Tag Archives: Marketing

LegitScript Opens The Spigot & Congress Chimes In on Internet Marketing

One of our favorite reporters in this space, Behavioral Healthcare Executive’s Julie Miller, broke the news that LegitScript has released the first wave of “certified” advertisers for whom using AdWords and PPC will be accessible again.

I reported about this new structure back in April 2018 in my article “Google Reinstates Ads for Addiction Treatment Centers, With Pre-Certification by LegitScript” but since that time, there has been little to no public information released about the process or the status of applications.

According to Miller’s article, “Treatment centers secure inaugural AdWords certifications,” over 100 treatment providers have been approved so far, according to David Khalaf, communications specialist for LegitScript, Google’s independent partner overseeing the certifications. This far exceeds the 20-30 that LegitScript initially reported they believed they would be able to accommodate.

“Completing the LegitScript application was a rigorous task, according to Doug Tieman, president and CEO of Caron Treatment Centers. Caron has facilities in six states and is one of the newly certified organizations now cleared to bid on premium Google AdWords. Although earning the certification takes time and effort, Tieman says the benefit for the industry is that such vetting will help eliminate black-hat marketers from even participating in the more robust Google paid search options. Only the documented good guys will have the privilege.”

“’Unethical marketing practices in the addiction treatment industry have become common,’” Tieman says. “’Yet prohibiting all treatment facilities from advertising is not a viable option for anyone—Google, treatment centers or consumers.’”

Seabrook, with multiple centers in New Jersey, has also secured its certification.

According to Miller: “It’s important to keep in mind that the certification is still ramping up and that it only applies to AdWords advertising. Organic search engine optimization and Google Maps will remain in place. For the newly certified organizations, LegitScript will also continue to monitor their activity.”

This all comes on the heels of a 2.5 hour hearing that the House Energy & Commerce Committee hearing on Tuesday, July 24th, where House Representatives questioned entities such as Michael Cartwright, Chairman and CEO of American Addiction Centers as well as owner of Rehabs.com, on how their online platforms work.

While the hearing is not “must watch TV”, it seemed apparