to climb 

out of this crisis. Opiates killed more than 115 Americans a day in 

2016, and millions more continue to suffer. That’s bad enough, but 

to see people taking advantage of this crisis by preying on victims 

to make money is unconscionable. 

The Affordable Care Act expanded access to substance abuse 

treatment for millions of Americans. It also required insurance 

companies to cover this treatment just as they would cover any 

other chronic disease. Thanks to the ACA and Medicaid expansion, 

Americans who could not get access to this treatment before, now 

can. Unfortunately, people with substance use disorder still face 

barriers to accessing treatment. According to SAMHSA, of the 19 

million adults who had a substance use disorder in 2016, 17 million 

did not receive treatment. 

We need to do everything we can to help more Americans access 

this treatment. Unfortunately, there are companies preying on individuals in desperate need of treatment services. Some of the companies this committee has been examining claim they are merely 

filling a market need, but anyone advertising treatment services 

must put the needs of the patient first, and they must employ well 

qualified staff that can provide quality treat or ensure that they 

are only referring patients to quality treatment providers. 

This committee’s investigation into patient brokering revealed 

shocking examples of companies that claim to offer treatment and 

special perks to individuals suffering from opioid addiction. Families that were desperate to help their loved ones put their trust and 

hope in many of these treatment facilities. But as our investigation 

has found, many of those entities are a scam, and do not offer actual treatment. In some instances, these facilities are actually putting people’s lives at risk. 

Now the Committee has broadened its focus to look at treatment call centers and 

marketing tactics. And unfortunately, we’ve discovered that some companies have 

looked at this devastating epidemic as an opportunity solely to make money. 

For instance, reports indicate that some of these call centers or 

‘‘call aggregators’’ advertise opioid treatment to get people to call 

looking for help, and then sell those calls to various facilities. And 

it is unclear how this helps the patient. 

Other companies actually appear to offer treatment for opioid use 

disorder, but they also engage in aggressive marketing tactics. For 

example, some facilities operate multiple websites with different 

names and phone numbers, with the goal of maximizing the number of beds filled. 

11 

And this raises questions about how transparent these companies are about the services they offer and how they help patients 

find the treatment that’s right for them. It also raises questions 

about how a prospective patient is supposed to navigate the countless number of treatment offerings and find quality care against 

the backdrop of the array of services being advertised. 

So I’m hopeful our witnesses can shed some light on the types 

of marketing and treatment practices that are best designed to put 

the patient first and help them find quality care. 

And unless someone else wants my time, I yield back, Mr. Chairman. 

[The prepared statement of Mr. Pallone follows:] 

PREPARED STATEMENT OF HON. FRANK PALLONE, JR. 

The opioid epidemic continues to devastate families and communities around the 

nation. We still have a long way to go to climb out of this crisis. Opioids killed more 

than 115 Americans a day in 2016, and millions more continue to suffer. That is 

bad enough—but to see people taking advantage of this crisis by preying on victims 

to make money is unconscionable. 

The Affordable Care Act expanded access to substance abuse treatment for millions of Americans, and it also required insurance companies to cover this treatment 

just as they would cover any other chronic disease. Thanks to the ACA and Medicaid Expansion, Americans who could not get access to this treatment before now 

can. Unfortunately, people with substance use disorder still face barriers to accessing treatment. According to SAMHSA, of the 19 million adults who had a substance 

use disorder in 2016, 17 million did not receive treatment. 

We need to do everything we can to help more Americans access this treatment. 

Unfortunately, there are companies preying on individuals in desperate need of 

treatment services. Some of the companies this Committee has been examining 

claim they are merely filling a market need. But anyone advertising treatment services must put the needs of the patient first, and they must employ well-qualified 

staff that can provide quality treatment or ensure that they are only referring patients to quality treatment providers. 

This Committee’s investigation into patient brokering revealed shocking examples 

of companies that claimed to offer treatment and special perks to individuals suffering from opioid addiction. Families that were desperate to help their loved ones 

put their trust and hope in many of these treatment facilities. But as our investigation has found, many of those entities are a scam and do not offer actual treatment. 

In some instances, these facilities are actually putting people’s lives at risk. 

Now the Committee has broadened its focus to look at treatment call centers and 

marketing tactics. And unfortunately, we’ve discovered that some companies have 

looked at this devastating epidemic as an opportunity solely to make money. 

For instance, reports indicate that some of these call centers or ‘‘call aggregators’’ 

advertise opioid treatment to get people to call looking for help, and then sell those 

calls to various facilities. It is unclear how this helps the patient. 

Other companies actually appear to offer treatment for opioid use disorder, but 

they also engage in aggressive marketing tactics. For example, some facilities operate multiple websites with different names and phone numbers, with the goal of 

maximizing the number of beds filled. 

This raises questions about how transparent these companies are about the services they offer, and how they help patients find the treatment that’s right for them. 

It also raises questions about how a prospective patient is supposed to navigate the 

countless number of treatment offerings and find quality care against the backdrop 

of the array of services being advertised. 

I am hopeful our witnesses can shed some light on the types of marketing and 

treatment practices that are best designed to put the patient first and help them 

find quality care. 

For example, Dr. Kenneth Stoller from the Johns Hopkins Hospital Broadway 

Center for Addiction can tell us about how they conduct outreach to individuals who 

may be in need of substance use disorder services and enroll patients seeking care. 

He can also tell us about how treatment providers should clinically assess the needs 

of each patient to determine the best course of treatment, and the role of medication-assisted treatment (or MAT) for opioid addiction. 

12 

I also look forward to hearing from some of the other treatment providers on their 

marketing and treatment practices to understand if they are designed to always put 

the patient first and guide them to the care most appropriate for their condition. 

This is important considering that not all families seeking help have access to objective information or even know what to look for in evaluating treatment options. 

And this problem is especially complicated when families stumble upon misleading or confusing websites, designed not to educate people about the best forms 

of treatment available. So we need to hear from the panel about what they regard 

as quality care, and what a family in crisis should look for in a treatment program 

as they struggle to find help with their addiction. 

I support efforts that get more people into quality treatment. Marketing and advertising can be important tools in educating people about the different treatment 

options available to meet their needs, but if these companies want to be in the treatment business, they simply must put the patient first. And this Committee must 

continue to work to ensure that any American suffering from this terrible disorder 

gets the treatment they need. 

Thank you, I yield back. 

Mr. HARPER. The gentleman yields back. 

I ask unanimous consent that the members’ written opening 

statements be made a part of the record. 

Without objection, so ordered. 

Additionally, I ask unanimous consent that Energy and Commerce members not on the subcommittee on Oversight and Investigations be permitted to participate in today’s hearing. 

Without objection, so ordered. 

I would now like to introduce our witnesses for today’s hearing. 

Today, we have Dr.Marvin Ventrell, who is the Executive Director of the National Association of Addiction Treatment Providers. 

Next, is Mr. Mark Mishek, President and CEO of the Hazelden 

Betty Ford Foundation. Third, is Mr. Michael Cartwright, who is 

the Chairman and CEO of American Addiction Centers. Mr. Robert 

Niznik, who is the CEO of Addiction Recovery Now and Niznik 

Behavorial Health. Then we have Mr. Jason Brian, Founder of 

Redwood Recovery Solutions and TreatmentCalls.com. And finally, 

Dr.Kenneth Stoller, who serves as the Director of John Hopkins 

Hospital Broadway Center For Addiction. 

We welcome each of you here. 

You are all aware that the Committee is holding an investigative 

hearing. And when doing so, we have had the practice of taking 

testimony under oath. 

Do any of you have any objection to testifying under oath? 

Every witness has replied no. 

The chairman then advises you that under the rules of the House 

and the rules of the committee, you are entitled to be accompanied 

by counsel. 

Do you desire to be accompanied by counsel during your testimony today? 

Let the record reflect that all the witnesses have replied no. 

In that case, if you would please rise and raise your right hand, 

I will swear you in. 

[Witnesses Sworn.] 

You may be seated. 

All the witnesses responded affirmatively. And you are now 

under oath and subject to the penalties set forth in Title 18 Section 

1001 of United States Code. And you may now give a 5-minute 

summary of your written statement. 

13 

There should be a light system that will tell you when that time 

is come, so you’ll have 5 minutes. It should go yellow at 1 minute, 

at red when your time is up. 

And I will now start with Mr. Ventrell. You may begin. Make 

sure your mic is up close and you turn your button on when you 

testify. 

TESTIMONY OF MARVIN VENTRELL, EXECUTIVE DIRECTOR, 

NATIONAL ASSOCIATION OF ADDICTION TREATMENT PROVIDERS; MARK MISHEK, PRESIDENT AND CEO, HAZELDEN 

BETTY FORD FOUNDATION; MICHAEL CARTWRIGHT, CHAIRMAN AND CEO, AMERICAN ADDICTION CENTERS; ROBERT 

NIZNIK, CEO, ADDICTION RECOVERY NOW AND NIZNIK BEHAVIORAL HEALTH; JASON BRIAN, FOUNDER, REDWOOD RECOVERY SOLUTIONS AND TREATMENTCALLS.COM; AND DR. 

KENNETH STOLLER, DIRECTOR, JOHNS HOPKINS HOSPITAL 

BROADWAY CENTER FOR ADDICTION 

TESTIMONY OF MARVIN VENTRELL 

Mr. VENTRELL. Thank you, Chairman Harper. Thank you, Ranking Member DeGette. I also recognize the comments of Ranking 

Member Pallone and the comments made by the committee at large 

chair, Mr. Walden. 

Thank you for the opportunity to be here today to present this 

testimony. I represent the National Association of Addiction Treatment Providers. I am the Executive Director of the National Association, also known from time to time as NAATP. Our folks will say 

NAATP. That all refers to us. 

It is an honor to be here. I’m excited to give this testimony because our association is fully supportive of the work of this subcommittee. This has in fact been the focus of the National Association for the past several years. 

We are horrified by the behaviors that have occurred in this 

field. They are not us. It is not unusual for a trade association such 

as ours to perhaps object or resist certain regulation. We do not do 

so in this instance. In fact, we have been at the forefront of asking 

for this sort of regulation for some time. That is why, among other 

things, we developed our new code of ethics and are in the process 

of writing a resource guidebook for the ethical and proper operation 

of addiction treatment centers. 

So thank you again for this opportunity. We wholeheartedly support what you are doing. We want to be part of that. We want to 

provide as much information as we possibly can for you. And I look 

forward to giving this testimony today and answering your questions. 

Ranking Member DeGette specifically asked in her opening comments for recommendations for choosing treatment centers and for 

red flags in understanding what is not an appropriate center. We 

have worked diligently on these very things. Much of that resource 

is attached to my written testimony as a supplement, and it should 

be ultimately in the record. And I look forward, again, to articulating any of those principles. 

Our association is grateful for this opportunity. On behalf of our 

members and the thousands of patients that they serve, and we 

14 

support this committee’s efforts to clean up the practices that are 

harming us all. 

This matter, ethical operation, professional operation, and legal 

operation of addiction treatment is at the forefront of our work. 

What has happened in our industry is among the greatest threats 

to the success of our work as an addiction treatment field that we 

have ever seen. 

Historically, the practice of addiction treatment has been 

marginalized. It has been stigmatized. And we have functioned on 

the outskirts of healthcare. We are poised to make a change in this 

regard now. We are poised with all of the developments that have 

occurred in terms of science, social science, and opportunity for 

funding and treatment. We are poised to do the best work we have 

ever been able to do. That is what we wish to do, and we are being 

delayed, and we are being impeded from that by bad actors. 

These bad actors that are the source of comments that the committee made are a minority. They are a small minority, but they 

are an effective and very damaging minority. They are not our 

members. I wish to say that they are not we. 

The National Association of Addiction Treatment Providers is 

comprised of approximately 850 treatment campuses around the 

country. These are good centers doing good work. The source of the 

problem is not the national association. It is not common, as I indicated, for a trade association to resist regulation. Once again, we 

do not, in fact, we are promulgating much of that within our practices now. 

The primary issues have been accurately identified. I applaud 

the subcommittee’s staff memorandum. It is accurate, and I adopt 

all of it. The problems we are facing are primarily these. 

Patient brokering, billing and insurance abuses, credential misrepresentation, predatory web practices and foremost, in predatory 

web practices is the matter of deceptive, unbranded or inadequately branded websites. 

While a trade association is not typically in the business of policing, we have undertaken that role as it concerns our members, and 

we have adopted an initiative called of the quality assurance initiative, which has 11 components. 

I would like to explain all of them to you. Of course, I don’t have 

time do that, but hopefully, you will ask me questions about those. 

In each of these 11 initiatives, many of which are focused specifically on deceptive advertising matters are addressed in the quality 

assurance initiative which will be fully articulated in the guidebook 

that will be published later this year. 

I see that my time is up, and I thank you for the opportunity. 

[The prepared statement of Mr. Ventrell follows:] 

15 


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NATIONAL ASSOCIATION 

ADOlCTlON TREATMENT PROVIDERS 

Written Testimony of Marvin Ventrell 

Executive Director 

National Association of Addiction Treatment Providers (NAATP) 

Submitted: July 22, 2018 

Supplemental Material: 1. NAA TP Code of Ethics 

2. NAA TP Article: Time to Raise the Floor 

3· NAA TP Guide to Locating Addiction Treatment 

Congress of the United States 

Committee on Energy and Commerce 

Subcommittee on Oversight and Investigations 

Hearing: 

"Examining Advertising and Marketing Practices 

within the Substance Use Treatment Industry" 

Thank you for the opportunity to provide testimony regarding this critically important matter. I 

serve as Executive Director of the National Association of Addiction Treatment Providers (NAATP). In 

this capacity, I am charged with directing the NAATP mission to provide leadership, advocacy, training, 

and member support services to ensure the availability and highest quality of addiction treatment. 

NAATP, founded in 1978, is a not-for-profit professional membership association of addiction 

treatment providers. NAATP functions as a trade association for addiction treatment providers. NAATP 

is comprised of approximately 850 member-facilities that provide varying addiction treatment services 

along the continuum of care. The core membership of NAATP is the residential addiction treatment 

center that provides comprehensive integrated addiction treatment. 

Substance Use Disorder (SUD), also known as addiction, alcoholism, drug addiction, or 

chemical dependency, is a serious health care condition that effects in excess of 20 million Americans 

(SAMHSA). SUD is a chronic brain disease with biological, psychological, social, and spiritual 
16 


35759.002

manifestations. While chronic and potentially fatal, SUD is treatable. If provided with proper care, 

patients can recover to lead healthy, happy, productive and useful lives. In excess of an additional2o 

Million Americans identify themselves as such persons in long-term recovery from addiction 

(SAMHSA). Addiction treatment, when provided along a comprehensive continuum of care that 

addresses all of the above referenced disease manifestations (bio-psycho-social-spiritual), also known 

as integrated care, is effective. Problematically, SUD treatment delivery is hampered by several factors 

that result in the lack of service to the majority of patients suffering. We estimate that only 

approximately lO% of those suffering from the disease get the care they need (SAMHSA). Disease 

stigmatization, unavailability of services, and a serious lack of payment resources (including no health 

care coverage and difficulty accessing existing insurance payments) are at the root of the problem. 

In recent years, excellent progress has been made toward narrowing this treatment gap 

through professional and societal acceptance of addiction as a disease, parity law, and more recently 

bipartisan congressional funding of addiction services through legislation (CURES Act and increased 

appropriations). As an industry, we have become increasingly better positioned to treat this disease. 

However, the problem became more complicated over the past decade with the advent of the 

Opioid Epidemic, wherein it is estimated 2 million individuals suffer from dangerous opioid addiction 

(ASAM) and as many as us individuals die from opioid overdoses each day (CDC). While alcohol 

(Alcohol Use Disorder or AUD) continues to be the substance within SUD that causes the most harm 

(84%), opioid addiction impacts approximately g% of the SUD population (SAMHSA) and has the 

capacity to kill faster than alcohol and other SUD substances. 

It is at this stage of our work that the specific subject matter of this hearing entered the picture. 

Whereas many competent and ethical treatment providers have been delivering addiction care since as 

early as the l940S (Alcoholics Anonymous was founded in l939), a new population of addiction 

treatment providers (and some longer-standing providers) entered the addiction service business 

2 
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35759.003

market and began marketing their services in an unprofessional, unethical, and sometimes illegal 

fashion. Addiction treatment began to be perceived as a highly profitable industry. Whereas consumers 

in the American business market may vary in vulnerability to marketing tactics, the population seeking 

treatment is particularly and highly vulnerable to manipulation because the disease of addiction is 

misunderstood and the patient and family seeking help are in serious and desperate distress. 

From the perspective of the National Association of Addiction Treatment Providers, the 

harmful actions took the following forms: 

1. Patient Broke ring 

2. Billing and Insurance Abuses 

3· License and Credential Misrepresentation 

4. Predatory and Deceptive Web Practices 

a. Unbranded Marketing Pages 

b. Web and Call Directory Deception 

c. Consumer Identity Aggregation 

d. Google Platform Deception 

AdWords 

iL Maps 

ii. Search Engine Optimization (SEO) 

Over the past several years NAATP became increasingly aware of these advertising and 

marketing tactics as they became more and more prevalent. The behavior caused serious harm to the 

consumer patient, the patient's family, insurer, and the addiction treatment industry at large. While we 

believed and continue to believe that these harmful practices are limited to a minority of providers 

generally and an even smaller minority within our own association membership, the harm caused was 

and is too great for us, as the industry trade association, to not act. It is important to note that the 

3 
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35759.004

action we have taken is extraordinary in the typical operation of a trade association. Like many trade 

associations, NAATP is a voluntary membership society wherein members, in our case treatment 

programs, come togetherfor education, training, resources, convening, networking, and collegiality. 

We are not a licensing, accrediting/certifying, or policing body. We have no authority to control 

addiction providers' business or clinical practices beyond our membership conditions. We believe, 

however, that by setting high values-based professional and ethical membership standards, we can 

achieve and maintain an association that is comprised of treatment providers on which the public and 

payer/insurer can safely rely. We also believe that we can, by these actions, lead the entire field by 

example and influence best practices across the industry through public policy. 

Therefore, in the summer of 20l?, NAATP adopted its Quality Assurance Initiative (The QAI) designed 

to: 

Promote best business practice 

Deter problematic business practice 

Inform law and policy makers 

Protect and assist the consumer 

Train the provider 

The QAI is comprised of the following 11 Programs: 

NAATP Code of Ethics (Ethics 2.0) 

Ethics Code Enforcement Provider Conduct Review Process 

Adoption of Accreditation as an NAATP Provider Requirement 

• Addiction Industry Directory (The AID) 

Quality Assurance Guidebook 

Google LegitScript Advertising Advisement 

Outcomes Measurement Toolkit 

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Insurance Industry Collaboration 

Cross Agency Collaboration 

Annual National Conference Training Program 

NAATP Provider Webinar Series 

The subject matter and time limits of this hearing do not allow for an expansive description of 

each of these programs. NAATP will be pleased to provide this Committee with comprehensive 

information as to all programs upon request. The following testimony will be focused on the first six of 

the foregoing programs: 

NAATP Code of Ethics (Ethics 2.0) 

The foundation of the NAATP QAI is the NAATP Ethics Code (Ethics 2.0) provided herein as 

supplemental material. It was adopted by the association in December 2017 and became effective 

January 1, 2018. It was preceded by our code that, while similar in terms of philosophy and intent, did 

not adequately articulate the prohibited conduct that became problematic. Ethics 2.0 was 

implemented so that our members knew the rules and knew they were required to follow them as a 

condition of membership. Our membership embraced this move. Ethics 2.0 is comprised of these parts: 

Preamble I Philosophy 1 Adherence Required 

1. Treatment Ethics 

2. Management Ethics 

3· Facilities Ethics 

4· Marketing Ethics 

a. Financial Rewards 

b. Deceptive Advertising I Marketing 

c. Client Identities 

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35759.006

Each of the harmful practices described in this testimony is articulated and specifically 

prohibited by the Code (Patient Broke ring, Billing and Insurance Abuses, License and Credential 

Misrepresentation, Predatory and Deceptive Web Practices). Most applicable to the subject matter of 

this hearing is Marketing Ethics. Within the provisions of Section IV, parts A, 8, and C, the code 

describes and specifically prohibits the deceptive, misleading, and non-transparent marketing of 

treatment services. 

Ethics Code Enforcement Provider Conduct Review Process 

Prior to launching Ethics Code 2.0, NAATP worked with legal counsel to develop a 

comprehensive process whereby addiction treatment provider members of NAATP who are suspected 

of ethics code violations would be reviewed for code compliance. Fellow members, non-member 

providers, and the public may file a complaint against an NAATP member based on ethics code 

violations. Thereafter, the alleged conduct is reviewed by NAATP and notice and opportunity to 

respond is given to the provider. If a violation is found to exist, the NAATP member may incur the 

following penalties: notice and opportunity to cure the violation or expulsion from membership. Our 

goal is to encourage compliance rather than punish. As part of code enforcement, NAATP also began, 

as of January~, 20~8, a process whereby members' code compliance can be internally assessed when 

the member's annual membership is expiring. This process allows NAATP to determine whether the 

member that is expiring should be invited back based on code compliance. 

Since implementation of the code and process, NAA TP has removed from our member roles 99 

addiction treatment campus locations operated by 24 parent companies. This has resulted in the 

forfeiture of $n~,~so in dues revenue. This has significant negative economic impact for our 

association. Nonetheless we believe the action must be taken and continue to be taken in order to 

serve the objectives of the OAI and ensure our association integrity. Our objective is to distinguish the 

NAATP member as a reliable ethical treatment provider. We believe that we diminish our own value 

6 
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35759.007

and do a disservice to the good provider by associating with providers who do not function as 

professional, values-based ethical programs. The primary reasons for removal of these members from 

our roles are unbranded websites and the buying or selling of leads. Members were also deleted based 

on licensing misrepresentation and billing abuses. 

Adoption of Accreditation as an NAATP Provider Requirement 

At the 2018 Annual Meeting of the NAATP Board of Directors in May of 2Dl8, our leadership voted to 

adopt a new membership requirement whereby an addiction treatment provider must obtain 

accreditation as an addiction treatment provider to qualify for membership. This month, July 2018, the 

NAATP membership at large approved this measure, effective January 1, 2019. The measure is 

consistent with our OAI objective to ensure competence and reliability of NAATP members. While 

accreditation alone is not dispositive of high quality care, it is strong indicia of such. Addiction 

treatment accreditors, primarily CARF and The Joint Commission, typically work to ensure patient 

treatment quality and safety. Combined with the NAATP OAI efforts to ensure ethical business 

practice, we all take a significant step forward toward protecting the consumer and improving care. 

Addiction Industry Directory (The AID) 

Consumers, payers, and treatment professionals must have a reliable source to locate addiction 

treatment. For-profit call centers, treatment center operated directories, and similar web directories do 

not reliably fulfill this function and frequently mislead the consumer. The NAATP Addiction Industry 

Director is a comprehensive and transparent listing of all members without rank or recommendation, 

just data on service, location, staffing, programs, and credentials. Combined with the NAATP Guide to 

Selecting Addiction Treatment, the AID serves the OAI objectives and helps protect the consumer as 

well. 

Quality Assurance Guidebook 
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The Quality Assurance Guidebook is a major effort that will result in the publication this year of a 

comprehensive resource for addiction treatment provider operations. It will serve as a kind of rule book 

for the field. No such resource currently exists. The Guidebook will detail the competencies for 

operations in the following form: Guideline, Commentary, and Implementation Resource. The list of 

Guidelines is as follows: 

A. Operations 

Guideline A-1: Treatment Philosophy 

Guideline A-2: Licensing 

Guideline A-3: Accreditation 

Guideline A-4: Governance 

Guideline A-s: Policies and Procedures 

Guideline A-6: Strategic Planning 

Guideline A-7: Leadership Practices 

Guideline A-8: Facilities 

Guideline A-9: Management 

B. Admissions I Patient Screening 

Guideline B-1: Admission Process 

Guideline B-2: Screening I Assessment 

C. Training and Credentialing 

Guideline C-1: Staff Training 

Guideline C-2: Professional Staff Credentials 

D. Billing 

Guideline D-1: Calculating Cost of Service 

Guideline D-2: Usual and Customary Rates 

Guideline D-3: Balance Billing and Receiving 

Guideline D-4: Toxicology 

E. Discharge & Continuing Care 

Guideline E-1: Continuum of Care 

Guideline E-2: Discharge Planning 

Guideline E-3: Atypical Discharges 

F. Outcomes Measures 

Guideline F-1: Tracking Patient Outcomes 

G. Community Engagement, Public Relations, and Public Policy 

Guideline G-1: Participation in the Community 

Guideline G-2: Public Relations Strategy 

Guideline G-3: Public Policy Position 

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H. Marketing, Advertising, and Visibility 

Guideline H·~: Transparency 

Guideline H-2: Treatment 

Guideline H·J: Management 

Guideline H-4: Facilities 

Guideline H·s: Marketing 

a. Policy 

b. Finance 

c. Deception 

d. Client Identities 

Google LegitScript Advertising Advisement 

The internet serves as the primary source for consumer location of addiction treatment. This is 

not the case for most health care and NAATP encourages consumers to approach addiction treatment 

search as one would any other health care matter. Consumers should seek professional referral and 

speak to one's medical and mental health provider for example. 

Nonetheless, the internet is used in this fashion and has been manipulated by unscrupulous 

providers to deceive consumers. The majority of internet searches are performed on the Google 

platform. Deceptive practices on Google by unscrupulous providers include AdWords misuse, search 

engine optimization (SEQ) misuse and dominance, and Google Map deception. While Google was, at 

one time, unresponsive to our requests to control this behavior, they became responsive in 2017 and 

took the significant are largely unprecedented step of suspending the purchase of AdWords associated 

with addiction treatment. NAATP and industry colleagues met with Google staff in the fall of 2017 to 

begin a dialogue on the matter. Since that time, NAATP has become an advisor and advisory board 

member to Google and the company LegitScript. LegitScript is the entity that now reviews a treatment 

provider's qualifications to purchase AdWords. Without the LegitScript authorization based on 

treatment operation criteria, Google will not approve the entity for AdWords purchase. This month, 

LegitScript approved the first batch of 31 authorized providers through a beta process. Going forward, 

LegitScript will approve providers on a rolling basis. 

9 
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In addition to the Ad Words issue, NAATP is scheduled to meet later this year with Google staff 

to discuss a regulatory process for managing the concerns regarding SEO and Maps. 

~0 
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Summary of Key Testimony Points 

l.. The Role of the National Association of Addiction Treatment Providers (NAATP). As the long-standing addiction 

mdustry trade association, NAATP provides resources, education, and training to the professional community and sets a 

standard of reliable, high-quality, eth1ca! addiction treatment program operation. NAATP also provides guidance to the 

consumer, insurer, and pol1cy maker. 

2. The Context of Addiction Treatment in the United States. Addiction is a chronic brain disease with biological, 

psychological, social, and spintual components effecting over 20 million Americans. While treatable1 most individuals 

suffering do not get adequate care. Significant progress has been made in terms of treatment knowledge and service 

delivery, but the problem became exacerbated by the Opioid Crisis and bad actors coming into the work who are more 

focused on prof1t than good care. 

3· The Problem of the Unscrupulous Provider. The unscrupulous provider harms the highly vulnerable consumer and 

the entire treatment system through unprofessional, unethical, and even illegal practices. Harmful actions Include patient 

brokering1 billing abuses, license and credential misrepresentation, and predatory and deceptive web practices. The web 

practices fall primarily 1n the areas of unbranded web pages, web and call directory deception, consumer identity 

aggregation, and Google platform deception. 

4· The NAATP Quality Assurance Initiative (QAJ) Response. The Quality Assurance Initiative (OAI) responds to the 

problem through a series of measures that promote best business practice, deter problematic business practice, inform law 

and policy makers, protect and assist the consumer, and train the provider. NAATP Ethics Code 2.0 is the foundation of the 

program. Enforcement of Eth1cs 2.0 NAATP has resulted m NAAP removing 99 add1ction treatment campus locations 

resulting, in the forfeiture of $111.11.50 in association dues revenue. The OAt components that address the concerns of this 

committee hearing are: NAATP Code of Ethics (Ethics 2.o), Ethics Code Enforcement Provider Conduct Review, Adoption of 

Accreditation as an NAATP Provider Requirement, Addiction Industry Directory (The Al0) 1 Quality Assurance Guidebook, 

and the Goog!e LegitScript Advertising program. 
26 

Mr. HARPER. Thank you, Mr. Ventrell. 

The chair will now recognize Mr. Mishek for 5 minutes for the 

purposes of his opening statement. 

TESTIMONY OF MARK MISHEK 

Mr. MISHEK. Thank you, Chairman Harper, Ranking Member 

DeGette, and members of the subcommittee for inviting me. It is 

an honor. 

I am grateful for your leadership in addressing the opioid crisis 

and addiction, and for the opportunity to testify today about business practices and quality standards in the addiction treatment industry. 

My name is Mark Mishek, and I am the President and CEO of 

the Hazelden Betty Ford Foundation, a non-profit addiction treatment provider with 17 sites in 9 States. We treat over 21,000 people annually and are also engaged in prevention, education, publishing, research and advocacy related to the disease of addiction. 

On behalf of the millions of vulnerable people and families suffering from substance use disorders, thank you again, for your bipartisan look into patient brokering and related issues. 

Growing market demand for addiction treatment, driven by the 

opioid crisis and expanded insurance coverage has attracted unprecedented investment and an influx of new providers all operating in a field that is under-regulated and lacks consistent quality 

standards. It is in this environment that our industry has seen the 

rise of unprofessional, unethical, and sometimes illegal practices 

such as deceptive marketing and patient brokering—not to mention 

excessive consumer billing and insurance fraud. In too many cases, 

people who need help are instead being harmed. 

Most in our field do great work. But to ensure ethical, quality 

care for all who seek help for addiction, we believe it is time to establish quality standards and a consistent, enforceable regulatory 

framework for the addiction treatment industry. The stakes—patient safety and public confidence in addiction treatment—are high. 

Now, patient referrals, of course, are not bad, per se. The problem is when referrals are made with little or no regard to what is 

clinically appropriate for the patient when there is a lack of transparency in the process and especially when financial kickbacks are 

involved. That’s when referrals become patient brokering. Many 

brokering schemes begin with deceptive marketing. 

Now, at Hazelden Betty Ford, all of our treatment marketing 

leads to one website, one consumer website, 

HazeldenBettyFord.org. That is not the case for others who use 

multiple sites and multiple brands to acquire patients. 

Often, it is not clear who is behind ads for addiction treatment 

or who consumers will get when they reach out for help. Some providers obscure their affiliations to other organizations or misrepresent the services they provide, the conditions they treat, the credentials of their staff, or the insurance that they actually accept. 

And some use online bait-and-switch techniques to get calls from 

people intending to call a different treatment center. Something, 

unfortunately, we see frequently with our name. 

All of this can lead to bad treatment for consumers. The lack of 

transparency on top of minimal quality standards in the industry 

27 

puts patients at risk. These kinds of practices certainly would not 

be tolerated in any other area of healthcare. And in light of them 

and because of the life saving work that we do, it is more imperative than ever for the addiction treatment field to hold itself to the 

highest ethical, legal, and quality standards. 

Ultimately, we think reforms are needed to bolster State licensure requirements, accreditation standards, clinician education 

qualifications and access to comprehensive evidence-based care. 

Beyond State initiatives, Federal oversight through the Federal 

Trade Commission, for example, is essential. Fraudulent advertising and patient brokering obviously cross State lines. Finally, we 

think a Federal law explicitly outlawing patient brokering is critical. 

Without such accountability, our field will continue to evolve into 

a sector where success is predicated not on whether patients get 

well or families heal, but on the size of your advertising budget, 

your website analytics, your search engine optimization, and your 

call center tactics. 

Now is the time to restore faith and accountability in the addiction treatment field, and it’s time to establish quality standards in 

that enforceable regulatory framework. 

Thank you for the opportunity to share my testimony. And I look 

forward to answering your questions. 

[The prepared statement of Mr. Mishek follows:] 

28 


35759.012

Testimony of Mark Mishek, President and CEO, Hazelden Betty Ford Foundation 

Before the House Energy & Commerce Committee 

Subcommittee on Oversight and Investigations 

Jnly 24, 2018 

Summary: Chairman I larper, Ranking Member DeGette, and Members of the Committee, thank you for 

inviting me to participate in this important hearing. I am grateful for your leadership in addressing the 

nation's opioid overdose epidemic and the addiction crisis that underlies it. l appreciate the opportunity to 

testify today about advertising and marketing practices in the addiction treatment industry and to 

contribute to the subcon1mittcc's bipartisan investigation into patient brokctlng. 

My name is Mark J\Jishek, and I am the President and CEO of the Hazelden Betty Ford Foundation. Our 

nonprofit organization proYides addiction treatment as well as education, prevention and recovery 

services. \\?c were founded in 1949 in Minnesota, where we remain headquartered. We now have 17 sites 

in nine states, including the Betty Ford Center, founded in 1982 by the former first Lady. At our clinical 

sites, we treat more than 20,000 people annually. Our nonprofit also includes an accredited graduate 

school of addiction studies; a publishing house; a research center; an education ann for tnedical 

professionals; a program for young children affected by addiction in the family; and an advocacy function 

focused on public education, policy and stigma reduction. 

On behalf of the millions of ''ulnerable people and families suffering from substance usc disorder, thank 

you again for your interest in this devastating public health issue. 

Growing market demand for addiction treatmcnt--driYcn by the opioid crisis and expanded insurance 

coverage-has attracted unprecedented private investment: and an influx of new pro,·iders, all operating in 

a field that is under-regulated and lacks consistent quality standards. It is in this etwironment that our 

industry has seen the tisc of unprofessional, unethical and sometimes illegal practices such as deceptive 

marketing and patient brokcring-not to m.ention excessive consutncr billing and insurance fraud. In too 

many cases, people who need help arc instead being harmed. 

Most in our field do great work. But to ensure ethical, quality care for all wbo seck help for addiction, we 

believe it is titnc to establish quality standards and a consistent, enforceable regulatory framework for 

the addiction treatment industry. The stakes-patient safety and public confidence in addiction 

treatment--are high. 
29 


35759.013

M1shek Tcst:mony: P8ge;: of 10 

Testimony (Cont.): :\s this subcotnmittcc discoYcrcd in its earlier hearing on patient brokcring, la\VS 

prohibiting commissions and kickbacks for patient referrals arc not strong, or even existent, cvcry\vhere. 

;\sa result, sotnc treatment providers pay a third· party "lcad"generation" scrYicc for calls, turning patients 

into commodities. \\lc'vc also heard of patient brokers tnonitoring Twckc Step meetings, drug courts and 

the streets to find people they can send to trcatrnent centers willing to provide a kickback, regardless of the 

clinical appropriateness. 

In addition, some brokers arc \vooing addicted patients into treatment centers and sober homes with 

protniscs of ft'cc tran.J and healthcarc, spa--like accmnmodations, free rent, gift cards, trips to casinos, cash 

and dmgs. Some brokers are actually encoura1,>ing relapse just to churn people through the system and 

generate claims and kickbacks as many times as possible. \V'c have read these reports in the news, just like 

many of you. But \VC also hear them from our patients, staff and peers in the field. 

While some patient brokcring practices arc blatantly inappropriate, others arc more subtly so-and may 

C\'Cll scctn \Vell·intendcd. Referrals, of course, arc not bad per sc. The problem is \vhcn referrals arc made 

\Vith little or no regard to what is clinically appropriate for the patient, when there is a lack of transparency 

in the process, and especially \vhcn financial kickbacks arc in,Tokcd. 

l)cccptivc n1arkcting is enabling sotnc of these patient brokcring practices. Often) it is not clear who is 

behind TV and online ads for addiction treatment, or \Vho callers will get when they reach out for help. 

Some treatment providers also deny or obscure their affiliations to other organizations, or 1nisrcprcsent 

the services they provide~ the conditions they treat, the credentials of their staff, or the insurance plans 

they accept. ,\nd some usc online bait~and·switch techniques to get calls from people who actually arc 

intending to call a different treatment center. 
30 


35759.014

!v11shek Tf's;imony l 3 of 10 

Deceptive marketing and patient brokcring can lead to bad treatment for consumers. The lack of 

transparency, on top of tninimal quality standards in the industry, puts patients at risk. These kinds of 

practices certainly would not be tolerated in any other area of hcalthcarc. 

The specialty addiction treatment field has long been marginalizcJ and a step rcrnovcd from mainstream 

health care-not tntegmted, not taught in medical school and not even rccogni:;:cd as a specialty until 

recently. Stigtna has kcpr it separated, \vhich is one reason it has been able to exisr under a looser 

regulatory framework Congress needs to assist in tightening the regulatory framnvork. 

It is also more imperative than ever for the field to hold itself to the highest ethical, legal and <Juality 

standards in the health care industry, comn1cnsurate \Vith the lifesaving \vork of helping people overcome 

the disease of addiction, \\le arc among rncmbers of the National1\ssociation of ,\ddiction Treatment 

Providers (N :\. \TI') committed to a robust new code of ethics, which prohibits, among other things: 

Patient brokering or any kind of financial rewards for patient referrals or leads~ 

The offering of non~clinical amenities to induce prospectin; patients; 

Anll false, deccptiYc or mislc;~.ding statements, a(_kcrtising or marketing practices of any kind. 

I want to also address sotnc of the same tp.Icstious you posed in your recent letters to companies 

involved in aggregating calls from prospective patients. 

First, we do ha"\T our own call center that accepts calls made directly to us. In 2017, \VC received 1,200 

calls a week. This year, we arc a\·craging 1,400 calls a week-on track for 72,000 calls total. Our call 

center employees arc trained only on our o\vn programs and services, and that's because our call 

center policy is to '\JOT refer callers to other treatment providers unless they arc deemed 

inappropriate for our scr:.riccs. 
31 


35759.015

We screen all callers and involve tnedical and mental health staff if there is a question about 

appropriateness for our services. If something outside the scope of our services-such as a primaty 

eating disorder, t,:rambling disorder or severe mental illness, for example-is a factor, we refer callers to 

their insurance company and to the treatment directory operated by the Substance Abuse and I\fental 

Health Services Administration (SAMHS,\). If we know of options in the caller's area, we may 

occasionally mention those, too, but not as a fonnal referral and certainly not \Vith any financial 

incentive. Because we Uon't route our calls to other providers and list our number only alongside the 

name of our organization, our callers clearly knuw they ha-ve reached the f lazclden Betty l""'onl 

Foundation. 

The referrals we do make arc to support the continuing care of our patients. For exatnplc, son1conc 

rnay travel to access our treatment and then need to return home. \X/c may refer such people to a 

provider that we trust to continue their care in their home area-in the same way that a pritnary care 

doctor tnight refer to a specialist or pharmacist. This is standard practice in the hcalthcarc industry, 

and kickbacks arc never involved. \Xlc arc also stepping up our efforts to tnorc thoroughly vet and 

collaborate with other pl'Ovidcrs. We recently launched a Patient Care Network (PCN)-unique to our 

field but common clsc\vhcrc in hcalthcarc--to foster collaboration '\vith t-Jwdity, like-minded providers 

and to help extend the continuun1 of care for our patients. ()ur PCN members each complete a robust 

application, host us for a site visit and arc researched thoroughly. ()ur aim. is to collaborate \vith 

licensed, accredited, evidence-based programs that provide effective, accessible, paticnt~centcrcd, 

equitable and safe services and resources across a continntml. 

\Y!c have three wcbsites with phone numbers that ring to our main treatment call center, all clearly and 

consistently btanded: Hazeldcn.otg, HazcldcnBettyFord.org and HBFFoundation.org. \X?c also own 
32 


35759.016

M;gheK Testimony i 

nine other \vebsites---one for our prevention arm) for cxan1ple-but they do not ring to our call 

center because they are not treatment sites. 

We do pay search engines and social media platforms for ads to help drive traffic to our 

HazeldcnBcttyFord.org website. Specifically, we have paid Google for ads, as well as Bing and 

5 of ·to 

Face book. \'Ve appreciate that Googlc is now vetting ads and ad buyers more rigorously, and support 

that process. In fact, just this past week-after a thorough application process-we were certified by 

LegitScript to resume ads on Google. 

To discourage deceptive and unethical pmctices-and also ensure quality-efforts must be undertaken to 

improve the nation's regulatory framework fm addiction treatment. Reforms ought to holster state 

licensure requirements; accreditation standards; clinician education qualifications; and access to 

comprehensive, evidence-based care and support that is coordinated and integrated with the rest of the 

health care system. To help inform such efforts, the Hazelden Betty Ford Foundation has identified quality 

standards in collaboration with another nonprofit provider and NA;\ TP member, Caron Treatment 

Centers. I will touch on 12 of the standards we identified, all of which reflect our views on the key 

attributes of a c1uality provider. 

1. Accreditation and Licensure. The first essential characteristic of a quality addiction 

treatment provider is ongoing accreditation fron1 external regulatory organizations. such as the 

.Joint Commission (JCAHO) or the Commission on Accreditation of Rehabilitation Facilities 

(C-\RF). It is also important to maintain a state license. Surprisingly, many addiction treatment 

providers throughout the Cnited States have not received accreditation, and there is no 

mandate in the field requiring providers to have accreditation in order to operate. 

Accreditation and licensure should be "tninimutn requirements" of any organization offering 

addiction treatment. 
33 


35759.017

M!shok Te>i.timony; 10 

2. Qualified Clinicians. Well-trained and credentialed clinicians are critical to providing quality 

care. Quality providers employ addiction medicine physicians, doctoral-level psychologists, and 

licensed or certified addiction counselors who have, at a minin1um, a bachelor's degree from an 

accredited institution with a preference for those prepared at the master1

s lc\Tl; they also 

implement clinical training programs that keep clinicians up to date in their fields and 

continuously advance their clinical skills. In addition, they develop staff from within to both 

improve performance and enable continuity of 'luality through periods of growth and changes 

in the CV(Tcvoldng and complex hcalthcarc system. 

3. Tcchnolo!,>y and Data Systems. Quality care providers usc state-of-the-art tools for 

conducting all aspects of business, including clinical operations. Such tools include a welldesigned, integrated electronic health record that allows information to be shared across all 

and providers of care. Organizations should have solid Information Technology (IT) 

platforms, case management systems and other data systems that facilitate care and allow quick 

and seamless con1munication among staff and stakeholders. It is also important for these 

platforms to provide accurate and reliable data that can be used for benchmarking and guality 

performance asscssn1cnt. Quality care providers also usc technology to dcli,-cr care and 

ongoing suppon for patients. 

4. Evidence~ Based Treatment. In this environment of under-regulation, the market has seen an 

int1ux of for-profit centers that offer exclusive, spa~likc cnvironnKnts guaranteeing success, but 

little in the way of evidence- based treatn1ent or dcmonsttatccl. outcomes. Clinical services should 

be "evidence-based," serve as "practice-based evidence" and/or be rooted in research and 

aitncd at establishing new innoYations in practice. In addition, quality providers should have a 
34 


35759.018

M1shek Testimony i Page 7 ot 10 

hard· wired process for routinely reYiC\.ving the ongoing research literature and exploring ways 

to incorporate new practices and methods as the evidence base for these develops. 

5. Care for Co-Occurring Disorders. Most individuals with a substance use disorder also have a 

co-occurring mental health condition or other co-existing addiction. A quality addiction 

treatment provider should have a comprehensive behavioral health team capable of providing 

integrated treatment for these co-occurring disorders. 

6. Performance Measurement. Quality care providets should have fotmahzed, proven methods 

for measuring several aspects of organizational perforn1ance, including patient outcon1es. 

Patient outcome 1neasures should include reports frotn patients then1se1Yes, reports from 

families, infonnation from other professionals, and scicnce~based, physical measures such as 

urine drug screens. Practitionei·s and scholars have yet to agree on the precise met1·ics that 

should he collected and reported throughout the addiction treatment field. As such, we urge 

the development of standard outcome measures so that all programs can be compared based 

on the same measures. 

7. Commitment to Quality and Process Improvement .. ·\quality provider with a valid 

perforrnancc measuretnent systcnl also engages in <-Iuality and process irnprovetncnt, and 

participates in national benclunarking efforts to den1onstrate accountability. Benchmarking 

criteria should include (but not be limited to) satisfaction rates, average length of treatment, 

successful treatment con1plction, abstinence rates, rc-engagetnent rates and integration of 

family into treatment. Quality providers are transparent in sharing information regarding the 

quality of care and outcomes, and educating the consumer about services and expected results. 

Csing outside agencies and university· based researchers to evaluate the data is essentiaL Data 

should be displayed in a forthright, appropriate way so they are not misinterpreted. 
35 


35759.019

Mishek Testimony: Page 8 ot 10 

8. Full Continuum of Care. Quality care providers offer a full continuum of care that provides a 

complete range of services to rnect patients' unique needs) based on the acuity of their 

condition and their social and environmental situation. /\.vailable $Crvices should be explained 

and offered at the outset, prior to admission. They should span a wide range of areas) including 

prevention and education) intervention, treatment and post-treatment recovery support. 

Quality providers also provide extensive services for families, including children affected by a 

loved one's addiction. 

9. Education and Scholarship. The best addiction treatment providers collaborate with 

academic centers and universities to help advance addiction education and scholarship through 

programs, fellowships, internships and professional development opportunities, as well as by 

conducting or participating in research for publication in peer-reviewed scientific journals. 

10. Advocacy. Quality providers engage their stakeholders in activities to edncate the public about 

the problems of addiction and the pmmise of recovery; advance helpful public policy changes 

and reduce the stigma associated with addiction. This can be accomplished through 

membership with national trade associations, hosting and sponsoring events, and conducting 

interviews \.vith the n"lcdia, among other strategies. 

11. A Broad Reach. Compared to the rest of hcalthcare, the addiction treatment industry has 

been slo\v to serve underprivileged individuals \Vith litnitcd financial means. To the extent 

possible, services should be available to people of all socioeconomic backgrounds through 

insurance utilization, scholarships and patient aid programs. Quality care providers also 

emphasize diversity and inclusion; this includes having culturally appropriate symbols and 

employing staff who arc diverse and bilingual. 
36 


35759.020

Mishek Testm1ony j Page 9 of 10 

12. Sound and Ethical Business Practices. ,"s outlined earlier, marketing and billing activities 

should be ethical, truthful and legal. Paying organizations for patient leads is highly 

inappropriate, as is presenting misleading data or results. Regarding financials, a provider 

should also be well~capitalized to ensure stability for patients, alumni and employees. We 

belie,·e all addiction treatment providers should adhere to the previously mentioned NAATP 

code of ethics. 

These characteristics reptcscnt, in our view, the tninimutn standards of a Center of Excellence in 

addiction treatment. While the federal government docs not have regulatory authority over ethical and 

quality issues involving addiction treatment, it can develop and disserninatc standards for states to 

consider, provide training and technical assistance, and work with organizations like N:\Xl'P and agencies 

like the Substance Abuse and Mental Health Services Administration (S1\MHSA) to disseminate 

standards and best practice guidance. Therefore, our Hazelden Betty Ford Institute for Recovery 

,\dvocacy-which has made industry reform a top priority-advocates for the following: 

• Directing the Secretary of Health and Human Services to publish and disseminate a report 

assessing the adequateness and unifom1ity of licensure, accreditation and clinician education 

n:'C1U1Tctncnts for substance usc disorder treatment providers nation\.vidc. 

Directing Sr\:\IHSA to develop, publish and disseminate best practices for operating recovery 

housing that pron1otcs a safe environment for sustained recovery frorn substance use disorder. 

• Empowering the Federal Trade Commission to investigate and prosecute deceptive tnarkcting 

practices by addiction trcatn1ent proYiders and call aggregators, in response to cotnplaints from 

consumers and businesses. 

Directing SAMHSA to develop, publish and disseminate best practices, and practices to avoid, 

for ''intcrventionistsH who help fatnilies and individuals access addiction treatment. 
37 


35759.021

M1shek Testimony 1 Page 10 of 10 

• Directing the Department of J usticc to define "patient brokcring)> in consultation with 

S,\MHSA, with an eye toward outlawing such practices. 

• Directing the Secretary of Health and Hunu1n Services to assess the adequateness and uniformity 

of addiction treatment education atHl training in medical schools. 

\Ve also support an assortment ofkgishtion to improve addiction treatment quality by: 

Expanding and elevating the addiction trcatn1enr workforce. 

Encouraging greater integration of specialty addic6on care with primary care and all of 

mainstream medicine. 

Encouraging greater linkages to cmntnunity-bascd recovery support and throughout the 

continuum of care. 

• Incenting evidence-based practlccs and quality-based outcome n1casurcs and standards. 

It is tin1e to restore faith and accountability in the addiction treatment field. It is titne to establish 

quality standards and an enforceable regulatory framework to guide all treatment organizations, It is 

time to ensure ethical, <]uality care for all people who seck help for addiction. 

Thanks again for the opportunity to share my vie\vs. I look forward to ans\vcring your questions. 
38 

Mr. HARPER. Thank you, Mr. Mishek. The chair will now recognize Mr. Cartwright for 5 minutes for the purposes of his opening 

statement. 

TESTIMONY OF MICHAEL CARTWRIGHT 

Mr. CARTWRIGHT. Thank you, Chairman Harper and Ranking 

Member DeGette. Thank you for having me here. 

My name is Michael Cartwright I’m the Chairman and CEO of 

American Addiction Centers. 

Thank you Chairman Harper and Ranking Member DeGette. 

Thank you for having me here. 

My name is Michael Cartwright I’m the Chairman and CEO of 

American Addiction Centers. We operate in 9 States. We offer 39 

treatment centers. 

I’ve been a treatment counselor and executive for 23 years. For 

12 of those years, I operated a not-for-profit organization. I’ve also 

run both publicly traded, as well as privately funded drug and alcohol treatment centers. I have actually advised the U.S. Senate 

Health Subcommittee on Substance Abuse and Mental Health 

Services back in the early 2000s when we were looking at co-occurring disorders in this country and how we could better implement 

that. 

I also serve on the board of directors of the National Association 

for Behavorial Healthcare, which for 85 years has advocated nationally for mental healthcare and substance abuse. Its members 

include American Addiction Centers and other publicly traded 

healthcare companies like HCA and Acadia UHS, among others. 

I’ve been in recovery for 26 years. As a young man, I struggled 

with addiction. I know the pain of untreated addiction. AACs mission is to help with those who are struggling like I did, find the 

right treatment for psychiatric and community support. I’m glad 

that Congress is looking into treatment marketing practices. Treatment providers and government officials should work together not 

just to keep bad actors out, but to let potential patients and their 

loved ones know who they can trust. 

I’m glad that Congress is continuing to look at marketing practices and treatment providers and government officials. AAC’s recovery brands business operates online treatment directories, including Recovery.org and Rehabs.com. These directories provide information about treatment centers across the country. Centers that 

are also approved and listed by the Federal Government Substance 

Abuse and Mental Health Services Administration on 

SAMHSA.gov. 

In fact, about 300 treatment providers, who are members of the 

National Association of Addiction Treatment Providers or NAATP, 

Marvin’s association, either list or advertise on our websites. A lot 

of treatment centers don’t have large online presences in their own 

right. Addicts who need help reach these treatment centers 

through our website. 

We don’t engage in unethical market practicing like hijacking 

phone numbers. We are not a call center aggregator. We don’t take 

calls for other treatment centers, just for our own. We don’t sell information gathered on calls, AAC opposes this kind of lead generation. 

39 

We make sure that our website visitors know who they are contacting. Under our transparency guidelines, we work with treatment centers across the country to make sure their listings are upto-date and accurate. We make clear that users know which treatment centers are going to answer the numbers they call. We make 

clear that AAC’s toll-free numbers go to AAC’s call center. And 

when they pick up, AAC’s call center reps identify themselves as 

an AAC employee. 

Not all treatment centers market honestly, but they should. AAC 

supports legislation that criminalizes fraudulent advertising, outlaws tactics like hijacking of treatment center phone numbers, requires disclosures about who owns and operates call centers, and 

bans kickbacks and bribes. AAC has supported this kind of legislation in its home State of Tennessee and elsewhere. 

I have the following recommendations. Congress should ask the 

National Association of Insurance Commissioners or the National 

Alliance For Model Drug Laws to draft a model law banning deceptive marketing. Number two, existing or proposed laws in Tennessee, Florida, and California should be considered as models for 

reform. Number three, SAMHSA should update its treatment center locator regularly, and should include sober homes in its listings. 

SAMHSA should prioritize sober homes that are members of the 

National Association of Recovery Residences. Number four, existing 

FTC Truth in Advertising Guidelines should be used to stop misleading addiction treatment marketing. 

While there is rightfully a lot of attention being paid to bad marketing practices, I hope we don’t lose sight of all the great work 

that treatment centers do. Treatment does work. I’ve been clean 

and sober now for 26 years. And throughout this country we have 

great treatment centers, just like Hazelden Betty Ford. 

We need help. We have tens of thousands, almost 100,000 people 

a year dying from this disease. 

We definitely need to look into this as a matter of a marketing 

practice, but we also need to be looking at what are some of the 

solutions to solve this epidemic. 

Thank you very much for having me here today. 

[The prepared statement of Mr. Cartwright follows:] 

40 


35759.022

200 Powell 

Brentwood, TN 3'7027 

AmericanAddictionCenters.org 

STATEMENT OF MICHAEL CARTWRIGHT, CHAIRMAN & CEO 

OF 

AMERICAN ADDICTION CENTERS, INC. 

BEFORE THE U.S. HOUSE COMMITTEE ON ENERGY AND COMMERCE 

SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS 

HEARING TO EXAMINE ADVERTISING AND MARKETING PRACTICES WITHIN 

THE SUBSTANCE USE TREATMENT INDUSTRY 

JULY 24, 2018 

My name is Michael Cartwright. I'm Chairman and CEO of American Addiction Centers, which 

operates 39 treatment locations in 9 states. I've been a treatment counselor and executive for 23 

years. For 12 of those years I ran a non-profit treatment organization. I've run both publicly and 

privately funded treatment centers. I've advised the U.S. Senate Health Subcommittee on 

Substance Abuse and Mental Health Services. 

I also serve on the board of trustees of the National Association for Behavioral Healthcare, which 

for 85 years has advocated nationally for mental healthcare, including addiction treatment. Its 

members include AAC and other publicly traded healthcare companies, among them Hospital 

Corporation of America and Acadia Healthcare. 

I've been in recovery for 26 years. As a young man, I struggled with addiction. I know the pain 

of untreated addiction and mental illness. AAC's mission is to help those who are struggling like 

I did, find the right psychiatric care and community support. 

I'm glad that Congress is looking into treatment marketing practices. Treatment providers and 

government officials should work together not just to stop bad actors, but to let potential patients 

and their loved ones know who to tmst. 

AAC's Recovery Brands business operates online treatment directories, including recovery.org 

and rehabs.com. These directories provide information about treatment centers across the 

country, centers that are also approved and listed by the federal government's Substance Abuse 

and Mental Health Services Administration, on samhsa.gov. 

In fact, about 300 treatment providers who are members of the National Association of 

Addiction Treatment Providers, or NAATP, either list or advertise on our websites. A lot of 

treatment centers don't have a large online presence of their own. Addicts who need help reach 

these treatment centers through our websites. 

Page 1 
41 


35759.023

We don't engage in unethical marketing practices, like hi-jacking phone numbers. We're not a 

call center aggregator. We don't take calls for other treatment centers, just for our own. We don't 

sell information gathered on calls. AAC opposes this kind of lead generation. 

We make sure that our website visitors know who they arc contacting. I've included with this 

statement a presentation that illustrates our transparency guidelines. Under these guidelines: 

o We work with treatment centers across the country to make sure their listings are upto-date and accurate. 

o We make clear that users know which treatment centers are going to answer the 

numbers they call. 

o We make clear that AAC's toll-free number goes to AAC's call center and when they 

pick up, AAC call center reps identify themselves as AAC employees. 

Not all treatment centers market honestly. But they should. AAC supports legislation that: 

o Criminalizes fraudulent advertising, 

o Outlaws tactics like the hijacking of treatment center phone numbers, 

o Requires disclosure about who owns and operates call centers, and 

o Bans kickbacks and bribes. 

AAC has supported this kind of legislation in its home state of Tennessee and elsewhere. 

I have the following recommendations: 

I. Congress should ask the National Association of Insurance Commissioners, or the 

National Alliance for Model State Drug Laws, to draft a mode/law banning deceptive 

marketing. 

2. Existing or proposed laws in Tennessee, florida and California should be considered 

as models for reform. 

3. SAMHSA should update its treatment center locator regularly ami should include 

sober homes in its listings. SAMHSA should prioritize sober homes that are members 

of the National Association of Recovery Residences. 

4. Existing FTC truth-in-advertising guidelines should be used to stop misleading 

addiction treatment marketing. 

AAC also supports online advertiser vetting processes such as those currently being put into 

place by Googlc and its certifying agency, LegitScript LLC. A.AC has offered to share its 

Page 2 
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35759.024

viewpoints on industry advertising and marketing practices to LegitScript. AAC is glad that 

LegitScript is seeking the perspectives of participants across the industry, which we hope would 

include those of both for-profit and non-profit treatment operators, as well as members of the 

National Association for Behavioral Healthcare. 

While there is rightfully a lot of attention being paid to bad marketing practices, I hope we don't 

lose sight of all the great work most treatment centers do. Treatment works. Research shows that 

those who follow sound treatment plans stay clean and sober. But those seeking help from 

addiction shouldn't have to worry about false advertising. 

Thank you for the opportunity to testify. I am happy to answer your questions. 

Page 3 
43 

Mr. HARPER. Thank you, Mr. Cartwright. 

The chair will now recognize Mr. Niznik for 5 minutes for his 

opening statement. 

TESTIMONY OF ROBERT NIZNIK 

Mr. NIZNIK. Chairman Harper, Ranking Member DeGette, and 

members of the subcommittee. 

Thank you for the opportunity to share my perspective as you 

continue your important investigation into various aspects of the 

opioid crisis confronting our country. 

Our focus at Niznik Behavorial Health is in offering quality 

treatment to those seeking help at a time when such services are 

most in demand and when there’s a shortage of available providers. 

We help kids, mothers, fathers, individuals from a variety of 

walks of life as they seek to take control of their lives, overcome 

their battles with addiction, and return to their families. We’ve 

helped thousands of individuals through our inpatient and outpatient services at facilities we operate in Texas, Florida, and in 

California, several of which fill a need in underserved markets. In 

Texas, for example, our inpatient facilities in our rural county is 

served by only one other provider. We will soon be opening an additional facility in New Jersey which will also help individuals in an 

underserved market. 

At the outset, I want to emphasize that neither NBH nor ARN 

has ever operated as a patient broker, nor have we made any payments to any intermediary or third parties for referrals. We have 

not engaged in any of the activities that would appear to be of concern to your and your colleagues as expressed in the committee’s 

May 29th letter. NBH is in the business of treating patients. All 

of our NBH programs are licensed, in good standing, and are accredited by the Joint Commission. 

Our staff include board-certified psychiatrists, licensed masters 

and doctorate-level clinicians as well as a comprehensive nursing 

team. We offer a variety of specialized programs, including an adolescent program. 

I am very proud of what we have accomplished in only 5 years. 

We started with one facility in Miami, and upon being licensed by 

the State of Florida, that facility began answering calls from individuals seeking its services. As we added other facilities, the customer service function relating to all facilities was assumed by 

NBH. We now employ over 500 individuals and support hundreds 

of additional jobs. In fact, I’m proud to say that we’ve given jobs 

to people in recovery. 

Based on our experience, I would be pleased to share with you 

how we market and advertise our services with full transparency. 

Like you, we want to make sure that prospective patients and their 

families are as well-equipped as possible when they’re seeking 

treatment for a loved one or for themselves. 

Choosing a healthcare provider is an important decision. We believe it is essential that prospective patients know who a provider 

is and that it described with full transparency what services it offers, where it makes them available so that prospective patients 

can make an informed decision. 

44 

When one of our customer service representatives receives a call, 

the individual answering the call immediately identifies himself or 

herself as an NBH employee. That way, all callers know at all 

times that they are speaking directly with NBH. 

If a caller seeks admission to an NBH facility, trained and licensed medical and clinical personnel determine the medical necessity and the clinical appropriateness of the services to offer that individual. 

The work of an NBH customer service representative is akin to 

a receptionist in a doctor’s office. A person who answers a call, provides information regarding the service that the doctor offers, and 

then schedules an appointment for the doctor if a patient requests 

help. 

We believe there are several factors that a patient should consider when looking to identify a quality provider such as whether 

they are accredited. They also want to know what programs, therapies, and specialty that provider offers. They will then be in a position to determine whether a provider can help them or a loved one. 

We’re in the business of helping people and are only able to succeed as a company when we provide quality and effective care. Our 

patients consistently report that they are overwhelmingly pleased 

with the quality of care and the services they have received. 

We have helped thousands of individuals get control of their 

lives. And as part of our goal of helping people in need, we have 

provided 296 full scholarships. With a full scholarship, the patient’s 

entire stay through all levels of care and services is free. 

In closing, I want to emphasize that we appreciate this opportunity to put in perspective how we operate our business, how our 

license and medical and clinical personnel help people in need and 

how we believe individuals seeking treatment can identify a quality 

provider. 

Thank you again for the opportunity to make this opening statement. I will be glad to answer your questions. 

[The prepared statement of Mr. Niznik follows:] 

45 


35759.025

Written Statement 

of 

Robert Niznik 

Chief Operating Officer 

Addiction Recovery Now and 

Niznik Behavioral Health, Inc. 

Hearing 

To Examine Advertising and Marketing Practices within the 

Substance Use Treatment Industry 

Before 

The Subcommittee on Oversight and Investigations 

The Committee on Energy and Commerce 

U.S. House of Representatives 

July 24, 2018 

Chairman Harper, Ranking Member DeGette, and Members ofthe Subcommittee, thank 

you for the opportunity to share my perspective as you continue your important investigation 

into various aspects of the opioid crisis confronting our country. I appreciate your interest in 

the advertising and marketing practices within the substance abuse treatment industry. 

Our focus at Niznik Behavioral Health (NBH) is on offering quality treatment to those 

seeking help at a time when such services are most in demand, and when there is a shortage of 

available providers. 

NBH is a national provider of behavioral health services. We help kids, mothers, 

fathers--individuals from all walks of life--as they seek to take control of their lives, overcome 

their battles with addiction, return to their families, and again become productive members of 

society. We have helped thousands of individuals through our inpatient and outpatient services 

at the facilities we operate in Florida, Texas, and California, several of which fill a need in 

underserved markets. In Texas, for example, our inpatient facility is in a rural county served by 

only one other provider. We will soon be opening an additional facility in New Jersey, which 

also will help individuals in an underserved market. Addiction Recovery Now (ARN), an affiliate 

of NBH, is a non-NBH branded free web resource that provides helpful information about 

addiction and related topics for NBH's wholly owned healthcare services and facilities. 
46 


35759.026

At the outset, I want to emphasize that neither NBH nor ARN has ever operated as a 

patient broker. Neither ARN nor NBH has any affiliation with any third-party call centers, lead 

generators, or similar intermediaries. And neither company makes any payments to any 

intermediary or other third-party for referrals. In short, we do not now and never have engaged 

in any of the activities that would appear to be of concern to you and your colleagues, as 

expressed in the Committee's May 291etter to me and other of the panelists appearing before 

you today. 

NBH is in the business oftreating patients. All of our NBH programs are licensed, are in 

good-standing, and are accredited by the Joint Commission, an independent, not-for-profit 

organization that accredits U.S. healthcare organizations and programs and maintains the most 

stringent standards for national accreditation. Our licensed medical and clinical care teams 

have successfully treated thousands of individuals. We have provided free services--what we 

refer to as "scholarships" --to nearly 300 individuals who otherwise would be unable to receive 

care. 

Based on our experience, I would be pleased to share with you our thoughts on what 

comprises quality treatment. Like you, we want to make sure that prospective patients and 

their families are as well-equipped as possible when they are seeking treatment for themselves 

or for a loved one. 

I am very proud of what we have accomplished in only five years. We built our services 

from the ground up, starting with one facility in 2013. We now employ over 500 individuals and 

support hundreds of additional jobs in the markets in which we provide our services. In fact, we 

have given jobs to people in recovery. 

So that you have a better perspective on how we operate our business, let me provide 

some background about our structure and our growth. 

We opened our first Inpatient Detoxification Facility in May 2013 in Miami. Upon being 

licensed by the State of Florida, that facility--Harbor Village--began answering calls from 

individuals seeking its services. The employees working for that facility would answer calls for 

only that facility. As we added other facilities, the customer service function relating to all 

facilities was assumed, on a facility-by-facility basis, by NBH. 

When one of our customer service representatives receives a phone call, the individual 

answering the call immediately identifies himself or herself as an NBH employee--that way all 

callers know at all times that they are speaking directly with NBH. The work of an NBH 

customer service representative is akin to a receptionist in a doctor's office--a person who 

answers a call, provides information regarding the services the doctor offers, and then 

schedules an appointment for the doctor if the prospective patient decides to seek help. 

Upon receiving a call, NBH customer service representatives collect information from 

the caller regarding the purpose of their call and what services they are seeking. They then 
47 


35759.027

provide information about NBH programs that might meet the caller's anticipated needs. Our 

customer service personnel do not select a particular facility for a caller. Rather, they seek to 

answer questions and educate a caller on the various facilities we operate, and the types of 

services we offer. This assists a caller in identifying which, if any, NBH facility can meet their 

needs, considering factors such as age (NBH serves adolescents in Florida but not in Texas and 

California), certain types of therapy, specific foreign language-based programs, and the like. 

Based on this information, callers make their own selection of the facility they consider most 

appropriate for their needs. Or they decide we don't offer the services they are seeking and 

they look elsewhere. In short, callers are simply provided with the array of available NBH 

facilities and programs, and make their own choices based on what we have to offer. 

If a caller thereafter seeks admission to an NBH facility, trained and licensed medical 

and clinical personnel determine the medical necessity and clinical appropriateness ofthe 

services to offer that individual. 

How does ARN fit into this system? ARN was developed several years ago to offer a free 

online resource for individuals searching for information about addiction and behavioral health 

services. Today, the website does not have a significant online presence, accounting for 

approximately 1% of all calls answered by NBH. A telephone number on the ARN website 

allows callers to reach an NBH customer representative. The fact that NBH will be answering 

the call is disclosed to visitors to the website. As noted above, the customer service center 

consists of employees of NBH who answer telephone calls on behalf of NBH facilities. As a 

result, individuals accessing the ARN website who call the phone number listed on the website 

are interacting at all times with an NBH employee. 

We're in the business of helping people. We are only able to grow as a company when 

we provide quality and effective care. Our patients provide us with feedback on their 

experience. They consistently say they are overwhelmingly pleased with the quality of care and 

the services they've received. As I noted at the outset, we have helped thousands of individuals 

get control of their lives and return to becoming productive members of society. We have 

provided 296 full scholarships to individuals in need. With a full scholarship, the patient's entire 

stay through all levels of care and services is free. We also have provided partial scholarships as 

part of our goal of helping individuals in need. 

Despite the help we provide, we face zoning challenges, NIMBYism, and landlord 

discrimination regarding the use of their properties to provide our services. Another unique 

problem stems from the fact that we are required to respond to a number of different 

standards of care depending upon the insurance carriers with whom we are dealing. 

Unfortunately, there is no uniform standard. As a result, complying with a multiplicity of 

standards is a logistical and administrative ordeal. Finally, there is the ever-increasing challenge 

of securing authorizations from carriers to provide the treatment required for our patients. 

We believe we are providing a much-needed service. We appreciate this opportunity to 

put in perspective how we operate our business, how our licensed medical and clinical 
48 


35759.028

personnel help people in need, and how we believe we excel in the way in which we deliver 

care to people from all walks of life who need help. 

Thank you again for the opportunity to provide this statement for the hearing record. 
49 

Mr. HARPER. Thank you, Mr. Niznik. 

The chair will now recognize Mr. Brian for 5 minutes for his 

opening. 

TESTIMONY OF JASON BRIAN 

Mr. BRIAN. Thank you. My name is Jason Brian, and I founded 

Redwood Recovery Solutions, the organization that owns 

TreatmentCalls.com. It is my pleasure to be here today to share 

with this committee my perspective on marketing and treatment. 

My background prior to this industry is in insurance and automotive marketing. Although we were successful in those areas, my 

team and I shared the vision of wanting to make a difference. And 

so Redwood started by quoting projects where this was a strong 

purpose motivator not just a profit motivator. 

Redwood’s model was at its core simply an advertising and marketing firm that worked closely with many different types of media 

companies that operated in TV, radio, search engine advertising, 

and other marketing channels to generate inbound phone calls 

from persons seeking substance abuse help and then get them connected with a licensed treatment center. Redwood did not own 

these sources or the agencies that ultimately built or controlled the 

distribution of the media companies’ advertisements. Due to this, 

Redwood developed a strict set of marketing standards and requirements for these agencies to follow in order to work with us as an 

affiliate. These rules forbid the use of any sort of incentive to the 

caller for making the call. The use of any treatment centers intellectual property, any attempt at intentionally deceiving the caller, 

or any provision of any clinical guidance, just to name a few. 

These affiliates were compensated a flat pre-negotiated rate per 

call to Redwood. And at no time was their fee structure contingent 

on the outcome of any call or the placement of any patient. After 

receiving a call from an affiliate, Redwood would then route this 

inbound phone call directly to a licensed treatment provider within 

its network. Redwood did not answer any of these inbound phone 

calls, but rather, the licensed treatment providers were responsible 

to answer the calls. It was in the sole discretion and professional 

judgment of the licensed treatment program answering the inbound call along with the caller themselves, to make any decision 

about the appropriateness or lack thereof, of a program best suited 

for the caller or their loved one. If a referral was needed to another 

facility or level of care, it would have been done solely by the licensed treatment provider as Redwood made no referrals whatsoever. 

I need to add clarity surrounding my past tense use of Redwood, 

and share my brief opinion on the unfortunate reality of painting 

with broad strokes. In January of this year, collectively with my 

team, Redwood decided it was time to move on from this industry. 

Far too often this industry and those watching it from the sidelines, want to typecast marketing companies as bad and unethical 

because of the abuse of a few immoral, disgusting individuals. I 

would liken this to saying that all treatment centers are bad simply because a few have given the industry a black eye. That would 

be wrong and misleading and unfortunate to those that they could 

have ultimately served. Inevitably, when I discussed this topic 

50 

within the industry, people want to use a crisis moment and vulnerability as a supporting argument for why companies like mine 

are bad or unethical. 

This past week, a good friend of mine lost her husband to an 

overdose. He went to the best treatment money could buy, she said. 

We all prayed this day would not happen, but his family and I 

knew that this day might come. And indeed, our worst nightmare 

came true. 

The reality is that people seeking treatment do so for some time. 

They search for months and even years in some instances for a solution. This disease often gets worse over years or even decades. I 

am in no way downplaying the seriousness of, or the importance 

of, making the phone call, but to suggest that the calls received are 

random impromptu decisions caught in a moment of vulnerability 

is simply inaccurate. 

The second point that always comes up pertains to the appropriateness of a facility that the call is routed to. If you find yourself 

asking how do you know if a generic help line call was a good fit 

for a specific center, consider this. If you search for treatment online and called any treatment center that came up directly, would 

you finding them online qualify that center to be the best fit for 

you or your loved one? If you used a phone book and called one listed there, would that be a perfect fit? If a center placed an advertisement on television directly, might that do the trick in finding 

the right one? 

Of course, none of these things independently change anything 

about the quality of care or experience one might receive at any 

given center. Don’t lose sight that these treatment providers are licensed to do the work that they are doing. And outside of gross 

negligence, these centers who share the same licensure, even internally, still disagree largely on what type of treatment is best for 

the same client. And ultimately, that subjectivity is largely part of 

the disparagement on where a call would be best suited. We’ve 

never entered that conversation and have always taken the stance 

that their licensure was good enough for us to work with them. 

Placing a scarlet letter on marketing companies like so many 

have doesn’t change how treatment centers will handle the phone 

call. And in fact, at least in our case, actually chases away good 

people and good corporations that want to do good work helping 

people. 

Over 519,000 individuals place calls that were routed through 

my company to facilities licensed to provide them with help. Regardless of anything anyone may claim, lives have been changed 

and saved because Redwood cared enough to do something that 

made a difference. And I’m proud of that. 

I would strongly urge anyone in this industry and those who are 

tasked with creating legislation in it, to reconsider how they look 

at marketing companies. 

Quickly summarized, without them less money will be spent connecting people with the help that they desperately need, and even 

if all the marketing companies were gone, there wouldn’t be any 

fewer people in need of help and the bad centers would still exist. 

51 

I’m happy to be part of this conversation and continue any dialogue that helps accomplish the initial goal Redwood set out on of 

helping people. 

[The prepared statement of Mr. Brian follows:] 

52 


35759.029

My name is Jason Brian, and I founded Redwood Recovery Solutions ("Redwood"), the 

organization that owns TreatmentCalls.com. It is my pleasure to be here today, to share with this 

Committee my perspective of the opioid epidemic in this country. 

My background prior to my involvement with Redwood was in insurance and automotive 

marketing. After successfully building a lead company that specialized in those two arenas, I 

lound myself pondering my childhood moment when I said: "when I grow up I want to be .... " 

This was always followed by my response: a career that makes a ditTen:nce in the lives of others 

--I never thought: "when I grow up I want to sell leads to insurance agents and car dealerships." 

Although successful in those areas, my team at Redwood shared the vision of wanting to make a 

difference in the lives of others, so we started courting projects where there was a strong "purpose 

motivator" rather than just a profit motivator. The Redwood goal was to take the proven model 

we had developed in the past-- connecting people and applying it to connecting people in need 

of treatment from fully licensed treatment providers who could guide them on that journey. 

Redwood's model was, at its core, simply an advertising and marketing firm that worked 

closely with many different types of media companies that operated in TV, radio, search engine 

advertising and other marketing channels. Its purpose was to generate inbound phone calls from 

persons seeking substance abuse help, and then connect them to a licensed treatment center. 

Redwood did not own these sources or the agencies, and ultimately did not build or control the 

distribution of the media companies' advertisements. Rather, Redwood developed a strict set of 

marketing standards and requirements f(Jr these agencies to follow. These rules prohibited the usc 

of any sort of incentive to the caller for making the call, as well as forbidding: 1) the use of any 

treatment center's intellectual property; 2) any attempt at intentionally deceiving the caller; 3) 

providing clinical guidance; and 4) other safeguards. These affiliates were compensated a flat, 

1 
53 


35759.030

pre-negotiated rate per call sent to Redwood. More importantly, this fcc structure was never 

contingent on the outcome of any call or the placement of any patient. 

As part of the operations, after receiving a call from an affiliate, Redwood would route this 

inbound phone call directly to a licensed treatment provider within its network. Redwood did not 

answer these inbound phone calls, but rather the licensed treatment providers did. Redwood made 

it clear that it was in the sole discretion and professional judgement of the licensed treatment 

program answering the inbound call, along with the caller themselves, to make any decision about 

the appropriateness (or lack thereof) of a program best suited for either the caller or the person on 

whose behalf they were calling. Furthermore, if a referral was needed to another facility or level 

of care, it would have been done solely by the licensed treatment provider, as Redwood made no 

referrals whatsoever. 

It is important to clarify my ''past tense" reference to Redwood and share my opinion on 

the unfortunate reality of painting with broad strokes the problems with treatment for addition. In 

January of this year, collectively with my team. Redwood decided that it was time to move on 

from this industry. Far too often, this industry itself and those watching it from the sidelines want 

to type cast all marketing companies as "bad and unethical'' because of the abuse of a few 

unethical, disgusting individuals. Not all treatment centers arc bad; however, a few have given the 

industry a black eye. 

Inevitably, when I discuss this topic within the industry, the first criticism that people make 

as support for the notion that marketing companies arc ·'bad or unethical" is that the decision to 

choose a treatment facility occurs at a crisis moment when the individual is most vulnerable. This 

past week a good friend of mine lost her husband to an overdose, and in conversation she candidly 

told me: "[ojver and over Robert went to the best treatment money could buy. He would do 

2 
54 


35759.031

anything for me and his family --anything-- but he would not quit using. We all prayed that it 

would not happen. but his family and I knew that this day might come, and indeed our worst 

nightmare came true." The reality is that persons seeking help for addiction do try all sorts of 

remedies- daily or weekly meetings, visiting therapists, joining religious groups, or whatever they 

can do to help themselves or their loved ones. They search for months, and even years, for 

solutions. But their addiction did not catch anyone by surprise, as this disease often gets worse 

over years, or even decades. I am not downplaying the seriousness and importance of someone 

making the phone call, but to those that suggest that the calls received arc random, impromptu 

decisions, caught in a moment of vulnerability, is just not accurate. 

The second criticism voiced always pertains to the appropriateness of the facility to which 

the call is routed. The question is asked, "How do you know if a generic help line call is a fit for 

the center that received the call?" Consider that if you searched for treatment online, and called 

any treatment center that came up directly, would your discovery of them online then qualify that 

center to be the best one? Would it not qualify as a perfect fit? If instead you used a phone book 

and called one listed there. would that one qualify as a perfect fit? If a center placed an 

advertisement on television directly, might that help someone find the best fit? Of course, none of 

these mechanisms independently change anything about the quality of care or experience one 

might receive at any given center. 

More importantly, these treatment providers arc licensed to do the work that they are doing. 

Outside of gross negligence, these centers who share this licensure even internally disagree on 

what types of treatment are best for the same client, and ultimately that subjectivity is used as part 

of the disparagement on where a call would be best suited. Redwood never took part in that 

3 
55 


35759.032

conversation but rather objectively viewed a treatment center's licensure as sut1icicnt proof of 

the professionalism that allowed Redwood to work with them. 

Criticizing the marketing companies, as so many have done, by placing a scarlet letter on 

them, does not change how treatment centers will handle a phone call, and in fact, at least in our 

case, actually chases away persons and corporations that do want to help others in need. Over 

519,000 individuals -- moms and dads, brothers and sisters, sons and daughters, coworkers and 

friends -- have placed phone calls that were routed through Redwood to facilities licensed to 

provide them with help. Regardless of any criticism, there is no doubt that lives have been saved 

and changed because of Redwood. I am proud of that. 

In conclusion, I strongly urge anyone in this industry, as well as those tasked with creating 

legislation in it, to reconsider how they look at legitimate marketing companies. The real fix lies 

in creating increased guidelines for what "good treatment" is, requiring licensure which mandates 

that agreed upon minimum standard o/' care, and then holding individuals and corporations 

accountable to the new licensure. I am happy to be a part of this conversation and continue the 

dialog that accomplishes this goal of helping people- a goal that Redwood set out to accomplish. 

Thank you. 

4 
56 

Mr. HARPER. Thank you, Mr. Brian. The chair will now recognize 

Dr.Stoller for his testimony. 

TESTIMONY OF DR. KENNETH STOLLER 

Dr. STOLLER. Chairman Harper, Ranking Member DeGette, and 

members of the subcommittee, thank you for giving me the opportunity to speak with you today. 

With 64,000 overdose fatalities in 2016, we are fortunate to have 

at our disposal effective evidence-based approaches to treating substance use disorders. 

In my experience, the impact of treatment is optimized when 

three sequential actions are taken. Number one, using opportunistic times and settings to engage potential patients. Number two, 

completing a comprehensive initial assessment to determine the 

best setting and type of treatment for each individual. And number 

three, offering treatments that are evidence-based, high quality, 

and dynamically adjusted. 

Regarding action number one, I focus on referrals from locations 

where people are most in need of treatment. Accepting patients 

who have already been engaged in the healthcare system prevents 

lost opportunities for lifesaving treatment. Hospital emergency 

rooms and inpatient units have patients who survived overdoses, 

are being treated for medical problems, resulting from injection 

drug use, or are contemplating suicide. Other referrals come from 

medical offices, other treatment programs, and, of course, community walk-ins. By focusing on these sources of referral, we serve patients who are most in need and who otherwise would incur tremendous costs to the healthcare system as high utilizers of costly 

services. 

Regarding action number two, a comprehensive assessment is 

done by my clinical staff as each patient is unique in terms of their 

disorder, as well as their personal strength, liabilities, and resources. Past treatment experiences can also inform what to try 

next. For example, for those who have repeatedly failed limited 

time episodes without medications, I may recommend a medication 

trial in a setting of long-term outpatient counseling and those who 

have severe mental health and social problems might best succeed 

in a comprehensive program with resources to effectively address 

all of those problems. 

Regarding action number three, the actual treatment, I consider 

there to be five critical approaches that providers of high quality 

treatment aspire to offer. Number one, they use medications as 

clinically appropriate, including the three FDA approved medications for opioid use disorder and three for alcohol use disorder. 

They should be started, stopped, and switched over time according 

to ongoing response. Number two, they combine it with psychosocial treatments, including counseling delivered by skilled professionals. Number three, they use behavorial therapies that motivate 

positive change and increase treatment adherence. Number four, 

they use adaptive step care models. This means they use ongoing 

measurement of outcomes to continually adjust the intensity and 

types of treatment and to motivate engagement. And number five, 

they incorporate wraparound services provided within the program 

or through linkages with outside agencies to support a holistic apVerDate Nov 24 2008 12:09 Apr 10, 2019 Jkt 037690 PO 00000 Frm 00060 Fmt 6633 Sfmt 6633 U:\MY DOCS\HEARINGS 115\HEARINGS\115-155 CHRIS
57 

proach to recovery. This can include, medical, mental health, housing, vocational, 12-step, and certified peer support services. 

Solid linkages to aftercare must be facilitated at the time of discharge to ensure continuation of the recovery process. 

As an illustration of some of these points, Mr. A was a 55-year 

old man referred after a hospital detox admission to us for alcohol 

and heroin use. He had HIV, hepatitis, and a multitude of other 

medical problems. We began him on buprenorphine and later 

switched him to methadone. We provided him with counseling and 

housing when needed, and coordinated with his local medical providers. 

One day I received an inquiry from his managed care organization after they determined that over the prior 17 months, he had 

81 ER visits incurring tremendous cost. 

On further examination, I discovered that only 4 of the 81 visits 

were during his time with us. The reduction in cost for ER visits 

was ten-fold from a monthly average of over $3,000 to $325 when 

he was with us, illustrating that fiscal gains can result from comprehensive addiction treatment. 

In conclusion, we are fortunate to have the ability to meet these 

challenges head on with effective treatments for the opioid epidemic. Comprehensive opioid treatment programs are well-positioned to be hubs of expertise and coordination and can be scaled 

up nationally to narrow the gap between treatment, need, and 

availability. 

I applaud your recent work in Congress to both increase access 

and quality of substance use disorder treatment. 

Thank you. 

[The prepared statement of Dr. Stoller follows:] 

58 


35759.033

Testimony of: 

Kenneth B. Stoller, M.D. 

Submitted to The United States House of Representatives 

Committee on Energy and Commerce 

Subcommittee on Oversight and Investigations 

for hearing on "Examining Advertising & Marketing Practices within the Substance Use 

Treatment Industry" 

Tuesday, July 24, 2018 

RHOB 2123, I O:OOAM 
59 


35759.034

Main points 

Substance Usc Disorders (SUD) can be effectively managed when treatment is accessible and 

of high quality. 

There arc three primary steps necessary to provide impaetful treatment: 

I. Begin engagement in treatment during times and in settings of opportunity. 

2. Complete a comprehensive assessment of the individual to determine the best type, 

intensity and setting of initial treatment, and based on that, admit or make appropriate 

referral. 

3. Provide treatment that: 

uses medications for addiction treatment (MAT) when medically indicated; 

uses verbal therapies delivered by skilled professionals; 

uses behavioral therapies to facilitate change and reinforce treatment 

engagement 

uses adaptive models, that adjust treatment type and intensity based on ongoing 

indicators of patient response 

incorporates wrap-around services that are embedded when possible, and 

otherwise through solid linkages with community resources. 

By facilitating treatment that is both accessible and of high quality. gains can be made over 

time that reduce the devastation of SUD on the individuals, families, and communities. 

This can also lessen the extraordinary health care and other societal costs related to SUD. 
60 


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Testimony 

Chairman llarpcr, Ranking Member DeGctte, Committee Chaim1an Walden. Committee 

Ranking Member Pallone, and Members of the Subcommittee, thank you for the opportunity to speak 

with you today about the treatment of substance usc disorder (SUD), in the context of this national 

health crisis. 

I am an addiction psychiatrist, and direct the outpatient SUD treatment program at Johns 

Hopkins llospital, the Broadway Center for Addiction. l am also the medical director of a similar 

program at a Johns Hopkins affiliate hospital, and am an inpatient attending psychiatrist on hospital 

unit that focuses on SUDs. 

With an estimate of approximately 64,000 individuals dying from overdose in 2016, 1 most of 

which were related to opioids. we are fortunate to have at our disposal effective, evidence-based 

approaches to treating SUD. I feel privileged to be part of a system that treats patients with SUD, and 

as a member of local and national associations that endeavor to shape treatment systems to optimize 

care. 

3 Steps Enabling Impactful Treatment 

In my experience, the impact of treatment is optimized when we ensure that three sequential 

actions arc taken: I) Engage potential patients during opportunistic times and in opportunistic settings; 

2) Complete a comprehensive initial assessment to determine the best setting and type of treatment for 

each individual, and 3) Offer treatments that arc evidence-based, high quality, and dynamically 

adjusted. I will be focusing on these three actions tor the next few minutes. 

Action #I: Referral and Engagement 

1 Centers for Disease Control and Prevention. National Center for Health Statistics. Available on !inc at: 

Imps:/ /www. cdc.gov/nchs/products/databricfs/ db294 .htm 
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35759.036

Addressing the tirst step, where do I seek out patients for my treatment programs? I focus on 

locations where the individual is most in need of treatment and is experiencing a "teachable moment" 

when their likelihood of considering treatment entry is high. Accepting patients from settings where 

others have already engaged the individual, and are now seeking facilities to which to link them, helps 

to avoid the all-too-common experience of having the person drawn back into continued use, and 

missing an important and perhaps life-saving opportunity for treatment entry. Sadly, there is no 

shortage of potential patients in Baltimore, and many require immediate engagement. They are found 

in hospital emergency rooms and inpatient units - having survived an overdose, being treated for 

medical problems resulting from injection drug usc, or contemplating suicide due to being demoralized 

by the devastation of ongoing SUD. I Iospitals arc aware of our program and refer those individuals to 

us. Other sources of referral that! have cultivated include Baltimore-area primary care practices. 

Through that work, I established CoOP, a hub and spoke model of collaborative buprenorphine 

treatment that is gaining national recognition. 2 Two other common sources of referral include other 

treatment programs who may decide that one of their patients would be best served in our program. 

And of course, we accept citizens walking in [rom the community. Johns llopkins considers improving 

the health and well-being of the community surrounding our hospitals to be a critical mission. By 

focusing on these and related sources of referral, we serve patients who find themselves on the cusp of 

tragic consequences from their SUD. to themselves and their family. It also can avoid what would 

otherwise be tremendous costs to the health care system if active substance use continued to result in 

frequent avoidable emergency room visits and repeated costly hospital admissions, for people with the 

most severe substance usc, other medical and social problems. 

For example, I examined the emergency room utilization of a patient of mine whose managed 

care organization informed me that he had high volumes of ER visits. I was given data from the prior 

17 months, which included I year when he was not in our program, and 5 months when he was. He 

1 Stoller, K.B. A collaborative 

buprenorphine providers. In 

(CoOP) mode/linking opioid treatment programs ·with (~/]ice-based 

Clinical Practice. 2015: IO(Suppl I):A63. 
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35759.037

had an astounding 81 visits to the emergency room, but only 4 of them were during the time that he 

was in our program. The others were from prior to his admission, and during a brief period that he 

dropped out of care. For the MCO, this translated into a 1 0-fold reduction in monthly spending on ER 

visits alone. 

Finally, by focusing on treating people primarily in their own community, it is easier to 

leverage potential community supports such as family, friends, and local agencies who can help 

increase the strength of our patients' recovery foundation over the long term. 

Action 112: Comprehensive Assessment 

Moving on to the second of the three steps- the initial comprehensive assessment. When 

people ask me what causes SUD, my response oflate always starts the same way "It's complicated." 

In the field of medicine, complex problems require multi pronged and prolonged treatment elements. 

To treat asthma effectively, treatment recommendations are based on patient needs and change over 

time- including environmental abatement, steroid inhalers, nebulizers, pills, rescue inhalers, allergy 

testing, immunotherapy, and other approaches. To most efteetively treat each individual with SUD, my 

clinical and medical staff spend 2 or more hours to develop an initial clinical impression and treatment 

plan. Although SUD can be described by a common set of criteria such as those listed in the DSM-5 

manual,3 the number, combination, and severity of symptoms that individuals experience vary widely; 

and each person brings with them differing strengths, liabilities, and resources. Additionally, the 

person's past experience in treatment can determine next steps to try. You may have heard the saying 

"the detinition of insanity is doing the same thing over and over and expecting different results." Past 

treatment episodes can inform what has worked and what has not been helpful. I have had patients 

report repeated inpatient or residential treatment episodes that have resulted in prompt relapse, and that 

medications have never been tried. For them, I was more likely to recommend a medication trial in the 

3 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: 

American Psychiatric Publishing. 
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35759.038

setting of long-term treatment including counseling in an outpatient program. When other patients with 

opioid usc disorder and co-occurring severe mental health and social problems report failing officebased buprenorphinc treatment, l express that hope is present through participation in a comprehensive 

specialty SUD treatment program that has the resources to effectively address those problems 

alongside their SUD-specific treatment. 

Action #3: Five elements of high quality treatment 

This leads to the third key to impactful treatment the treatment itself. l consider there to be 5 

critical clements of high quality approaches. 

1) They usc medications as clinically appropriate. We are fortunate to have three FDA-approved 

medications for the treatment of opioid usc disorder methadone. buprenorphine and 

naltrexone; ·• and three for alcohol use disorder- naltrexone. disuliiram and acamprosate. 5 

These medications should be chosen, started. discontinued, and restarted over time, according 

to scicnti1ic evidence. considering patient ongoing response and preference. 

2) They combine it with psychosocial treatments. This includes counseling or psychotherapy, 

delivered in individual and group-based settings, by skilled, experienced staiTwho arc welltrained to work with this population. 

3) They usc behavioral therapies, such as contingency management, that motivate positive change, 

discourage drug use, and increase adherence to medication and psychosocial treatments. 6 

4) They usc adaptive stepped care models. This means that objective measures of treatment 

response, like toxicology results and treatment adherence, arc measured continually over time 

and arc used to adjust the intensity and types of treatment while motivating a high level of 

4 SAMHSA TIP 63: /vfedicationsj(;r Opioid Use Disorder. Full Document available for download at: 

https: 1/storc.samhsa.gov/product/TIP-63-Mcdications-for-Opioid-Usc-Disordcr-Full-Document-Including-ExecutiveSummary-and-Parts-I-5-/SMA 18-5063FULLDOC 5 SAMHSA. Afedicationfor the Treatment ofAh:ohol Use /)fsorder: A Brief Guide. Available for download at: 

https: i/store.samhsa. govlprod uct!Mcd ication-for -the-Treatment-of-A lcoho 1-Usc-Disorder-A-Brie f-Gu idc/S MA ! 5-4 907 6 Petry NM, ct a!. Contingency management treatment for ,Yubstam:e use disorders· !-low jar has it come, and tvhere dof!s d 

need tu go" Psycho I Addict Behav. 2017 Dec:JI (S):897-906. 
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35759.039

engagement in those treatments. We have studied adaptive treatment approaches extensively at 

Johns Hopkins, and have demonstrated its powerful impact/ and our accreditation body, The 

Joint Commission. publicly recognized it as an exemplary treatment programH 

5) They incorporate wrap-around services, whether provided within the program or through 

linkages, to support a holistic approach to recovery. This can include resources such as mental 

health assessment and treatment, supportive housing. vocational rehabilitation, 12-step 

facilitation, connections with the spiritual community. primary medical care or health home 

services, hepatitis C and IllY testing and specialty services, and certified peer recovery 

specialists. I recognize that not every program or provider can become a "megamall" of 

embedded services, but when services cannot be integrated directly into the program, strong 

linkages through referral can also be powerful. And speaking of linkage, the most important 

linkage is to carefully-chosen treatment resources at the time of program discharge. Those 

linkages should be facilitated in a way that maximizes patient follow-through and continuation 

in recovery. 

Conclusion 

We arc fortunate to have the ability to meet the challenge of the opioid epidemic head-on with 

e!Tcctivc treatment. The treatment workforce must be adequate in number. well-trained, well-paid and 

supported, and be hopeful and empathic. Comprehensive, highly-regulated, federally-approved opioid 

treatment programs arc well-positioned to be hubs of expertise, resources. and care coordination9 They 

arc an element of a treatment system that can be scaled up locally and nationally to close the treatment 

gap. I appreciate the recent work in congress to increase access to care, such as ellorts to create a 

'Brooner. R.K., KidorC M.S., King, V.L.. Stoller, K.B., Peirce, l.M .. Bigelow. G.E .• Kolodner, K. Behavioral 

contingencies improve counseling attendance in an adaptive treatment model. Journal of Substance Abuse Treatment 

2004: 27(3):223-232. PMID: 15501375. 8 The Joint Commission Ernest Amory Codman Award. National Health Care Award for Performance Measurement 

https ://wv·.'W .j ointcomm ission. org/assets/ l /6/ Addict ion _Treatment __ Services_"_ o(_ John~- H opki ns.pdf 9 Sto!lcr. K.B., eta!. fntegrated Service Delivery Afode!sfhr Opioid li"eatment Programs in an Fra of Increasing Opioid 

Addiction, !fea/th Re.fi:;rm, and Pari(J'. Substance Abuse and Mental Health Administration. 

http://www.aatod.org/policiesimat~hub-setting-whitepapers/ Published online July 13, 2016. 
65 


35759.040

Medicare reimbursement model for our seniors in need of treatment. And I applaud your efforts to 

ensure that when encouraging increases in treatment access, we do not inadvertently sacrifice quality 

of care. 

Sincerely, 

Kenneth B. Stoller, M.D. 

(Note: The statements above reflect the opinion of Dr. Stoller, and not necessarily that of Johns 

Hopkins Medicine.) 
66 

Mr. HARPER. Thank you, Dr.Stoller. 

It is now time for the members to each ask questions of you as 

witnesses. And I’ll begin by recognizing myself for 5 minutes. 

As part of its investigation, the committee has learned about a 

variety of advertising and marketing business models within the 

treatment industry, including the use of websites and phone numbers. There is a wide variation within the industry. For example, 

Hazelden Betty Ford Foundation has three websites that advertise 

its hotline. 

Niznik Behavorial Health has ten websites. American Addiction 

Centers has 13 facility-specific websites, and in addition, has a subsidiary Recovery brands who operates a portfolio of websites. 

And Jason Brian of Redwood Recovery, TreatmentCalls.com has 

84 domains, most of which appear to be related to substance use 

disorder treatment. 

So my question is, and I’ll start with you, Mr. Mishek, but also 

Mr. Cartwright, Niznik, and Brian, do each of your websites contain information that discloses which company or which facilities 

the websites are affiliated with? 

Mr. MISHEK. Our main website, HazeldenBettyFord.org, most of 

our web hits come to that website. The other two that you referenced are prior to our merger with the Betty Ford Center. 

The Hazelden.org is about our publishing, and the other website 

relates to philanthropy. So for consumers seeking treatment, they 

go to one website, HazeldenBettyFord.org. 

Mr. HARPER. And have those disclosures always been on your 

website? 

Mr. MISHEK. Absolutely. 

Mr. HARPER. OK. Mr. Cartwright. 

Mr. CARTWRIGHT. Thank you, Mr. Chairman. 

Yes, we have a variety of websites that specifically to American 

Addiction Centers or our drug and alcohol treatment centers in the 

different States, Desert Hope, Green House and Texas, we have a 

treatment center. And then we have Recovery Brands, which is the 

portfolio that you are concerned about. 

Mr. HARPER. OK. My question is, to be sure that I’m clear here, 

do those disclose which company or which facilities those websites 

are affiliated with at that point? 

Mr. CARTWRIGHT. Yes, sir, they do. 

Mr. HARPER. OK. And have those disclosures always been on 

those websites? And if not, when were they added? 

Mr. CARTWRIGHT. They were not. We had bought Recovery 

Brands. It was a company that was out of the State of California. 

And when we bought that company, one of the things that we do 

as a publicly traded company, we have a group of lawyers that vetted those sites, went through them, looked at those websites, 

looked at where we should be, make sure we’re in compliance. And 

we’ve done that over about a 2-year period. 

Mr. HARPER. Were they—— 

Mr. CARTWRIGHT. Go ahead. 

Mr. HARPER. Were they operational while they were being reviewed and looked at by your team? 

Mr. CARTWRIGHT. They were. They were owned by another company. We had a group of attorneys that reviewed them, looked over 

67 

the websites, and we found that they were the most ethical, 

straightforward websites that we saw as related to third-party 

websites that we could find out there. 

We asked them to do some changes, which they did, and before 

we bought that organization. When we bought that organization 

and since we’ve operated, it has absolutely been 100 transparent 

websites. 

Mr. HARPER. Mr. Niznik. 

Mr. NIZNIK. Of the websites you mentioned, the majority of them 

are facility websites. And when you go on the website you know 

that it is the facility you’re calling, or the NBH websites, so you 

know who you’re reaching. And then of the other two websites we 

operate that are now branded as our programs, they do disclose 

who owns them, who answers the calls, and then when someone 

does call, the employee answering the call identifies themselves as 

an employee of the company. 

Mr. HARPER. Have those disclosures always been on those 

websites? 

Mr. NIZNIK. They have. 

Mr. HARPER. From the beginning? 

Mr. NIZNIK. They have. 

Mr. HARPER. OK. Then Mr. Brian? 

Mr. BRIAN. Thank you. You referenced that we own 84 websites. 

The question that was directed to me prior to this in the phone 

call that I had was to provide a list of any domains that I owned. 

Those 84 domains, I own. The company owns. 

None of which are geared towards addiction treatment outside of 

TreatmentCalls.com and Redwood Recovery Solutions. 

Mr. HARPER. OK. 

Mr. BRIAN. And so those two sites are business-to-business sites. 

So we don’t have any sites. We’ve never owned sites that induced 

a call from a treatment-seeking individual to a treatment center. 

That wouldn’t be our model. 

Mr. HARPER. OK. So those other 82 domains? 

Mr. BRIAN. Yes, sir. 

Mr. HARPER. Are not related to addiction or recovery? 

Mr. BRIAN. They were domains that were purchased. They probably, most of which don’t even have any content on them. They 

were just websites that were listed that we purchased from an online domain buying service. 

Mr. HARPER. Are they operational today? 

Mr. BRIAN. No, sir. 

Mr. HARPER. Not operational? 

Mr. BRIAN. I would imagine that less than a dozen of those are 

operational, which are business-to-business like 

TreatmentCalls.com is. 

Mr. HARPER. All right. And those dozen or so, they are set up to, 

if you contact them, where does it go? 

Mr. BRIAN. It would ring directly into TreatmentCalls, to Redwood Recovery Solution, to our organization. There’s no businessto-consumer or consumer-facing sites designed to have somebody 

call in for addiction help. 

Mr. HARPER. Does that domain, does it show on its face that it’s 

affiliated with Redwood? 

68 

Mr. BRIAN. Yes, sir. 

Mr. HARPER. All of those? 

Mr. BRIAN. To other businesses, to treatment centers seeking our 

service? Yes, it would say that. 

Mr. HARPER. All right. And my time is expired. So I will now recognize the ranking member of the subcommittee, Ms. DeGette for 

5 minutes. 

Ms. DEGETTE. Thank you very much, Mr. Chairman. Mr. Chairman, I have here in my hand a list of Mr. Brian’s websites that 

you were referring to. I would ask unanimous consent to put it in 

the record. 

Mr. HARPER. Without objection. 

[The information appears at the conclusion of the hearing.] 

Ms. DEGETTE. So Mr. Brian, I’m looking at all this list of 

websites. I’m trying to figure out exactly how your business 

worked. 

Mr. BRIAN. Yes, ma’am. 

Ms. DEGETTE. So what would happen is somebody—here’s one, 

TreatmentCalls.com. Somebody might go on to that website and see 

a phone number and call, and that would go into your call center. 

And then you would, your business would refer that off to a certified treatment center, is that correct? 

Mr. BRIAN. No, ma’am. And I can—— 

Ms. DEGETTE. OK. Tell me what happened, please, briefly. 

Mr. BRIAN. Yes, ma’am. So TreatmentCalls.com is a site that offers treatment call services to treatment centers. It’s not a site designed for consumers who might be looking for help. 

Ms. DEGETTE. I see. So the way your business works though—— 

Mr. BRIAN. Yes, ma’am. 

Ms. DEGETTE [continuing]. Is treatment centers would pay you 

to refer calls to them. So there would be advertising, people would 

call in—— 

Mr. BRIAN. Yes, ma’am. 

Ms. DEGETTE [continuing]. To your phone numbers, and then 

they would be referred out, right? 

So there was no judgment on the part of your business about 

which centers would be appropriate to send the calls to. The calls 

would be referred to the centers based on who, which centers paid 

you money to refer the calls to them, right? 

Mr. BRIAN. If I can just correct one portion of it. 

Ms. DEGETTE. Please. 

Mr. BRIAN. We did not own the phone numbers or the websites. 

We worked with third-party affiliates that we—— 

Ms. DEGETTE. OK. 

Mr. BRIAN [continuing]. Made a per call fee. 

Ms. DEGETTE. Right. 

Mr. BRIAN. We paid them. 

Ms. DEGETTE. Right. 

Mr. BRIAN. And the treatment centers ultimately paid us a per 

call fee for sending them calls. 

Ms. DEGETTE. So people called the phone number. 

Mr. BRIAN. Yes, ma’am. 

Ms. DEGETTE. And then that went somewhere else. 

69 

Now, Dr.Stoller, has your organization ever used a system like 

this to get patients for your facility? 

Dr. STOLLER. Well, fortunately or unfortunately, the prevalence 

of substance use disorders—— 

Ms. DEGETTE. Yes or no will work. 

Dr. STOLLER. No. 

Ms. DEGETTE. Have you ever used a substance like this, and why 

not? 

Dr. STOLLER. No, we haven’t. 

Ms. DEGETTE. Why not. 

Dr. STOLLER. We don’t need to do that sort of outreach for patients. 

Ms. DEGETTE. Do you think that’s an effective way for patients 

to get matched with an appropriate treatment facility? 

Dr. STOLLER. We prefer to link with other providers who have already engaged with patients. 

Ms. DEGETTE. So, in other words, you think the best practice, as 

you testified in your testimony, is when a doctor or somebody else 

sees a patient or an emergency room refers them to you. Is that 

right? 

Dr. STOLLER. I do. 

Ms. DEGETTE. Now, Dr. Mishek, let me ask you that same question. Does your organization use call centers like this where people 

come in and are referred to you? 

Mr. MISHEK. Absolutely not. 

Ms. DEGETTE. And why not? 

Mr. MISHEK. Well, we don’t need to. Number one, we’re overwhelmed with calls directly into our call center. And number two, 

we need to take the people who come to us and assess them. We 

don’t need a third party to be funneling someone to us who may 

have an eating disorder and shouldn’t be coming to us in the first 

place. 

Ms. DEGETTE. Well, this is an interesting question to me because 

the two of you gentlemen are here representing two of the premier 

centers in this country, but there are thousands of people who need 

addiction services who might be going to other centers. So do you 

think there’s some kind of inherent problem with using these call 

aggregators like we heard about from Mr. Brian? 

Mr. MISHEK. I certainly do. Only 1 out of 10 people who need 

help get help, so there are plenty of patients out there who need 

help. It’s not like there’s a scarcity of patients and we’re all fighting over the next patient. 

Ms. DEGETTE. Right. 

Mr. MISHEK. It’s not that way at all. 

Ms. DEGETTE. Right. 

Mr. MISHEK. So, treatment centers that are accredited, have 

good, licensed staff, and are doing great work generally don’t have 

any trouble acquiring and attracting patients, both through professional referrals, through word of mouth, and through community 

reputation. 

Ms. DEGETTE. Mr. Ventrell, you look like you want to add. 

Mr. VENTRELL. Well, I was nodding along, Congresswoman. The 

issue becomes whether a clinical assessment is being made or—— 

Ms. DEGETTE. Right. 

70 

Mr. VENTRELL [continuing]. A sales assessment is being 

made—— 

Ms. DEGETTE. Right. 

Mr. VENTRELL [continuing]. And that’s essentially the distinction 

that’s drawn here today by Dr. Stoller and Mr. Mishek. People are 

looking for healthcare. 

Ms. DEGETTE. Right. 

Mr. VENTRELL. The word ‘‘rehab’’ itself has caused us to go down 

the wrong path, but people are looking at healthcare and you look 

for healthcare at the hospital. You look for healthcare at the facility that provides that healthcare. To have a website that does not 

identify primarily as its owner, the clinical provider is fundamentally deceptive, in our view. 

Let me just also say quickly that the little ‘‘I’’ isn’t good enough. 

The little ‘‘I’’ isn’t good enough. So one of the questions that the 

chairman asked is, does your site identify or disclose your identity? 

Ms. DEGETTE. Yes. 

Mr. VENTRELL. That’s a very thoughtful question, but I don’t 

think it should even have—that question shouldn’t even have to be 

asked. 

Ms. DEGETTE. Right. They should know who they’re calling. 

Mr. VENTRELL. It should simply be the site of the individual. 

Ms. DEGETTE. Right. 

Mr. VENTRELL. I don’t go to the little ‘‘I,’’ and consumers in crisis 

certainly don’t know how to do that. And the fact that it ultimately 

identifies it is, frankly, wholly inadequate. 

Ms. DEGETTE. Thank you very much. Thank you, gentlemen. 

Mr. HARPER. Ranking Member DeGette yields back. 

The chair will now recognize the chairman of the full committee, 

Chairman Walden, for 5 minutes. 

Mr. WALDEN. Thank you very much, Mr. Chairman. 

Again, thanks to everybody on the panel as we try and dig into 

this issue and figure out how things are working, how they’re not 

working, and where there needs to be improvement. 

So I guess one of the questions I’d have off the top is, the business model for one of today’s witnesses, Mr. Brian of Redwood Recovery, appears to be entirely based on the sale of prospective patient calls to treatment facilities. And my question is, have your 

companies, your facilities, or your subsidiaries ever paid or sold for 

leads? And I would address that to Mr. Niznik, Mr. Cartwright, 

and Mr. Mishek. 

Mr. NIZNIK. So we advertise in a lot of mediums online, on television, on the radio. So the only sorts of advertising we do is that 

sort, the traditional advertising where someone sees an ad or 

comes across our website and calls us. 

Mr. WALDEN. OK. So the question is, have your facilities or your 

subsidiaries ever paid for or sold leads? 

Mr. NIZNIK. No, we haven’t. 

Mr. WALDEN. OK. Next, Mr. Cartwright. 

Mr. CARTWRIGHT. With Recovery Brands’ websites, it’s a business 

model very similar to YP.com, yellowpages.com, or WebMD. We 

have advertisers on those websites. Three hundred advertisers are 

NAATP members. Actually, Betty Ford Center used to be a pretty 

71 

large advertiser of ours as well. So we have advertisers on our 

websites, recoverybrands.com. 

So thank you very much. 

Mr. WALDEN. All right. 

Mr. MISHEK. No, we never have. 

Mr. WALDEN. Never paid or sold leads? 

Mr. MISHEK. No, we never have. 

Mr. WALDEN. OK. Mr. Ventrell, the National Association of Addiction Treatment Providers recently updated its code of ethics, 

with particular focus in the advertising and marketing space, to 

fight back against practices of patient brokering, including this 

kind of lead generation. Can you explain and perhaps write a few 

examples for what practices the Association was seeing in the substance use disorder treatment industry that led it to revise its code 

of ethics? What did you see? 

Mr. VENTRELL. Yes, Mr. Chairman. Thank you. National Association had a code of ethics for some time. In spirit, it prohibited all 

the kinds of practices that have been discussed here today. However, it wasn’t thought necessary, prior to last year, that we specifically articulate exactly what right and wrong is. Our good providers didn’t need to be told right and wrong. They were just doing 

right. But we came to understand that that’s not true across the 

board, and we approved our new ethics code 2.0 on December 31, 

2017, and it became effective on January 1. It specifically defines 

and prohibits the kinds of conduct we’re talking about today. 

The first and foremost of these would be patient brokering. 

Under no circumstances may an NAATP member or under any circumstances should any treatment provider, in our view, buy leads 

or sell leads. And so if there’s a connection with doing that, it is 

prohibited by our code and you may not be an NAATP member. 

A second area that came up frequently was licensing and accreditation misrepresentation. It is difficult enough for the consumer to 

understand what they need. When the provider misrepresents or 

does not adequately display precisely what they are licensed or accredited for, the consumer can’t know what they are getting, and 

that lack of regulation is extremely dangerous. 

The third and most prevalent reason why we removed certain 

members from our rolls, Mr. Chairman, is what we call unbranded 

or inadequately branded sites. You received information from your 

staff that indicates, among other things, that we have sacrificed approximately $100,000 in dues revenue and removed 24 parent companies from our membership rolls primarily for this reason. 

There are multiple reasons, but the primary reason why members were not renewed, or as incoming applications occur and are 

denied, is because we find that there is inadequate branding on the 

site for the same reason that I just discussed with Ranking Member DeGette: The ability to somehow investigate and determine ultimately that the site is connected to a provider is simply not adequate. It should be branded as, for example, the Hazelden Betty 

Ford site is. 

So for the most part, where we have removed members or not invited members or declined an application it has been because of the 

deceptive websites. 

Mr. WALDEN. All right. 

72 

Mr. VENTRELL. It’s just a question of transparency, Mr. Chairman. 

Mr. WALDEN. Thank you. Thank you. 

I want to go back, because I maybe didn’t hear this right, to Mr. 

Cartwright. I was looking at my notes here. Just yes or no, have 

your companies, your facilities, or your subsidiaries ever paid for 

or sold leads? 

Mr. CARTWRIGHT. No, we don’t pay for or sell leads. Recovery 

Brands has an advertising model very similar to WebMD or 

yellowpages.com, and I’m assuming that Hazelden Betty Ford and 

NAATP must like that model, because about 300 of the NAATP 

members are advertisers of ours. About half of our advertising revenue comes from NAATP members, so we hold ourselves up as a 

solid organization of the way you can do and should do advertising 

on the internet. 

Mr. WALDEN. I’m just sensing, Mr. Chairman, with your indulgence, maybe a disagreement on the other end of the panel. Is that 

accurate? Mr. Cartwright—— 

Mr. VENTRELL. Mr. Chairman, are you recognizing me? 

Mr. WALDEN. Yes. 

Mr. VENTRELL. Thank you. I—Mr. Cartwright’s written testimony, which I saw for the first time yesterday, indicated this 300 

number, that there are 300 NAATP members which advertise on 

the site. I am unfamiliar with this. I’m surprised to hear this information, but I am entirely open to finding out exactly what it is. 

I would ask for the opportunity to determine whether that’s true 

by being provided a list of those 300 members, and then also ask 

ourselves what do we mean by advertising, right. There is a common practice generally among the problems on the website to bring 

in good providers, put them on the site. 

I’m not saying this is the case here. I don’t know that. But there 

is a common practice to grab a Hazelden Betty Ford or a Caron or 

a Harmony Foundation and put their information on the site as if 

it were part of when, in fact, there is not a motive to produce 

that—— 

Mr. WALDEN. Right, OK. Mr. Cartwright, are you OK sharing 

that information with them so we can get to the bottom of this? 

Mr. CARTWRIGHT. I would be happy to share it. And the easiest way to look at it is, we generate about $8 million a year of our 

$400 million annual budget through advertising. And about onehalf of that $4 million a year is coming from NAATP members. 

Mr. WALDEN. Thank you for your indulgence, Mr. Chairman. 

Mr. HARPER. Chairman Walden yields back. 

So if you’ll make sure, Mr. Cartwright, you get us that list, that 

would be very helpful. 

The chair will now recognize the gentlewoman from Florida, Ms. 

Castor, for 5 minutes. 

Ms. CASTOR. Thank you, Mr. Chairman and Ms. DeGette, for 

calling this hearing. 

There are all sorts of press reports out there about unscrupulous 

actors that engage in deceptive marketing practices and who take 

advantage of patients, and I’ve heard directly from many families 

back home in Florida. And I’d like to discuss some of the problems 

and what we can do to solve it. 

73 

Mr. Ventrell, you’ve gone into some detail here with—could you 

further expand on what you see as major problems with deceptive 

sales in the addiction treatment industry and how they prevent patients from getting the care that they need? 

Mr. VENTRELL. Thank you, Congresswoman. If one begins by assuming that we need a transparent clinical assessment, much of 

the problem goes away. The fundamental problem is that most of 

the problematic areas do not promote a clinical assessment where 

the patient or the consumer understands who is performing that 

assessment. It’s compounded by the fact that folks don’t know what 

clinical assessment that they need. 

The primary areas continue to be licensing and accreditation confusion and misrepresentation, unbranded or inadequately branded 

sites. And toward those goals, we have been very clear in two ways: 

One, you must have that clearly branded site, and now our association has, as of this month, adopted a new requirement that all 

NAATP members must be accredited. 

There needs to be a system whereby quality and safety are adequately regulated and business operations are adequately regulated. The accrediting, certifying, licensing bodies traditionally and 

appropriately handle quality and safety. There has been very little 

regulatory oversight as it concerns business operations, and that is 

why we are producing the guidebook for operations, which I will 

hopefully commend to the committee for study. 

Ms. CASTOR. First of all, you have a family or an individual that 

is searching for information on how to get substance use treatment, 

you’re not shopping for clothing or something else. 

And, Dr. Stoller, you highlight this problem too. Is it appropriate 

to go shopping on the internet for how you’re going to be treated 

for addiction? 

Dr. STOLLER. I would recommend somebody looking for treatment 

on the internet to go to particular sites, such as the SAMHSA 

treatment locater. The National Institute on Alcoholism and Alcohol Abuse has recently created a website that helps consumers to 

look at those sorts of things. 

The other thing is that jurisdictional entities, such as county 

health departments, are really good sources for information about 

substance use disorders and also where they—that people might be 

able to go to achieve the best match for the person’s needs with the 

treatment program that can provide them with those services. 

Ms. CASTOR. Rather than shop in general on the internet and see 

what comes up in the ranking on that page and then hit the first 

one and—— 

Dr. STOLLER. That’s correct. 

Ms. CASTOR. So, Mr. Ventrell, you said your organization has removed members for failing to adhere to the code of ethics. You 

went into some detail on that, on patient brokering and buying and 

selling leads. Is it possible that conduct by one of your former 

member organizations that violated the code of ethics also violated 

the law? 

Mr. VENTRELL. It’s possible, Congresswoman, but I don’t know 

specifically of an instance of that. Certainly, it is possible. 

Ms. CASTOR. Does that need to be clarified? What do you understand the law to say? 

74 

Mr. VENTRELL. Relative to what precisely? 

Ms. CASTOR. To patient brokering. 

Mr. VENTRELL. Well, the law of patient brokering has been very 

confusing and, to some extent, nonexistent and State-by-State 

based. It needs to be clarified, and I would support Mr. Mishek’s 

recommendation that there be a Federal law in this regard. 

So we’ve all heard of the horrors that occurred in south Florida. 

Certainly, there was similar activity in Arizona and also southern 

California, and it’s probably not isolated to those States. If patient 

brokering, body brokering, paying for the delivery of a body for care 

was made, one would have to determine what the State regulation 

was and that would be a legal determination. 

I will say, however, that if Federal moneys were being involved 

in the treatment of that individual, Medicare, Medicaid, that I believe I would be correct in saying that that would have been a legal 

violation, irrespective of State law. 

Ms. CASTOR. Thank you very much. I yield back. 

Mr. HARPER. The gentlewoman yields back. 

The chair will now recognize the vice chairman of the subcommittee, Mr. Griffith, for 5 minutes. 

Mr. GRIFFITH. Thank you very much, Mr. Chairman. 

I’m going to build on some of the prior testimony and questions 

about NAATP’s updated code of ethics. 

Mr. Cartwright, as you’ve indicated to Chairman Walden, there 

are about 300 treatment providers that are members of NAATP 

who advertise on your website. So my question is, if I go to your 

website later today, am I just going to find your traditional straight 

advertising, treatment center A, treatment center B, treatment 

center C, and it just rotates based on who’s up next like the line 

of cabs? Is that how your system works? 

Mr. CARTWRIGHT. No, sir, it doesn’t. It operates very similar to 

YP.com, yellowpages.com. If you go into a particular area in the 

State of Colorado and you went into Denver, it would only list operators within that State, and then there would—I’m sorry. 

Mr. GRIFFITH. No, that’s fine. I got it. 

And so the question is, it helps focus where you’re going, is what 

you’re saying. But my question is, is it just advertising? Are you 

telling us that you don’t get paid anything for a straight referral 

or for a head count? 

Mr. CARTWRIGHT. That is correct. It’s straight advertising. 

Mr. GRIFFITH. And that’s never been the case? 

Mr. CARTWRIGHT. That’s never been the case. 

Mr. GRIFFITH. And so when these ads are up there, your folks 

don’t actually talk to the people, and it just focuses them in and— 

the next question is, what sort of vetting, if any, does AAC do before letting another treatment provider advertise on your website? 

Mr. CARTWRIGHT. They would need to be on the samhsa.gov. We 

really take that website very seriously, that we’re assuming the 

Substance Abuse and Mental Health Administration in their listing 

is vetting folks. They have to be licensed, joint commission accredited or CARF accredited. 

Mr. GRIFFITH. OK. Is AAC itself a member of the NAATP? 

Mr. CARTWRIGHT. We’re a member of a different organization, 

National Association of Behavioral Healthcare. It’s been around for 

75 

about 85 years. A lot of the larger companies join that. You’ve got 

to remember, most of NAATP is smaller, not-for-profit organizations. We feel like that with HCA and Acadia and UHS, some of 

the larger organizations, that’s meeting our needs more appropriately. 

Mr. GRIFFITH. Prior to the new ethics standards that we’ve 

talked about today, weren’t you all a member of the NAATP? 

Mr. CARTWRIGHT. I go back two decades being a member of 

NAATP, back to when I was on their board of directors. So, again, 

back when I was a not-for-profit agency, I thought that was a very 

effective organization. I could go back and look at the exact date 

that we’re no longer members, but you’re right, Marv asked us not 

to be members based on their new marketing practices or ethical 

guidelines that he has. 

I really don’t think he fully understood, though, our websites. I 

think he got confused with some other websites that are absolutely 

websites that are nontransparent. And we’re supportive of new 

marketing standards. In the State of Tennessee we just passed the 

toughest law on marketing standards, and we would recommend, 

just like Mr. Mishek did, let’s take that national. Let’s do that on 

a national basis and take a law like Tennessee or take a law like 

Florida—they’ve been working very, very hard in the State of Florida to get this right. We would support that. We actually were extreme supporters of that measure that passed in the State of Florida, California, and Tennessee. If you want to talk to some of the 

legislators in those States about our activity, I’m happy to put you 

in touch with them. 

Mr. GRIFFITH. Mr. Ventrell, you want to make any comment on 

that? 

Mr. VENTRELL. I must be demonstrative in my demeanor that 

suggests to the members of the committee to call on me when I 

haven’t raised my hand, but thank you. 

Mr. GRIFFITH. Was there merely a misunderstanding? That’s 

what I’m trying to find out. Did you not understand what he’s 

doing? 

Mr. VENTRELL. Mr. Cartwright just suggested that I might not 

fully have understood what American Addiction Centers was doing. 

What happened was at the expiration of American Addiction Centers term, which was December 31 of 2017, we reviewed its practices and determined that it wasn’t in sufficient compliance with 

our ethical rules. The primary reason for that was the website 

issue, the inadequately branded or unbranded website, so we did 

not invite them back. 

Mr. GRIFFITH. OK. 

Mr. VENTRELL. It’s as simple as that. 

Mr. GRIFFITH. So the primary issue was that you couldn’t tell— 

if you just went there—you couldn’t tell whether it was one of 

theirs or somebody else’s or what treatment center was being referred and who was telling folks to do that. Is that accurate? 

Mr. VENTRELL. Yes. We believed it was inadequately transparent. 

Mr. GRIFFITH. All right. I’ve got to move on to some other questions. 

76 

Mr. Cartwright, I’m going to switch gears on you. AAC operates 

several websites that might appear to consumers—and it gets to 

the same vein—but it might appear to consumers to be unaffiliated 

third-party resources, such as drugabuse.com, rehabs.com, 

projectknow.com. 

Mr. Niznik, your company does the same thing through its operation of addictionrecoverynow.net and findingtreatmentnow.com. 

Unless consumers click on the information buttons next to the 1– 

800 numbers advertised on the website, isn’t it true they may not 

realize who is behind the websites or answering their calls? 

First, Mr. Cartwright, yes or no. And then, Mr. Niznik, isn’t it 

true they may not realize who’s behind the websites or answering 

their calls? 

Mr. CARTWRIGHT. I think it’s very clear on our websites that they 

know who they’re calling. 

Mr. GRIFFITH. Mr. Niznik? 

Mr. NIZNIK. I also believe it’s pretty transparent on our sites who 

they’re calling, and then, more importantly, when they do call, they 

immediately know who they’re talking to. So even if they’ve read 

a blog or content online, as soon as they speak to someone, they 

know who they’re dealing with. 

Mr. GRIFFITH. And I see I’m over my time. But Mr. Ventrell earlier said pushing on the ‘‘I’’ doesn’t work. I’m out of time. I apologize. 

I yield back. 

Mr. HARPER. The chair will now recognize Mr. Tonko for 5 minutes. 

Mr. TONKO. Thank you, Mr. Chair. Thank you to our witnesses. 

When opioid addiction patients are seeking help, what matters 

most is that they get the quality care that they need. The problem 

is many families don’t know what to look for in an addiction treatment provider. And the promises that some facilities make, such as 

expensive housing and various forms of therapy, sound enticing, 

but families need to know what will actually help their loved ones 

in their treatment. 

So, Dr. Stoller, you run the addiction center at Johns Hopkins, 

which has an excellent reputation for high-quality treatment. And 

I understand you also provide all of the medication-assisted treatment options such as buprenorphine and methadone with that 

MAT concept. How do you determine whether a patient should receive MAT and which MAT therapy is appropriate? 

Dr. STOLLER. Thank you. We do a comprehensive evaluation 

upon consideration of admission of any patient. At the end of that 

comprehensive evaluation, we might recommend that the person go 

someplace else. Maybe they need an inpatient admission for alcohol 

detoxification or something else. 

The most important thing is that the patient has particular 

needs that we feel like we can match. The way that we match that, 

let’s just look at medication-assisted treatment, is that we look at, 

number one, patient preference. So some people come with a particular preference. Number two, we look at their past history of 

treatment, both their successes and their failures. Both are important in determining what the person might need right now. We 

also look at other medications that they might be on, their parVerDate Nov 24 2008 12:09 Apr 10, 2019 Jkt 037690 PO 00000 Frm 00080 Fmt 6633 Sfmt 6633 U:\MY DOCS\HEARINGS 115\HEARINGS\115-155 CHRIS
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ticular symptoms of disorder, how long they’ve been using, and the 

severity of their use. 

Mr. TONKO. Thank you. 

And as we know, millions of Americans are affected by this crisis, and not every family can afford the higher-end facilities. Dr. 

Stoller, what treatment options are there for people with limited 

means, and do you have to spend a lot of money to get quality care? 

Dr. STOLLER. So I’ll go back to my written and oral presentation. 

I think that there are particular requirements of a treatment program in terms of delivering care that is comprehensive. The use of 

medication-assisted treatments for people with opioid use disorder 

is very important, and if the particular program doesn’t deliver it 

themselves, for whatever reason, then connections and very strong 

linkages with programs and physicians who do is very important. 

We have a hub-and-spoke model where we use our opioid treatment program as a hub, and we work very closely with area primary care providers and psychiatrists who might be providing that 

medication-assisted treatment. 

Mr. TONKO. Thank you. And what are some reliable metrics to 

use to demonstrate a success rate for opioid addiction treatment? 

Dr. STOLLER. One of the most important ones is retention within 

the system of care at a level of care that matches the person’s need. 

So when somebody leaves treatment with us, despite the fact that 

they need ongoing treatment and they’re leaving the treatment system, that’s not an indication of success. That said, if the person is 

leaving with a very positive sense of hope of what a treatment program can offer them and they come back to us, that could be good. 

We also—— 

Mr. TONKO. OK. I’ve got a few questions here to go, so I want 

to get to everyone. 

Mr. Mishek, Hazelden Betty Ford is another gold standard in 

this industry. Your written testimony speaks to quality standards 

you’ve identified for addiction treatment providers. Briefly, how do 

you determine what a successful treatment is, and how do you 

measure outcome for your patients? 

Mr. MISHEK. We measure outcomes by checking back with our 

patients at 1 month, 3 months, 6 months, 9 months, and 1 year 

after they leave our care, at whatever point they leave our care, 

whether it’s after an extensive long-term treatment or after, let’s 

say, 3 weeks of residential care. We measure three things: continuous abstinence during that period of time; second of all, we measure percent days abstinent. That is, they may have relapsed during 

that period of time, but if they got right back into the program 

with hope and move forward, that’s great, and we would consider 

that a success. And then finally, we have a series of quality-of-life 

measures that we measure over that period of time. So those are 

the metrics that we have in place that we’ve had for a number of 

years. 

Mr. TONKO. Thank you. 

And, Mr. Cartwright, turning to you, I’ll ask you about how your 

facility ensures high-quality care. And first of all, in your response 

to the committee’s letter, you provided your client outcome study 

that found ‘‘63 percent of AAC patients maintain abstinence 1 year 

after treatment.’’ How many patient responses is that 63 percent 

78 

success rate based upon, and just how many patients enter the 

doors of AAC treatment centers each year? 

Mr. CARTWRIGHT. Thank you very much. I’m most proud of the 

outcome studies. We partnered with an organization in Nashville, 

Centerstone Research Institute, to do a 3-year longitudinal study. 

Many times you’ll see SAMHSA do these studies or NAADAC do 

these studies. We had 4,000 patients that went through this study 

with Centerstone Research Institute. They’re the ones that conducted the followup calls, very similar to Mr. Mishek. They did 

that on the intake process, 2 months, 6 months, and 1-year 

posttreatment. And we have an entire study. We can get all the 

members of the committee that study. Be happy to dig in and get 

you in touch with Centerstone Research Institute that actually conducted the study. 

Mr. TONKO. And how many are you saying completed that 1 

year? 

Mr. CARTWRIGHT. Four thousand. Four thousand people went 

through the study, and I can get you the details on the entire 

study. TCenterstone Research Institute is the one that did the 

study. We didn’t do that ourselves. We didn’t have our staff members calling the patients back. It was a research institute that did 

that for us. 

Mr. TONKO. So I’m clear on the response, so you said you sent— 

you had—approached how many people to respond? 

Mr. CARTWRIGHT. Four thousand. 

Mr. TONKO. And how many responded that had that 63 percent 

success rate? How many of those 4,000 responded? 

Mr. CARTWRIGHT. Again, I can get you the exact numbers from 

Centerstone Research Institute. They’re the ones that conducted 

the study. My staff didn’t conduct the study, but I can get you the 

details on that study if you’d like it. 

Mr. TONKO. Thank you very much, Mr. Chair. I yield back. 

Mr. HARPER. The gentleman yields back. 

Before I recognize the next member for questions, I just want to 

be clear, Mr. Ventrell, you had stated earlier that the little ‘‘I’’ isn’t 

good enough. And I assume by that you’re referring to the little circle, the information button on a website that you have to click on? 

Mr. VENTRELL. That’s correct. 

Mr. HARPER. OK. With that, the chair will now recognize Dr. 

Burgess for 5 minutes. 

Mr. BURGESS. Well, thank you, Mr. Chairman. 

And, Dr. Stoller, thank you for your testimony, and thank you for 

your honesty when you address the fact that it’s complicated. In 

the treatment of these patients, the disease itself is complicated. 

The people who are affected by the disease themselves can be 

sometimes very complex individuals with very complex histories 

and, oftentimes, there are confounding comorbidities that have to 

be taken into consideration. And as a consequence—well, let me 

just back up a little bit. 

Your expertise that you bring to this, you are a board certified 

psychiatrist? Is that correct? 

Dr. STOLLER. Yes, I am, and with additional qualifications in addiction medicine. 

79 

Mr. BURGESS. So the committee had the ability to refer everyone 

with this problem to you or someone of similar qualifications, but 

unfortunately, that’s not always the case. And we are left with trying to provide as much care as possible to protect the greatest 

number of people, but recognize that it’s an imperfect process. 

But at some point I would love to visit with you and get your 

perspectives on how much is OK, how much is too much. And I suspect you have some pretty keen insights into this, and I really 

would welcome the opportunity to follow up with you on your experience in treating, again, this very complex type of patient. 

Dr. STOLLER. My pleasure. 

Mr. BURGESS. Mr. Ventrell, let me ask you a question. 

And thank you for that answer. 

Your organization, the National Association of Addiction Treatment Providers, so you had some people that you did not renew because they did not meet your standards. Is that correct? 

Mr. VENTRELL. That’s correct. 

Mr. BURGESS. And tell me again how many different centers you 

did not renew? 

Mr. VENTRELL. Yes. First of all, let me explain that sometimes 

we will hear a number that represents campuses, other times you 

will hear a number that represents the parent corporation. 

The answer to your question is 24 parent corporations, 99 facilities. And that is the number, sir, as of last week, Friday. 

And so what has happened is the majority of NAATP membership functions on a calendar year. The majority of members expire 

on December 31 of the calendar year. So that is why the vast majority of those who are no longer part of our rolls were deleted at 

that time. But this continues to go on throughout the year, and as 

we receive applications or see other issues, we may remove based 

on that. 

So the number has increased since December 31, which was the 

number that that your committee staff gave you. 

Mr. BURGESS. So you’re in the rehabilitation business or you represent companies that are. Are there some of those people who fell 

through that—some of those organizations or those facilities that 

were just one or two clicks off of being OK where you could work 

with them and bring them back into the fold, or was it once you’re 

done, you’re done? 

Mr. VENTRELL. Thank you for that question, because our goal is 

not to remove members. Our goal is to create a society, a professional society of treatment providers that are aligned in terms of 

values-based care and ethics. And so what we want to do when we 

receive a complaint or become aware of an act is to contact that 

treatment provider and say, this is a problem. Can you fix it? 

Mr. BURGESS. Let me ask you about that, that becoming aware 

of something. And I’m purposely not asking our other witnesses 

about any history of lawsuit activity or pending litigation. I don’t 

want to get into that. But is that something that you consider 

through NAATP, if there has been a settlement, if there has been 

an action or an allegation, is that something that you evaluate? 

Mr. VENTRELL. As it concerns potential liability to our organization, is that your question? 

80 

Mr. BURGESS. No. The liability experience of one of the providers. 

Is that something that would be a red flag? 

The reason I bring that up is I cited the testimony that we had 

last December from Eric Gold, who was an assistant attorney in 

the Massachusetts Attorney General’s Office. And I asked him the 

question, I said, look, I’m a doctor. I practiced for years. If things 

are not going well, you worry about liability lawsuits, and where 

are those liability lawsuits for the types of organizations that he 

brought before our committee that morning. And he said, well, it 

just doesn’t happen. And that was a little bit astounding to me. I’ve 

got to believe that sometimes litigation does result. 

Do you evaluate that litigation when that’s all public knowledge, 

correct? 

Mr. VENTRELL. Certainly. We want to know what all of our centers are doing in terms of clinical and business operation, and if we 

become aware of that, that would certainly be a red flag that concerns us. 

Mr. BURGESS. And so has that happened? 

Mr. VENTRELL. Not specifically to my knowledge, no. 

Mr. BURGESS. Has not. And, again, I find that surprising. 

I just have one last observation, and I want to ask our treatment 

centers predominantly to get back to me with this information. One 

of the family members that was interviewed in our roundtable earlier this year talked about her son. She said it was continued on 

her medical insurance up to age 26, eventually died of an overdose, 

but not before he had been resuscitated seven times with Narcan 

in emergency rooms. 

And her question to us was, how can he still be on my insurance 

and I not be informed of this type of activity, and what was preventing someone from telling me that my son was in an emergency 

room seven times requiring Narcan? So, again, I’m going to submit 

that question for the record, but I would be interested in your responses to that. 

And I yield back, Mr. Chairman. 

Mr. HARPER. The gentleman yields back. 

The chair will now recognize the gentlewoman from Indiana, 

Chairman of our Ethics Committee, Mrs. Brooks, for 5 minutes. 

Mrs. BROOKS. Thank you, Mr. Chairman. 

And I would like to talk a little bit about the call center employees and concerned about the types of incentives that might happen 

relative to call centers and connecting. Although I certainly appreciate that, as we’ve talked and heard, those with addictions that 

I’ve talked to or their families, I appreciate that it is incredibly difficult work that treatment centers provide. And success rates are 

very difficult. Relapses are common. Dropping out of centers is 

common. This is an incredibly difficult group of people to work 

with. 

Unfortunately, it’s large and growing, and we’ve got to make 

sure, in our oversight role, that we are providing and making sure 

that these folks are not being taken advantage of. 

And addicts that I have talked to, by the time they get to the 

point where they’re ready for treatment, they are that desperate or 

their families are that desperate and have usually tried many cenVerDate Nov 24 2008 12:09 Apr 10, 2019 Jkt 037690 PO 00000 Frm 00084 Fmt 6633 Sfmt 6633 U:\MY DOCS\HEARINGS 115\HEARINGS\115-155 CHRIS
81 

ters. The last center I visited, one young man said it was about his 

third or fourth center he had been in. 

And so I think that this is a really difficult problem we’re trying 

to work on, and that’s why we want to make sure, whether they 

go to the internet, whether they’re going to a phone book—I don’t 

even know that anybody is using that anymore—but whatever 

they’re doing, we want to connect them with the best treatment 

possible. 

And with all due respect, no one knows what SAMHSA is. An addict doesn’t. I would say, we as government and providers do, but 

we have got to get this figured out. And there also aren’t nearly 

enough psychiatrists coming out of our med school classes and addiction specialists. And so we’ve got to keep focused on this problem because we are losing far too many people. 

I’d like to know, maybe Mr. Cartwright, Mr. Mishek, and Mr. 

Niznik, how are your call center employees paid, and are they 

given bonuses? 

Mr. Cartwright? 

Mr. CARTWRIGHT. Yes. Thank you very much. And I appreciate 

your comments. You’re so right in terms of the devastation of this 

disease in keeping it on treatment and quality of care. I’m in a 

unique position because I—— 

Mrs. BROOKS. And I’m sorry, I have several questions. And I appreciate that, comments on my comments. But how are your call 

center employees paid and what fact—and are they given bonuses 

and what determines whether or not they receive a bonus? 

First, how are they paid, Mr. Cartwright? 

Mr. CARTWRIGHT. Today they’re paid a salary. 

Mrs. BROOKS. OK. A salary. No bonuses? 

Mr. CARTWRIGHT. Today it’s a salary. Prior to July 1—and again, 

I go back to the Tennessee State law that was passed. I think it’s 

the most aggressive law in the State related to these bad practices 

that we all want rid of. They were paid on a commission basis. 

Mrs. BROOKS. And you’ve changed that? 

Mr. CARTWRIGHT. Yes, ma’am. 

Mrs. BROOKS. Mr. Niznik, how about you, how are your call center employees paid? 

Mr. NIZNIK. So our call center employees are all salaried employees who also do receive a discretionary bonus. It’s based on many 

factors that you’d expect someone who answers calls to measure, so 

courtesy, returning calls, not missing calls. 

But I think what’s important is that no one that answers these 

calls has any impact on the sort of care someone receives. So when 

a patient comes to us, the doctors, the nurses, the therapists, they 

make that determination. Really just being measured how good of 

a job they do in explaining the services that we offer and performing just the typical job duties of answering calls. 

Mrs. BROOKS. But how would one call center employee get a 

bonus versus another call center employee? How does that information come to you or whoever their supervisor is as to whether or 

not they receive a bonus? And is it monthly? How is it determined? 

Mr. NIZNIK. The bonus is monthly. And, again, it is discretionary. 

It’s based on maybe 7, 8, 10—it’s based on a list of factors that I 

provided in my written testimony. But you measure things like do 

82 

they answer the call? Have they missed calls? Are they helpful? 

When the managers walk around and hear a call, are they being 

polite? Are they knowledgeable in the program? So all these factors 

are relevant in determining is the person answering the call doing 

a good job. 

Mrs. BROOKS. OK. Mr. Mishek, are your call center people paid? 

Mr. MISHEK. Our call center employees have always been salaried? 

Mrs. BROOKS. Without bonuses? 

Mr. MISHEK. Correct. 

Mrs. BROOKS. Are there any minimum admissions goals for any 

employees, kind of like sales quotas? 

Mr. MISHEK. No. 

Mrs. BROOKS. Mr. Cartwright? 

Mr. CARTWRIGHT. Today, no. 

Mrs. BROOKS. OK. There have been in the past, but there are not 

any longer? 

Mr. CARTWRIGHT. Yes, ma’am. Again, I go back to the State law 

in Tennessee, and we’d love to see that nationwide. 

Mrs. BROOKS. OK. Thank you. 

Mr. Niznik, are there any imposed minimum admission goals? 

Mr. NIZNIK. There’s no minimum admission goals per person, but 

collectively as a group, we want to make sure that people answering the calls are doing a good job. And like I said in my oral testimony, that like a receptionist in a doctor’s office, you want to make 

sure the person answering your questions is being polite and doing 

a good job. 

Mrs. BROOKS. I’m sorry. My time is up, and I may submit a couple of more written questions. Thank you. Thanks for your work. 

Mr. HARPER. The gentlewoman yields back. 

The chair will now recognize the gentleman from New York, Mr. 

Collins, for 5 minutes. 

Mr. COLLINS. Thank you, Mr. Chairman. 

And the witnesses, it’s an intriguing hearing because this problem is almost insidious in its nature and it’s almost hard to begin. 

Let’s start with the Federal regulations versus Tennessee. 

Mr. Mishek, you pretty much were calling on Congress to do 

something and to call on the FTC to regulate. 

Mr. MISHEK. That’s correct. 

Mr. COLLINS. Maybe quickly, if I could ask the other witnesses, 

do you agree that this situation we need—in this case, Mr. Cartwright, you talked about Federal law versus State law, which is 

popping up here or there, you believe this is a place the Federal 

Government should step in and broadly regulate what’s going on, 

especially in the advertising area? 

Mr. CARTWRIGHT. I do. I think there are existing FTC laws that 

get to this, that need to be enforced. But I also think your attention 

to this is much welcomed. 

Mr. COLLINS. Yes. 

Mr. NIZNIK. I think it’s important that, just broadly, all providers 

are transparent in the service they offer, that when someone receives a call, they identify themselves. So I think, even though we 

practice that in all of our facilities, even the States where there 

isn’t necessarily regulation, I think it would be helpful. And I think 

83 

equally as important would be regulation that would look at standardizing care so that providers—— 

Mr. COLLINS. But you’re talking about in Federal—but you’re 

saying some States aren’t doing anything, others, Tennessee, may 

be doing a lot—— 

Mr. NIZNIK. Right. 

Mr. COLLINS [continuing]. In which case you’re saying the Federal Government, in this case, should step in. We’re always somewhat cautious about Federal versus States’ rights and so forth, but 

it’s sounding like, in this instance, you’re calling for the Federal 

Government to step in? 

Mr. NIZNIK. Right. Because, for example, the standard of care, 

there isn’t a national one that’s consistent from provider to provider. So even as a facility, we defer to the professional judgment 

of our doctors and clinicians, but I think it would be better if they 

knew exactly what was, at least at a minimum level, expected from 

them. 

Mr. COLLINS. Mr. Cartwright. 

Mr. CARTWRIGHT. I do think we need Federal intervention and 

not just in marketing practices. We have a similar issue related to 

licensure. Licensure standards in the State of Minnesota or the 

State of Tennessee or the State of California can be completely different where, for example, out in California, in six-bed houses, you 

could be doing detox services. We both, Mishek and myself, through 

our organizations have CDRHs. They’re hospitals for detoxification 

services. So we should have some standardizations across the country. 

One of the difficulties is we have 19,000 different treatment centers across the United States with an annual budget of about $5 

million. We’ve never really caught the attention of the Federal Government or even the healthcare system. And today we do, right. We 

have people dying in the streets all over this country, and we really 

do need to do something about this. 

And I’m very impressed with Congress in respect to what all you 

all have done over the last 2 years on this issue. But now I think 

we’re starting to get to the things that Mr. Ventrell, Mishek, myself want to see, and that’s consistency around advertising and 

marketing, but also consistency around quality of care and licensure standards. 

Thank you. 

Mr. COLLINS. Mr. Brian. 

Mr. BRIAN. From the advertisement perspective, I couldn’t agree 

more. We want nothing more, wanted nothing more than to work 

with great centers that were licensed to do what they were tasked 

to do. And I think that the ultimate underlying message that I 

would like to leave is that people will search however they choose 

to search, not how we think might be most appropriate for them 

to search. So if they decide to go online, they’re going to go online. 

That’s what they’re going to do. 

And so if we are holding our treatment programs to a higher 

standard and ultimately the licensure required for them, I think 

we’ll be in much better shape regardless of who’s on the other end 

of the phone call. 

Mr. COLLINS. Dr. Stoller. 

84 

Dr. STOLLER. I’m afraid my work doesn’t overlap advertising 

enough to render a very informed opinion, but what I would say 

is that access is very important. And I really appreciate the work 

that the Congress has done to increase access, for example, through 

Medicare reimbursement for opioid treatment programs and anything else that could be done to make sure that treatment is accessible and that parity is enforced. 

Mr. COLLINS. So, Mr. Ventrell, finishing with you, NAATP is the 

organization that is certifying and riding herd on these. Is that organization well known like almost we think of the Good Housekeeping Seal or something as in the vernacular? Somebody searching would know, I’ve got to start with do I see NAATP stamp of 

approval? 

Mr. VENTRELL. Well, I would hope so. And that certainly would 

be—— 

Mr. COLLINS. Or is there work to be done there? 

Mr. VENTRELL. There is work to be done, Congressman, as is 

demonstrated by the fact that we removed certain members so that 

we could have a moral high ground in order to say, look, if you 

want to be a member of the society, you have to follow these rules. 

So NAATP has been in existence for 40 years, so certainly we’re 

the longstanding trade association. I think that what you will find 

as this process develops and we continue to articulate best practices, that that is, in fact, the case, that you need to be part of this 

national association and that demonstrates a meaningful—— 

Mr. COLLINS. That would certainly be one way to weed out the 

very bad actors because they’re not part of the NAATP. So we’d encourage you to continue to promote your brand. 

Mr. VENTRELL. Thank you. 

Mr. COLLINS. With that, Mr. Chairman, I yield back. 

Mr. HARPER. The gentleman yields back. 

The chair will now recognize the gentleman from Pennsylvania, 

Mr. Costello, for 5 minutes. 

Mr. COSTELLO. Thank you, Mr. Chairman. 

Mr. Brian, information your company provided committee staff 

as well as your testimony indicates you routed more than 519,000 

calls to treatment providers from December 2014 to the present. 

Can you describe how those calls were generated? 

Mr. BRIAN. Yes, sir, of course. We work with third-party media 

agencies that operate in television, radio, search engine advertising, amongst other avenues, and they generate—in advertisement, typically it would be in the form of a help-line related call 

that clearly indicates that their call will be routed to a treatment 

center who pays to receive that phone call. That call is then routed 

directly to the treatment center through our platform, never stopping with us. 

Mr. COSTELLO. Contractually, do you have any approval over the 

type of language that they utilize in their advertising in order to 

generate that call? 

Mr. BRIAN. Yes, sir. Indirectly, we have what we call our marketing standards and practices attestation form, which allows and 

provides them a very clear guideline of what we allow and what 

we don’t allow, most of which is congruent and consistent with the 

same dialogue that we’ve had today. 

85 

Mr. COSTELLO. Do you pre-approve that? 

Mr. BRIAN. Not in all instances, but in most instances, yes. 

Mr. COSTELLO. Have you ever had occasion to tell them to remove a particular type of advertisement that did not accord with 

those guidelines that you just referenced? 

Mr. BRIAN. Yes, sir. 

Mr. COSTELLO. How much did you pay per call? 

Mr. BRIAN. It would vary depending on the type of call. It would range anywhere from $10, $15, $20 dollars on up to $60 or $70, depending on how the call was originated. 

Mr. COSTELLO. How did treatment facilities find Redwood? 

Mr. BRIAN. We participated in numerous trade shows, conferences. I’ve spoken at several of these conferences, and ultimately 

the organizations would find us typically through that. We also had 

a strong web presence where we would advertise directly to the 

treatment programs through our website, which was 

treatmentcalls.com. 

Mr. COSTELLO. So did Redwood find the facilities online? 

Mr. BRIAN. In some instances, yes, sir. Not in all instances. 

Mr. COSTELLO. OK. Let me shift gears. This is for everyone but 

Mr. Ventrell. I want to talk about success rates, because in a lot 

of these advertisements you hear talk of there being a successful 

treatment. We don’t necessarily know what success means. 

So for each of you, what is your facility’s success rate, and how 

do you define success? Is it admission to your facility? Completion 

of the program? Maintaining sobriety for a month? Six months? 

One year? Five years? Starting with Mr. Mishek. 

Mr. MISHEK. Thank you, Congressman. First of all, we don’t use 

that word, ‘‘success.’’ It’s outcomes. This is a chronic disease. You’re 

going to have it for your lifetime. Hopefully, you are in recovery 

and are happy, joyous, and free, as they say in the big book. 

We measure, as I said earlier, outcomes after 1 year of being 

with us, whatever point you leave us, and—— 

Mr. COSTELLO. Do you list that in your advertisement at all, 

what’s your outcome—— 

Mr. MISHEK. We don’t advertise it. 

Mr. COSTELLO. OK. And I want to hone in on the advertisement 

and the use of the word ‘‘success’’ or anything related thereto. Mr. 

Cartwright. 

Mr. CARTWRIGHT. We don’t use success rate on our advertising. 

We conducted an outcome study that we’ve published and put out 

there just recently over the last several months where 4,000 patients went through that, that I’m very, very pleased and proud of. 

But that doesn’t encompass all of our folks that are going through 

treatment annually. 

Mr. COSTELLO. Mr. Niznik. 

Mr. NIZNIK. We don’t advertise what our success rate is or define 

it in any of our ads. 

Mr. BRIAN. We don’t have treatment centers at all—— 

Mr. COSTELLO. Right. 

Mr. BRIAN [continuing]. So we don’t have success rates. 

Mr. COSTELLO. Dr. Stoller. 

Dr. STOLLER. Our position is similar to Mr. Mishek’s. We measure outcome over a continual time period. 

86 

Mr. COSTELLO. Mr. Mishek, share with me some of the other 

challenges in tracking success within the substance abuse industry. 

Mr. MISHEK. Well, again, success for us is lifetime recovery. It’s 

a chronic disease. One of the unfortunate features of it being a 

chronic disease is people relapse. People come back to treatment 

often many times. It’s important never to give up hope, to bring 

them back, get them back in the continuum. 

So success for us are things like, yes, completion of a particular 

episode of care is really important; participating in recovery management is really important; making it to 12-step meetings, if 

that’s the route you’re going, is really, really important. Those are 

the things that we really focus on and those are the things we look 

to for success. I hope that answers your question. 

Mr. COSTELLO. It does. Thank you. 

I yield back. 

Mr. HARPER. The gentleman yields back. 

The chair will now recognize the gentleman from Georgia, Mr. 

Carter, for 5 minutes. 

Mr. CARTER. Thank you all for being here. Very important subject. I’ve always described the opioid epidemic as being two types 

of problems: One is, how do we control that what I consider to be 

the tangible part, how do we control the number of pills out there, 

the number of prescriptions; and two, the intangible, and that is, 

what do we do with those 2.5 million people who are currently addicted? How do we help them? That’s why you’re here today because we need answers to that. That’s very difficult. 

I’ll start with you, Mr. Brian, and ask you this: Are you familiar 

with the Addiction Network? 

Mr. BRIAN. Yes, sir. 

Mr. CARTER. You are familiar with that? As I understand that 

features a gentleman, a bearded gentleman in blue scrubs saying 

call this number and you can get help. And is that your company 

doing that or what? 

Mr. BRIAN. It’s not our company doing that, sir. We—— 

Mr. CARTER. It’s not your company doing it? 

Mr. BRIAN. No, sir. 

Mr. CARTER. OK. So you have a list of companies that you refer 

people to, 

Mr. BRIAN. Yes. 

Mr. CARTER. Is that correct? 

Mr. BRIAN. Yes, sir. 

Mr. CARTER. OK. What are the qualifications for a company to 

be on that list? 

Mr. BRIAN. Licensed in the State that they are—— 

Mr. CARTER. Just licensed. 

Mr. BRIAN. Yes. 

Mr. CARTER. Anything else? 

Mr. BRIAN. Not with us, no. 

Mr. CARTER. Not with you. 

What about you, Mr. Cartwright? You do the same thing, the 

same business model. Is that correct? 

Mr. CARTWRIGHT. A little bit different business model, sir. 

Mr. CARTER. OK. Very quickly, how different? 

Mr. CARTWRIGHT. It’s an advertising model. 

87 

Mr. CARTER. It’s an advertising model. 

Mr. CARTWRIGHT. They don’t call into our call center, and then 

we don’t refer them out. 

Mr. CARTER. OK. Do you have any requirements for them to be 

on there? 

Mr. CARTWRIGHT. We do. They have to be part of SAMHSA’s 

website—— 

Mr. CARTER. OK. You mentioned that earlier. 

Mr. CARTWRIGHT [continuing]. Which I’m assuming is vetted. 

They have to be a licensed organization with CARF or JCAHO accreditation. 

Mr. CARTER. Do you take into consideration, as my colleague just 

asked, outcomes? Do you take that into consideration? Do you ask 

those companies before you put them on your list, tell me about 

your outcomes? 

Mr. CARTWRIGHT. We do not. 

Mr. CARTER. You do not. 

Mr. Brian, do you? 

Mr. BRIAN. No, sir. 

Mr. CARTER. You do not? 

Mr. BRIAN. No, sir. 

Mr. CARTER. So the outcomes has nothing to do with it. They’re 

just on the list. 

When you refer, Mr. Cartwright, a patient to one of these clinics, 

if you will, do they reimburse you for that? 

Mr. CARTWRIGHT. No, sir, we don’t refer people to clinics. 

Mr. CARTER. OK. When you refer people—— 

Mr. CARTWRIGHT. Correct. 

Mr. CARTER [continuing]. The company that you refer them to? 

Mr. CARTWRIGHT. If a call comes into our call center and we refer 

it out to another facility, no, we would never take money from 

them. 

Mr. CARTER. Does that facility reimburse you in any way at all? 

Mr. CARTWRIGHT. No, sir. 

Mr. CARTER. How do you make money then? 

Mr. CARTWRIGHT. We don’t make money from that at all. 

Mr. CARTER. Where do you make your money? 

Mr. CARTWRIGHT. We are a treatment organization. We have 39 

treatment centers in 9 States, and that’s where we make the bulk 

of our revenue, just like Hazelden Betty Ford Center. 

Mr. CARTER. Do you refer patients to other facilities besides 

yours? 

Mr. CARTWRIGHT. If somebody calls into our call center and 

they’re in a local area and we don’t have a treatment center in that 

area, absolutely, we’d refer them to the SAMHSA website. We may 

even walk through that SAMHSA website with them and let them 

know about local facilities in that area, but we would never take 

money from them. 

Mr. CARTER. OK. What about you, Mr. Brian, when you give a 

referral to another clinic, do you get reimbursed? 

Mr. BRIAN. We don’t make any referrals. So we don’t have a call 

center that accepts phone calls. 

Mr. CARTER. You don’t have a call center. So when you route 

them—— 

88 

Mr. BRIAN. Yes, sir. 

Mr. CARTER [continuing]. To that clinic—— 

Mr. BRIAN. Yes, sir. 

Mr. CARTER [continuing]. Do they reimburse you any at all for 

that referral, if you will? 

Mr. BRIAN. For the phone call, we receive compensation for it, 

yes, sir. 

Mr. CARTER. Do you receive it from the clinic? 

Mr. BRIAN. For the phone call itself, yes. 

Mr. CARTER. OK. So, again, you don’t take into consideration, 

there’s no prerequisites for that company, for that clinic to be on 

your list. You just simply go in and list them. 

Let me ask you something. When you make these kind of referrals, if you will, do you interview the patient? Do you sit there and 

say, OK, tell me what your problem is, tell me what your pay type 

is, tell me what you’re looking for? Do you do anything like that 

or you just say, hey, this is in your area, this is who we recommend? 

Mr. BRIAN. We don’t recommend. We don’t talk to the client ever 

in that engagement at all. We don’t have any interaction at all 

with the prospective—— 

Mr. CARTER. Then how do you know who to refer them to? 

Mr. BRIAN. We refer them to a licensed facility, sir. The prerequisite to work with us, if it was good enough for the State to 

issue licensure for them, that’s our prerequisite in order to do business with us. 

Mr. CARTER. OK. Do you think that serves the best interest of 

the patient? 

Mr. BRIAN. I believe it serves the law in the State of Florida that 

I live and work in. And I would welcome this conversation. I believe that a lot more can be done to route these calls to the appropriate facility. 

Mr. CARTER. I would think so. 

Mr. BRIAN. I agree. 

Mr. CARTER. I would think if I called that, I’d want to have some 

information before I said, OK, this is where you need to go. 

Mr. Cartwright, you’ve referred to State laws that have been 

passed. Have they addressed any of that? 

Mr. CARTWRIGHT. I think what you’re getting at is the quality of 

the facility that you’re referring someone to. 

Mr. CARTER. The quality and the type of facility. If I say, I’ve got 

an addiction and I’m looking for something that’s faith based and 

I need your recommendation, do you take into consideration anything like that? 

Mr. CARTWRIGHT. Again, if Congress would support something 

like that through SAMHSA, I think that would be excellent. I do 

think that this is where it needs to land is in Congress’ lap, because each of the States are so different in terms of how they license—— 

Mr. CARTER. OK. I’m out of time. But listen, we’re very responsible people up here, and we want to do and we’re going to do 

what’s right. But we also look to you to have a certain level of responsibility as well. So don’t always look to Congress as being the 

ultimate answer here, OK. 

89 

Thank you very much, Mr. Chairman. I yield back. 

Mr. HARPER. The gentleman yields back. 

The chair will now recognize the gentleman from Florida, Mr. 

Bilirakis, for 5 minutes. 

Mr. BILIRAKIS. Thank you very much. 

Thank you for your testimony as well. And thank you, Mr. Chairman, for holding this very important hearing. 

If there’s one thing that’s been made clear in today’s hearing is 

that there is a lack of clarity on how individuals can ensure they 

are seeking care that will best meet their needs. I want to better 

understand how we can serve our constituents by creating a clear 

path forward here. 

Mr. Ventrell, does the Association have a definition of what quality care is? And then, what resources exist for the consumers to 

seek out quality care? 

Mr. VENTRELL. Thank you, Congressman. Yes. As part of the 

quality assurance initiative, NAATP developed a research called 

the NAATP Guide to Treatment Program Selection. It’s a comprehensive consumer tool, also useful for the field, that provides 

red flags and positive references. 

It is premised on four principles. Addiction treatment is 

healthcare and should be chosen as such. There are knowable indicia of quality of care. It’s not a mystery. We know what produces 

quality care. Third, there needs to be transparency in the marketing process. And fourth, the institution that you go to should adhere to a recognized code of ethics. 

Mr. BILIRAKIS. Let me ask you a question, and maybe this is for 

the panel as well. Would a star rating system be very helpful? Because that kind of simplifies it in certain areas rating the particular facility. I think that that might be simpler. Again, these are 

their loved ones and they want to make the right decision for them. 

So if anybody wants to chime in on that, I’d appreciate an answer. 

Yes, sir. 

Mr. VENTRELL. May I, sir? It’s an attractive solution, but I think 

it’s a dangerous one. Things are more complicated than ranking by 

star. I don’t think that that’s achievable in a reliable way. 

Mr. BILIRAKIS. Well, we do it for nursing homes. I distinguish 

that a nursing home as opposed to a substance use disorder facility 

or mental health facility. 

Mr. VENTRELL. Yes. Thank you. The floor needs to be clearly established in order for a process like that to work. In other words, 

nursing homes must exist, I believe, at a certain level of quality before you can start to talk about that. 

What I propose, or what we propose or suggest instead is that 

the floor, the basic operational requirements should be regulated 

sufficiently such that if you read, if they are, and then you read 

the services offered, the consumer can rely on that, and a star system wouldn’t be necessary. 

Mr. BILIRAKIS. OK. I just want to make it clear and less complicated for the consumer. And I want them to know where to turn 

to, where to find this information out. I want it to be easily accessible. 

90 

Let’s see, a big concern that this committee has is ensuring that 

when an individual or their loved one is seeking substance use disorder treatment, they know what things to look for. And you mentioned the flags. What things to avoid, again, to best protect themselves from falling prey to any deceptive marketing schemes that 

may be out there, and there are plenty out there. 

Could you identify a few red flags that individual should be on 

the lookout for when seeking care, as well as a few green flags that 

might indicate that a treatment center provides quality care? 

For example, some reports suggest paying attention to whether 

or not the facility lists a staff page or asking the person who answers the phone whether or not they are actually at the treatment 

center. 

So, Mr. Ventrell, you can start, if you like. 

Mr. VENTRELL. Sure. As part of the same document which I have 

referenced, we’ve listed red flags and questions to ask. Red flags 

generally that we believe should be observed are generic websites, 

call directories, or websites offering treatment placement. Many of 

these make referrals based on business relationships. That’s the 

problem. 

Questions to ask include licensing, accreditation. It’s all based on 

transparency. We would like them obviously to be members of our 

national association. How long has the facility been in operation? 

Who are the staff? What levels of care are provided? What are the 

placement criteria? What is your procedure for the continuum of 

care as the chronic disease exists one’s entire life? The list goes on, 

and I’m happy to provide that. In fact, it is part of the record. 

Mr. BILIRAKIS. OK. Let me ask one more question. I do have several here, but with regard to payment, because it’s difficult for a 

person to—obviously, you want to make the right decision, OK, but 

also, how many treatment centers take private insurance? What’s 

a percentage? 

Whoever wants to answer that question would be fine with me, 

or you can even just talk about your particular treatment center, 

whether that center accepts private insurance. 

Mr. CARTWRIGHT. Congressman, thank you very much, and going 

back to your previous question as well. I do think that the addiction treatment industry is very similar to the nursing home industry. It’s a maturing industry that could benefit from a star system 

like you were referring to. I think it’s very, very similar to the 

nursing home space where Federal regulation needs to be tighter 

across the board. That would be my personal opinion. So I really 

appreciate you bringing that up. 

Mr. BILIRAKIS. Oh, absolutely. Thank you. Thank you for your 

opinion. 

Mr. MISHEK. If I could talk about insurance. 

Mr. BILIRAKIS. I guess I probably have to yield back. 

Thank you very much. If maybe you can have some time, Mr. 

Chairman, for him to answer the question. But I’ll yield back. 

Mr. HARPER. The gentleman yields back, and I’ve got a couple of 

followup things, but I’ll recognize Ranking Member DeGette for 

purposes of entering a document. 

Ms. DEGETTE. Mr. Chairman, thank you. 

91 

We just received a letter from the Federal Trade Commission regarding this issue. And what Commissioner Chopra talks about in 

this letter is the for-profit treatment centers and what that can do 

in terms of driving up costs for insurance and for Medicare and 

Medicaid programs, as well as cost for patients out of their pockets. 

The letter also cautions about the deceptive trade practices in 

trying to match individuals to centers and the advertising. And it 

finally urges this committee to take a close look at the advertising 

and marketing practices in the industry to make sure that incentive compensation practices for employees and operators of treatment centers, as well as financial conflicts of interests with other 

firms, are addressed. 

And so I’d like unanimous consent to enter this into the record 

so that we can continue to look at these issues as we continue our 

investigation. 

Mr. HARPER. Without objection, so entered. 

[The information appears at the conclusion of the hearing.] 

Mr. HARPER. Any other comments, Ms. DeGette? 

Ms. DEGETTE. No. 

Mr. HARPER. I had a couple of followup items I just wanted to 

touch on. 

Mr. Cartwright, how do companies and their phone numbers end 

up on their website? 

And I ask that because we understand that there’s at least one 

phone number that doesn’t call the named facility that it is listed 

with. So how do companies and those phone numbers end up on 

your websites? 

Mr. CARTWRIGHT. We utilize the SAMHSA website in terms of 

the listings on there. And so if it’s not been updated through 

SAMHSA, maybe we didn’t update that. I’d love to know the phone 

number that didn’t go through correctly. We would certainly like to 

look at that. 

Mr. HARPER. Sure. We will make sure you have that info to clear 

that up. 

Also, Mr. Cartwright, I know that you do operate, a portfolio of 

websites under your Recovery Brands business line. Are you able 

to tell us how many websites are operated under Recovery Brands 

and give us that information today? 

Mr. CARTWRIGHT. I can get you the exact websites themselves. I 

think we’ve been asked by staff to provide that, and we can certainly do that. 

Mr. HARPER. That would be very helpful. 

One issue that this committee has explored, obviously, is abuse 

of billing practices, especially with urine drug testing. For example, 

the reports of clinics and labs charging more than $4,000 for a single urine test and for treatment facilities to test individuals two or 

three times a week. 

So for Mr. Mishek, Mr. Niznik, and Mr. Cartwright, can you explain how often your facilities test patients and what the average 

cost is? And answer, if you can, as quickly as you can. 

Mr. MISHEK. Sure. We do a urine drug screen upon admission for 

any level of care: Residential, day treatment, intensive outpatient. 

During the course, the patient may get two or three additional 

92 

tests, depending on whether they came up on the randomized thing 

we do or whether it was for cause. 

We don’t charge. We have no revenue from drug testing. The cost 

that we incur is about $20 a test roughly. It’s very, very low cost. 

Mr. HARPER. Are those tests performed at your facility or sent 

out to a lab? 

Mr. MISHEK. They are sent out to a national lab. 

Mr. HARPER. OK. Mr. Cartwright. 

Mr. CARTWRIGHT. Very similar. We use the same guidelines just 

like Hazelden Betty Ford Center, very similar in terms of intake. 

We generate about $50 for a urine sample, but we also own and 

operate our own laboratories.Two of them, one in Tennessee and 

one in the State of Louisiana. 

Mr. HARPER. So those are sent out to those facilities for testing? 

Mr. CARTWRIGHT. Correct. 

Mr. HARPER. OK. Mr. Niznik. 

Mr. NIZNIK. We also test upon admission. And then on average, 

it’s about 1 1⁄2 times per week, but it’s generally in the discretion 

of the medical doctor that’s overseeing the care of the patient to 

order whatever test they think is medically necessary. We send it 

out to the lab that we operate in Florida. 

Mr. HARPER. Is your mic on? 

Mr. NIZNIK. Yes. 

Mr. HARPER. How many labs and what do you charge, that you 

own. 

Mr. NIZNIK. We own one lab. We operate one lab. It services all 

of our facilities. And our average, I think, reimbursement is somewhere around $200 to $300. 

Mr. HARPER. OK. I’ll yield to Ms. DeGette for a followup. 

Ms. DEGETTE. So you say that you test on the average of 1 1⁄2

times per week. You send it out to your lab. Are you then billing 

the insurance the $200 to $300? 

Mr. NIZNIK. Yes, that’s the reimbursement we receive from the— 

no, that’s the reimbursement we receive from the insurance company. 

Ms. DEGETTE. Right. So you’re billing the insurance $200 to $300 

per 1 1⁄2 times a week, whereas these other facilities aren’t charging 

their people anything. 

Thank you, Mr. Chairman. 

Mr. HARPER. Final question, and Mr. Cartwright, I pulled up 

drugabuse.com, which is yours. And going through the website it 

has lots of information. It talks about the opioid crisis. It has an 

800 number. ‘‘It’s not too late to turn your life around,’’ ‘‘overcoming your addiction.’’ 

While we don’t measure success or outcome, it certainly might 

imply to one, that I will get that outcome if I go there. But you 

have to go to the small ‘‘I’’ that I asked Mr. Ventrell about earlier 

to find out that your visit will be answered by American Addiction 

Centers, AAC, or a paid sponsor. 

Why wouldn’t you just list that information at the top of your 

web page? You have to go hunt for that, either under the number 

or other things. Why wouldn’t you do that? 

93 

Mr. CARTWRIGHT. Again, our business model is very similar to 

WebMD. If you’d like us to change it and put it at the very top, 

I’m happy to do—— 

Mr. HARPER. I’m not asking about WebMD. I’m asking you, if 

we’re talking about transparency and what we’re looking at here so 

that it’s nothing is viewed to be deceptive, wouldn’t it be easy just 

at the beginning of your web page to say that information? 

Mr. CARTWRIGHT. Yes, sir, we can do that. 

Mr. HARPER. Who are the paid sponsors? 

Mr. CARTWRIGHT. It’s the advertisers that we were referring to 

earlier in the conversation. 

Mr. HARPER. Who determines on that call whether or not it goes 

to AAC or to a paid sponsor? 

Mr. CARTWRIGHT. All of the phone calls that are coming in 

through the 1–800 number that is like that, they all come to American Addiction Centers. 

Mr. HARPER. OK. 

Mr. CARTWRIGHT. The paid sponsors is referring to if they have 

an ad, and it’s very clear who that company is. 

Mr. HARPER. Do you send anything to an unpaid sponsor? Or is 

there such a thing as unpaid sponsor? 

Mr. CARTWRIGHT. Yes, there is. 

Mr. HARPER. OK. And how do you rotate—a call comes in, how 

do you determine who it goes to? 

Mr. CARTWRIGHT. It’s not a call that comes in. If they’re looking 

on the website, and if you go down through the website and you 

look in Denver, Colorado, it would have all the local providers in 

that area. They wouldn’t have to pay for that listing. It would have 

all of them listed there. All the not-for-profit agencies, all the hospitals, treatment centers. 

Mr. HARPER. But if I call that 800 number, or 877 number, whatever it is, if I were to call that, it would go to a facility or go to 

the hotline? 

Mr. CARTWRIGHT. That would only come to American Addiction 

Centers. 

Mr. HARPER. OK. All right. I got it. 

I want to thank everyone for their testimony. This is an issue 

that we’re obviously concerned about, but I thank you for your 

time, your patience, for your responses. 

I would remind members that they have 10 business days to submit questions for the record. And I would ask the witnesses that 

you respond as promptly as possible when you get such questions. 

With that, the subcommittee is adjourned. 

[Whereupon, at 12:10 p.m., the subcommittee was adjourned.] 

[Material submitted for inclusion in the record follows:] 

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35759.041

E C U.S. HOUSE OF REPRESENTATIVES 

COMMITTEE ON ENERGY AND COMMERCE 

EST. 1795 

July 20,2018 

TO: Members, Subcommittee on Oversight and Investigations 

FROM: Committee Majority Stafi 

RE: Hearing entitled "Examining Advertising and Marketing Practices within the 

Substance Usc Treatment Industry." 

The Subcommittee on Oversight and Investigations will hold a hearing on Tuesday, July 

24, 2018, at I 0:00 a.m. in 2123 Rayburn House Office Building. The hearing is entitled 

"Examining Advertising and Marketing Practices within the Substance Use Treatment Industry." 

The purpose of the hearing is to examine practices within the substance use treatment industry, 

including advertising and marketing and quality of care. 

I. WITNESSES 

• Jason Brian, Founder and Owner, Redwood Recovery Solutions and TreatmentCalls.com; 

• Michael T. Cattwright, Chairman and CEO, American Addiction Centers; 

• Mark Mishek, President and CEO, Hazelden Betty Ford Foundation; 

• Robert Niznik, CEO, Addiction Recovery Now and Niznik Behavioral Health, Inc.; 

• Kenneth Stoller, M.D., Director, Johns Hopkins Hospital Broadway Center for 

Addiction; and 

• Marvin Ventrell, Executive Director, National Association of Addiction Treatment 

Providers. 

II. BACKGROUND 

The United Stales remains in the throes of a national opioid epidemic, with 115 

Americans dying every day from opioid-involvcd overdoses. 1 Approximately 2.1 million 

Americans over the age of 12 are believed to have an opioid use disorder2 and, amid the epidemic, 

1 Centers for Disease Control and Prevention, Understanding the Epidemic, Opioid Overdose, (Aug. 30, 20 17), 

available at https:liwww.cdc.gov/drugoverdose/epidemic/index.html. 2 Substance Abuse and Mental Health Services Administration, Key Substance Use and Mental Health Indicators in 

the United States: Results from the 2016 National Survey on Drug Use and Health, (HHS Publication No. SMA 17-

5044, NSDUil Series ll-52) available at https://store.samhsa.gov/shin/content//SMA 17-5044/SMA 17-5044.pdf 
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Page 2 

the demand for treatment has increased greatly, The number of treatment facility admissions for 

opiate usc increased 58 percent between 2005 and 2015 3 

Beginning in Apri\2014, the Subcommittee on Oversight and Investigations has 

undertaken an examination of many of the root causes of the opioid epidemic and explored 

possible solutions to enable greater access to effective, evidence-based treatment for substance 

usc disorders. As part of this work, in July 2017, the Committee began examining the practice of 

patient brokering, through which individuals known as patient or body brokers are paid by 

treatment facilities for successfully enrolling patients in their treatment programs. 

The Committee wrote to the Department of Health and Human Services (HHS)4 in July 

2017, and to six states5 in November 2017, about the practice of patient brokering. On 

December 12, 2017, the Subcommittee held a hearing examining concerns about patient 

brokering and addiction treatment fraud 6 The Subcommittee heard testimony about problems 

stemming from the dramatic surge in substance use disorder treatment facilities, including 

practices employed by businesses known generally as "call aggregators." The President and 

Chief Executive Officer of one treatment facility testified that call aggregators "are essentially 

collecting leads for treatment centers who are willing to pay a price" and that the call centers will 

prescreen potential patients with the goal to "ultimately sell the patient's information to the 

highest bidder."7 On May 29, 2018, the Committee sent letters to eight substance use treatment 

businesses requesting information and documents about their advertising and marketing practices 

and to understand whether and, if so, how they utilize call centers or call aggrcgators, websites, 

and ad optimization. 

The need for quality substance use disorder treatment facilities is critical. An estimated 

21 million people over the age of 12, or one in 13 people in the United States, are believed to 

have needed treatment for a substance use disorder in 20168 Yet, only 3.8 million people 

received any form of substance use treatment in 2016, andjust 2.2 million received treatment at a 

3 TEDS data includes admissions to facilities that are licensed or certified by the State substance abuse agency to 

provide substance abuse treatment and may not include admissions to all private for-profit agencies. See Substance 

Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS) 2005-2015, available at 

https:llwwwdasis.samhsa.govldasis21teds yubs/20 15 _teds _ rpt_ natl.pdf. 

'Letter from Greg Walden, Chairman, H. Conun. on Energy & Commerce, eta!., to Tom Price, Sec'y, U.S. Dept. of 

Health & l Iuman Services, (July 13, 20 17), available at https:llarchivcsenergycommercc .house. gov lsiteslrepub I icans.energycommerce .house. gov I fi les/documents/20 I 70713l!HS. pdf. 5 Letters from Greg Walden, Chairman, fl. Comm. on Energy & Commerce, eta!., to Mr. Thomas J. Betlach (AZ), 

Dr. Karen Baylor (CA), Dr. Robert Werthwein (CO), Ms. Ute Gazioch (FL), Ms. Allison Bauer (MA), and Ms. 

Jennifer Smith (PA), (Nov. 17, 20 17), available at https:/lenergycomrnerce.housc.gov/news/letterllettersdepmtments-six-state-governments-patient-brokering-allegations/. 

6 H. Comm. on Energy & Commerce hearing, "Examining Concerns of Patient Brokering and Addiction Treatment 

Fraud, ··(Dec. 12, 20 17), available at https://energycommerce.house.gov!hearings/examining-concems-patientbrokering-addiction-treatment-fi·aud/. 

7 Testimony of Douglas Tieman, President and CEO, Caron Treatment Centers at H. Comm. on Energy & 

Commerce hearing, "Examining Concerns of Patient Brokering and Addiction Treatment Fraud," (Dec. 12, 2017), 

available at http://docs.house.gov/meetings/IF/IF02/20 171212/1 06716/HHRG-115-IF02-Wstate-TiemanD20171212.pdf 

8 SAM liSA, supra note 2. 
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Page 3 

specialty facility. 9 Opioid and heroin overdoses continue to plague communities across the 

country. According to the Substance Abuse and Mental Health Services Administration's 

(SAMIISA) 2016 National Survey on Drug Use and Health, 11.5 million people over the age of 

12 reported misusing prescription pain relievers in the past year. 10 In total, more than 351,000 

people have died since 1999 due to an opioid-involved overdose. 11 The crisis has become so 

severe that the average U.S. life expectancy declined in 2016, largely because of an increase in 

drug overdoses, including opioid overdoses. 12 

The increased demand for treatment has brought with it new concerns about treatment 

facilities' marketing practices as well as the quality of care patients receive. Patients in need of 

treatment resources often look for help on the internet, where some providers have used 

aggressive, and, at times, allegedly deceptive advertising tactics. 13 Many treatment-focused 

websites advertise phone hotlines that lead potential clients to call centers or call aggregators. 

These call centers may appear to be unaffiliated third-party referral services, but, in some cases, 

they are wholly operated by treatment facilities or are paid by facilities to refer calls. While 

some centers disclose their relationship with treatment facilities, others do not, and may engage 

in deceptive marketing tactics to hide the relationship. Reports indicate that call aggregators 

may refer patients to facilities that do not meet their needs, and once patients enter treatment, 

they may be vulnerable to exploitation by unscrupulous business owners. 14 

Though rates of opioid prescribing are on the decline, 15 the number of people receiving 

treatment for either heroin or prescription opioids has increased substantially over the last 

decade. 16 According to SAMHSA's latest Treatment Episode Data Set, opiates were the primary 

substance for which treatment was sought in more than 526,000 treatment facility admissions in 

2015, up from 332,000 primary opiate admissions in2005n 

"Id. 

II! fd. 

11 Centers fbr Disease Control and Prevention, Data Brief294. Drug Overdose Deaths in the United States, 1999-

20 16. available at https:/ /www .cdc.gov/nchs/data/databriefs/db294 _ table.pdtllpage•4. 12 Catherine Roberts, Opioid Overdoses /1re Pv!ajor Cause Behind Lijf: Expe<.-·tancy Decline, CDC Report Says, 

CONSUMER REPORTS, (Dec. 21, 2017). available a/ https://www.consumcneports.org/drug-usc/opioid-overdosesl i fe-expectaney-decline/. 

"Teri Sforza, Tony Saavedra, Lori llashcda. Rehab Riviera: ilddiclion advertising can trick you to death, ORANGE 

COUNTY R1.'GlSTER. (March 2, 20 18) available at https://www.ocrcgister.com/20 18103/02/rehab-riviera-addictionadvertising-can-trick-you-to-death/, and Cat Ferguson, SearchingjiH· help: She turned to Cioogle flw help gelling 

sober. Then she had to escape a nightmare, TilE VERGE, (Sept. 7, 201 7), available at 

https://www.theverge.com/20 I 7 /9/7/J 62574 I 2/rehabs-near-me-google-search-scam-llorida-treatmcnt-centers; David 

Segal, A doc/or with a phone and a mission, TilE NEW YORK TIMES, (Dec. 27, 20 I 7), available at 

https :1 /www. nyti mes .com/ interacti ve/20 17 I I 2/2 7/business/ drug -addiction-ads. htm I. 

11 !d. 

15 Opioid prescribing rates peaked at 255 million prescriptions in 2012 and have since dropped to 214 million 

prescriptions in 2016. See Centers fbr Disease Control and Prevention, U.S. prescribing rate maps. Opioid overdose, 

(last upda1ed July 31. 20 17), available at https:l/www.cdc.gov/drugoverdose/mapslrxrate-maps.html. 

"' SAMSI !A, supra note 3. 

p /d. 
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Majority Memorandum for July 24,2018, Subcommittee on Oversight and Investigations 

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Page 4 

a. Marketing and Advertising 

The increased demand for substance use disorder treatment has created a large and 

complex treatment industry, that has remained largely unregulated at the federal level and has 

wide variability in terms of how facilities are regulated at the state level. Competition for 

potential patients is significant, with some providers reportedly employing a host of aggressive 

and sometimes deceptive advertising tactics. A 2016 Palm Beach County, Florida grand jury 

report on fraud and abuse in Florida's treatment industry highlighted a number of problematic 

marketing abuses, including false representation of services, false representation of location, and 

real-time auctioning of patients through clearing houses or lead generators. 18 The report found 

that deceptive marketing practices "are detrimental to a patient's chances of receiving quality 

care and the appropriate level of care" and also harm reputable treatment centers. 

Some treatment facilities utilize call centers or call aggregators to engage with potential 

customers. One type of call center functions as an unaffiliated third-party referral service, which 

routes calls to treatment facilities for a per-call fee. In some instances, these call centers do not 

speak with potential patients to detem1ine their needs before routing them to the treatment 

facilities paying for calls. The price per call varies, but the Committee's investigation has found 

that some call aggregators charge between $20 to $40 per call. Other call centers are operated by 

businesses that also own treatment facilities, and the call centers are used to advertise their own 

facilities and services. In these cases, the Committee found that some call centers pay bonuses to 

employees for each successful enrollment of a patient in their treatment facility. While some call 

centers and websites disclose that they are owned and operated by treatment facilities, others do 

not clearly list or otherwise disclose their ownership or affiliations. In some instances, the 

contact information included in online listings for treatment facilities has been altered so that 

anyone who calls seeking treatment would be funneled to a call center or another treatment 

facility rather than the facility listed. 19 Those answering the calls could then either encourage a 

prospective patient to enroll in their treatment programs or collect the person's contact 

information and sell it to other interested treatment centers20 

In addition, some facilities or companies own and operate multiple websites, domains, or 

URLs to advertise treatment. Like call centers, the level of disclosure offered by treatment 

facilities about their ownership of treatment-related websites varies widely. 21 Some companies 

advertise solely through branded websites that disclose their treatment facilities and ownership 

structure. Others develop unbranded websites that may appear to be unaffiliated third-party sites 

meant to offer resources and helplines. To reach the greatest number of potential clients, some 

businesses have developed dozens of treatment-related websitcs. At least one business told the 

Committee that they developed unbranded websites in order to reach additional potential clients. 

The Committee has also found multiple examples of treatment industry business URLs that 

closely mirror other well-established treatment facilities or highly trafficked websites in an effort 

"Palm Beach County Sober Homes Task Force Report, (Jan. I, 20 17), available at 

http://www.sa 15 .slate. fl.uslstateattorney/Soberl-lomes/ contentiS!-ITFReport20 17.pdf. 19 Teri Sforza, eta!., supra note 13. 20 /d 

21 /d. 
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to capitalize on similar terms or misspellings. Businesses have also indicated they occasionally 

use television advertisements to promote 1-800 hotlines for treatment facilities. 

Online advertising practices in the treatment industry have also come under scrutiny. In 

2017, Google began restricting online advertising by treatment providers, with company officials 

citing ''a number of misleading experiences among rehabilitation treatment centers."22 Online 

search advertisements can be lucrative and Google was considered one of the largest referral 

sources for individuals seeking treatment23 Before Google suspended treatment industry-related 

searches within its Ad Words keyword auction system, treatment centers could bid to buy online 

ads that would show up when someone searched for terms like "drug rehab" or "addiction." 

Reports indicate that businesses were willing to pay upwards of $90 a click for specific search 

terms and Ad Words suggested a minimum bid of$187 per click for the term "drug rehab 

locations. "24 Google plans to resume treatment industry advertising this year through a 

partnership with the company LegitScript, which will vet and certify drug and alcohol treatment 

providers before they are allowed to advertise with Google. 25 Through the partnership, 

LegitScript' s President and Chief Executive Of1iccr said he hopes to provide better information 

to consumers about "which programs provide genuine treatment and which are, in essence, 

scams."26 

The issue of ethical marketing has also been of great concern among groups within the 

treatment industry. The National Association of Addiction Treatment Providers (NAA TP) 

recently adopted updated standards for advertising and marketing. Among the requirements 

outlined in the association's new code of ethics: members may not buy or sell patient leads, 

members may not engage in the practice of patient brokering, and members must be transparent 

regarding their identities and services. 27 NAATP announced in May that it did not renew 70 

member facilities who were unable to meet the association's new standards- a decision that cost 

the association $100,000 in lost membership fees 28 

Cat Ferguson, Exclusive: Coogle is cracking down on sketchy rehab ads, TilE VERGE, (Sept. 14, 20 17), available 

at https://www .thcverge.com/20 17/9/14/ l6309752igoogle-rchabs-near-me-search-adwords-crackdown. 23 Michael Corkery, Coogle sets limits on addiction treatment ads, citing safety, TilE NEW YORK TIMES, (Sept. 14, 

2017), available at https://www.nytimcs.com/20 17/09114/business/google-addiction-treatment-ads.html. 

"Michael Smith, Jonathan Levin, and Mark Bergen, Why it took Google so long to end shady rehab center ads, 

BLOOMBERG, (Sept. 26, 20 17), available at https:!/www.bloomberg.com/news/features/20 17-09-26/why-it-tookgoogle-so-long-to-cnd-shady-rehab-center-ads. 

25 LegitScript, Addiction treatment certification nears end ofpre-launch phase, (July 12, 2018), available at 

https:/ /www.legitscript.com/b log/20 l 8/07 I addiction-treatment -certification-enters-new-phase/. 26 John Horton, LegitScript 's new certification program for addiction treatment providers will help those most 

vulnerable, LegitScript, (April 16, 20 18). available at https://www.legitscript.com/blog/20 18/04/legitscripts-newcertification-program-for-addiction-treatment-providers-will-help-those-most-vulnerable/. 

27 Code of Ethics, National Association of Addiction Treatment Providers (last accessed July 16, 20 18), available at 

https :/ /www .naatp.org/resources/eth ics/code-eth ics. 28 Alcoholism and Drug Abuse Weekly. NAATP leadership: By speaking truth, field will gamer public trust, 

Volume 30, Number 21, (May 28, 2018). On file with the Committee. 
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b. Concerns within the Substance Use Disorder Treatment Industry 

Some have described the treatment industry as the "Wild West,'' and ripe for exploitation 

by unscrupulous business owncrs29 Concerns within the industry range from employees who do 

not have adequate training or education to care for patients, to abusive billing practices, and 

kickback payments made in exchange for luring patients to facilities 3 ° Further, there are 

concerns about a lack of transparency and usc of overstated or unqualified success rates. Success 

rates often do not define what qualifies as a success- be it sobriety for a year, six months, or 

even a week after leaving treatment. 31 Further, many success rates are based on self-rcpotiing by 

patients and can be di!1icult to verify. 

Another concerning practice involves treatment facilities allegedly prioritizing profit over 

recovery by requiring a patient to undergo costly and medically unnecessary testing that is billed 

to the patient's insurance company. 32 Few national urine drug testing standards exist, therefore, 

decisions regarding who should be tested, how often they should be tested, and for which drugs 

they should be tested are largely left up to providers. 33 For example, there are reports of clinics 

and labs charging more than $4,000 for a single urine test, and for treatment facilities to test 

individuals two or three times each week34 According to the Hcalthcare Fraud Prevention 

Partnership (I IFPP), the North American clinical laboratory services market is worth an 

19 Teri Sforza et al., flow some Southern Cal{fornia drug rehab centers exploit addiction, ORANGE COUNTY 

RI'GISTER, (May 21, 20 17), available at http://www.ocregister.com/20 17/05/21/how-some-southern-california-drugrehab-ccnters-exploit-addiction/; Amy Julia Harris and Shoshana Walter, Drug users got exploited Disabled 

patients got hurt One woman benefittedfi'om it all., Till' CHARLOTTE OBSERVER, (May 21, 20 18), available at 

http:/ /www.charlotteobserver.com/latest-news/article21 1600539 .html. 10 See, e.g., Paloma Esquivel, Murder Charges Against Rehab Center are a Firs! in California, LOS ANGELES 

T!M!'S, (Feb. 28, 2016), available at http://www.latimes.com/local!crime/la-me-rehab-murder-charge-20160228-

story.html; Amy Julia Harris and Shoshana Walter, Drug users got exploiled Disabled patients go! hurl. One 

woman benefllledji'om if all .. Till Cl!ARLOTTE OllSI'RVI'R, (May 21, 2018), available at 

http://www.charlotteobserver.com/latest-news/article211600539.html; Christine Stapleton, 2 addiction treatment 

center owners indicled afier reaping $50 million, PAlM BEACII POST, (June 27, 2018), available a/ 

https://www.mypalmbeachpost.com/news/addiction-trcatment-center-owners-indictcd-after-rcapingmillion/31NObOjWXx Y eA2rv V zvS/\01. 31 Christopher Moraff, Why Drug Rehab is Outdated. Expensive, and Deadly, TilE DAILY BEAST, (May 9, 2016), 

available at https:/lwww.thcdailybeast.com/why-drug-rehab-is-outdated-expensive-and·deadly; Melissa Locker, 

John Oliver Shines a Ugh! on !he Unregulated Rehab Industry on Las/ Week Tonight, TIME (May 21, 20 18), 

available at http:i/time.com/5285151/john-oliver-rehab-last-week-tonight/. 12 David Segal, In Pursuit ofLiquid Gold, THE NLW YORK TIMES, (Dec. 27, 2017), available a/ 

https:i/www.nytimes.comlintcractive/20 17/12/27/business/urine-test-cost.html; Fred Schulte and Elizabeth Lucas, 

How Doc/IJ/'S are Gelling Rich on Urine Tests jiw Opioid Patients, BLOOMBERG, (Nov. 6, 20 17), available at 

https:/ /www .bloombcrg,com/news/fcatures/20 17 -l 1-06/how-doctors-are-getting-rich-on-urine-tests-for-opioidpatients; Cat Ferguson. SearchingjiH' Help, TilE VERGE, (Sept. 7, 20 17), available at 

https:/ /www.theverge.eom/20 17/917 I 16257 412/rehabs-near-me-google-scarch-scam-florida-treatment-centers. 11 Fred Schulte and Elizabeth Lucas, /low Doctors are Gelling Rich on Urine TestsjiJr Opioid Patients, 

BLOOM!lt:RG, (Nov. 6, 20 17), available at https://www.bloomberg.com/news/features/20 17-11-06/how-doctors-aregetting-rich-on-uri nc-tests-for -op ioid-patients . 

. H David Segal, In Pursuit ~(Liquid Gold, THE NEW YORK TIMES, (Dec. 27, 2017), available a/ 

https:l/www .nytimcs.com/interactivc/20 17 I 12/27/business/urine-tcst-cost.htm l. 
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estimated $87.3 million35 The l-lfPP highlighted both the potential for and examples offraud 

and abuse within the market in a recent report. Their concerns include the routine use of 

definitive or quantitative urine drug testing in place of less expensive qualitative testing, 

fraudulent use of urine drug testing in sober living homes, and use of'·excessively broad panels" 

to detect the presence of less commonly used substances in order to maximize reimbursements36 

c. Federal and State Efforts to Combat :Fraud and Abuse 

Despite both the growing need for treatment and the increase in operation of private forprofit treatment facilities, 37 the federal government has not been heavily involved in oversight. 

According to HI IS. "[tjhe federal government has oversight of opioid treatment programs 

(OTPs) but does not have oversight authority over other levels of care states are responsible."38 

Other than for OTPs, there are no federal regulations of substance use disorder treatment 

facilities, and there is wide variability in terms of how facilities arc regulated at the state level. 

Several states have taken action to improve oversight of the treatment industry, including 

in areas related to advertising and marketing. Florida, which has seen an increase in growth of 

the treatment industry in recent years, passed legislation in 2017 that took aim at the practices of 

patient brokering and deceptive marketing. For example, the state now bans marketers from 

contracting with treatment facilities to generate patient referrals or leads through call centers or 

online advertising without disclosing the identity of the licensed treatment facilities paying the 

markctcr39 A Tennessee law, which took cflect in July, bans operators of alcohol and drug 

treatment facilities from making false statements in advertising materials about their identity, 

services, or geographicallocation40 Like the florida law, the new Tennessee law also bans 

marketers from generating patient leads without disclosing which treatment facilities pay them. 

Tennessee also bans the payment of any commission, rebate, kickback, or bribe to anyone in 

exchange for the referral or patronage of a patient- a practice similarly banned in Florida. 

In addition to florida and Tennessee, Arizona has also taken steps to reform the state's 

substance use disorder treatment industry. Legislation adopted this year in Arizona bans 

treatment facilities from paying fees or kickbacks to recruit patients and individuals from 

soliciting or accepting tees to deliver paticnts 41 The state also adopted laws that require sober 

35 1-lealthcare Fraud Prevention Partnership, Emmining clinical laboratory services, (May 20 18), available at 

https://hfpp.cms.govlllFPP-White-Papers/HFPP-Ciinicai-Lab-Services-White-Paper.pdf. 

36 !d. 

37 The number of patients treated for substance use disorder at private for-profit facilities grew trom 328,763 in 2006 

to 449,038 in 20!6. See Substance Abuse and Mental Health Services Administration, National Survey a/Substance 

Abuse Treatment Services {N-SSATS): 2016, Data on Substance Abuse Treatment Facilities, available at 

https:i /wwwdasis.samhsa.gov/dasis2inssats/20 !6 _ nssats_rpt. pdf: 38 U.S. Dept. of Health & Human Services Response to 1-!. Comm. on Energy & Commerce Letter, (Sept. 12, 2017), 

available at https://energycommerce.house.gov/wp-content/uploads/20 17/07/20 l70912HHS _ Response.pdf. 39 FLA. STAT.§ 397.55 (2017). 40 2018 TENN. PUB. Cll. 855. 41 Ken Alltucker, Ari=ona 's booming sober-home industry gets new oversight, Arizona Republic, (Aprill4, 2018), 

available a/ https:/ /www .azcentral.com/ story/money /business/health/20 I 8/04/ 14/law -provides-new-oversightarizona-booming-sober-home-industry/513243002/. 
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!!caring 

Page 8 

living homes to he licensed by the Arizona Department of Health and Human Services. 

Legislation is also being considered in California that would ban patient brokering and overhaul 

the treatment industry by requiring more oversight by the state42 

The U.S. is far from seeing the end of the opioid epidemic. The number of opioid-rclatcd 

overdose deaths continues to grow, as docs the number of people in need of treatment for opioid 

misuse. Those who reach out for help to find substance usc disorder treatment should be able to 

access appropriate care without being taken advantage of or misled. Understanding the scope of 

advertising and marketing practices within the treatment industry is essential in establishing a 

baseline for good practices and informing consumers about treatment options that meet their 

individual needs. 

III. ISSUES 

The following issues may be examined at the hearing: 

• Advertising and marketing practices within the substance use disorder treatment industry; 

• Transparency and disclosures within advertising and marketing in the substance use 

disorder treatment industry; 

• Efforts made within the industry to promote ethical advertising and marketing practices; 

and 

• How individuals seeking treatment can identify quality treatment that will meet their 

needs. 

IV. STAFF CONTACTS 

If you have any questions regarding this hearing, please contact Brittany Havens, 

Brighton Haslett, or Andrea Noble of the Committee staff at (202) 225-2927. 

Teri Sforza and Tony Saavedra, Legislators taking aim at scams in the drug rehab industrv, ORANGE COUNTY 

REGISTER. (April 24, 20 18), available at https:!/www.ocregister.com/20 18/04/24/legislators-taking-aim-at-scamsin-the-drug-rehab-industry/. 
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UN!Tf D STAr!.S OF /\Mf-J\!C;\ 

Federal Trade ( 'ommission 

O!llce of(\)mnmsioner 

Rohi1 Chopra 

The Honorable Gregory Walden 

Chairman 

House Energy and Commerce Committee 

U ,S. House of Representatives 

Washington, DC 20515 

The Honorable Gregg Harper 

Chairman 

House Energy and Commerce Subcommittee 

on Oversight and Investigations 

U.S. House of Representatives 

Washington, DC 20515 

July 24,2018 

The Honorable Frank Pallone 

Ranking Member 

House Energy and Commerce Committee 

U ,S, House of Representatives 

Washington, DC 20515 

The Honorable Diana DeGcttc 

Ranking Member 

House Energy and Commerce Subcommittee 

on Oversight and Investigations 

U.S, House of Representatives 

Washington, DC 20515 

Chairman Walden, Ranking Member Pallone, Chairman Harper, and Ranking Member DeGette: 

Nearly every eight minutes, an American dies of a drug overdose, 1 Across the country, opioid addiction 

is tearing apart the lives of individuals, their families, and their communities, There has been significant 

attention on pham1aceutical firms that withheld information about the misuse of addictive pain 

medication lor years in the pursuit of profit 2 

Today, a new crop ofunscmpulous actors is targeting addiction sufferers not to help them, but to gouge 

them, their families, and their insurance companies. There arc indications that there may be widespread 

abuse in the drug treatment industry. This is deeply harmful to honest treatment facilities and patients 

alike, I am concerned that Wall Street investors also see big profit potential and may be exacerbating the 

challenges our country faces. 

In my experience, the government's response to the abusive practices that follow painful events, such as 

the foreclosure crisis and natural disasters, is too slow, Giving the scale of the opioid crisis, it is 

especially critical that law enforcement agencies and policymakers crack down on deceptive lead 

generation practices in the treatment marketplace, 

1 See Christopher Ingraham, new opioid overdose figures: 'We're talking about more than an exponential 

increa.<,'e ', Washington Post, Dec. 21, al/ailahle at https:l/www. washingtonpost.com/news/wonk/wp/"0 17/12/21/cdcreleases-grim-nc\v-opioid~overdose-figures-were~talking~about-more-than~an-exponential~increasc/. 

2 The views expressed in this statement are my own and do not necessarily reflect those of the Federal Trade Commission or 

any other Commissioner. 
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Golden Age for For-Profit Treatment Centers 

When the foreclosure crisis devastated neighborhoods across the country, there were many actors who 

saw big opportunities for profit. When it comes to the devastation wrought by the opioid crisis, it is deja 

vu. Tbe opioid epidemic has led to a boom in the for-profit substance use treatment industry. Billions of 

dollars of capital have been Bowing into the sector from Wall Street, primarily from private equity 

investors. Many nonprofit treatment centers report that investors are seeking to buy them in order to 

convert them to a for-profit model. A decade ago, 60% of treatment centers were nonprofit; today, 60% 

are for-profit. 3 

Private equity funds differ ti:om funds that hold publicly traded stocks and bonds. Typically, private 

equity funds will purchase businesses and make certain strategic or operational changes. The hope is that 

these changes will lead to increased profitability, enabling the private equity fund to sell these 

businesses for a large increase in value. 

A private equity fund will usually want to enter and exit the investment over a relatively short time 

horizon, often between five and ten years. When an investor is highly motivated to drive up operating 

margins in a short time period for an eventual sale, it can lead to predatory practices that put families 

and honest competitors at risk. 

While private equity and other investments into the industry can suppmi capacity expansion and facility 

upgrades, I am concerned that investors' financial incentives may create the conditions for unfair or 

deceptive practices to nourish. Bad actors employ these practices to lure in patients and soak their 

insurers with excessive bills, rather than setting them on the road to recovery. 

Driving Up Margins 

As a nation, we would hope that for-profit treatment centers would be rewarded for achieving solid 

outcomes for patients. However. the most lucrative strategies for these treatment centers may be at odds 

with helping a patient struggling with addiction. 

For example, treatment facilities may heavily engage in frequent testing. This frequent testing, 

especially urinalysis, can be highly profitable. Lab and testing companies are now charging billions of 

dollars to insurers for urine tests. but these test orders may not be solely driven by medical necessity. 

Many of these companies have financial tics to doctors and treatment centers. 

There have also been reports of bait-and-switch bill shock, where a patient is lured to a facility that is innetwork within their insurance plan, but is later treated in that facility by an out-of-network physician, 

leading to far higher costs f()r the patient and their insurer. In addition to causing financial devastation, 

there is a real risk that this practice could lead patients to forgo needed treatment. 

Patients seeking substance use treatment may find that private insurance actually makes them more 

vulnerable. Importantly, ft)r treatment centers looking to drive up billing, patients with private insurance 

are the most enticing, since private insurers will typically pay rates that are higher than Medicare, 

Medicaid, and Tricare. Rather than seeking to serve any patient in need, unscrupulous treatment centers 

might specifically target these privately insured patients through lead generation. 

'See Jeanne Whalen and Laura Cooper, Privali!-EquiiJ' Pours Cash Into OphJid-Treatment Sector, Wall Street Journal. Sept 

2. 20! 7, availaNe a! https://www.wsjxom/anicles/opioid-crisis-opens-opportunities-for-private-equity-firms- I 504353601. 

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Lead Generators and Body Brokers 

In 2016, the Federal Trade Commission (FTC) published a StafTPerspective on lead generation. Lead 

generation is the process of identifying and cultivating consumers who may he likely to purchase a 

particular product or service. The FTC Staff Perspective highlighted the possible pitfalls with potentially 

deceptive lead generation practices.'' 

In the treatment industry. lead generators may seek to collect sensitive information about a potential 

patient, including information about their drug use and insurance coverage. Lead generators can then sell 

or even auction off-· this information for hundreds of dollars. 

Lead generators usually operate online. purchasing ads on Google and other search engines to attract 

potential leads. These leads arc so lucrative that companies have reportedly heen willing to pay hundreds 

of dollars per click. 5 In testimony last year, a nonprofit treatment center described how a lead generator 

hijacked its Google Local listing6 By masquerading as a legitimate treatment center and rerouting 

phone calls to its call center, the lead generator was able to intercept inbound inquiries ti·om patients 

looking for help. 

Similarly, the quest to rapidly drive up profits may also lead to a practice known as body brokering. 

Here, treatment centers might provide financial incentives to intermediaries who find patients in "sober 

homes" or other locations where the patients are seeking to recover. but may not be receiving medical 

treatment that is covered by health insurance. These body brokers can then earn kickbacks by steering 

these patients to treatment centers that will soak their insurers. 

These practices raise serious questions about the adequacy of oversight in this market. 

FTC Efforts 

The Federal Trade Commission enforces laws that prevent unfair or deceptive business practices. The 

agency has brought two enforcement actions against marketers of hogus withdrawal and addiction 

treatment products. 7 Earlier this year, the agency partnered with the Food and Drug Administration to 

send warning letters to marketers selling products that claimed to help with opioid addiction. The FTC's 

jurisdiction includes for-profit treatment centers and lead generators, and unfair or deceptive practices 

by these entities may violate Section 5 of the FTC Act. 8 

Federal, state, and loeallaw enforcement agencies are all working to confront the many challenges 

created by the opioid crisis. But, it is clear that we all must do more. 

1 FTC Workshop, Follow the Lead: An FTC Workshop on Lead Generathm (Sept 2016), available at 

https:i lwww. ftc. gov /system/ fi lcs/documents/rcports/sta JT-perspect i ve~ followlcad/statf perspective follow the lead workshop.pdf. 5 Cat Ferguson, Goog!e is cracking down on sketchy rehab ads, The Verge, Sept. 14, 20 J 7, available at 

https://www .thcverge.com/20 I 7/9/14/ I 6309752/google-rehabs-near-me-search-adwords-crackdown. 

{\US House Committee on Energy and Commerce, Hearing on Examining Concerns of Patient Brokering and Addiction 

Treatment Fraud. Dec. 12, 2017, (Testimony of Douglas Tieman, President & CEO of Caron Treatment Centers), available 

ar https:i/docs.house.gov:mectings/lf/1 F02/20 1712121106 7161HHRG· I 15·1 F02-Wstate· TiemanD-20 171212.pdf. 7 See Compl., FTC v. Carlin Enrerprises, Inc .. No. I: 17-cv-403 (W.D. Tex. tiled May 3. 20 17), available at 

https://www.ftc.govlsystem/filcs/documents/caseslwithdrawal case - complaint w exhibit.pdf; Amended Compl., FTC v. 

Sunrise Nutraceutica/s, LLC, Civil Action No.9: 15-cv-81567-D\1!\.1 (S.D. Fla. filed Jan. 8. 20 !6), available at 

httns:/.\vww. ftc.gov/system/fi!cs/documentslcasesfl60 l 08sunrisecmpt.pdf 

'See 15 U.S.C. § 45(a)( I). 

3 
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As Congress continues its work to investigate advertising and marketing practices in this industry, it 

must carefully look at how the billions of dollars of new investment in the sector may be spawning 

scams that harvest profits from patients and their families. 

Congress should closely examine incentive compensation practices for employees and operators of 

treatment centers, as well as financial conflicts of interest with other firms. Importantly, we must work 

to crack down on illegal lead generation practices, both online and oft1ine, for-profit and nonprofit. 

Too many firms are looking to profit off the pain offamilies dealing with addiction. In the absence of 

vigorous enforcement and sensible safeguards, the opioid crisis will inflict even more tinancial, 

physical, and emotional damage throughout our country. 

Respectfully submitted, 

Rohit Chopra 

4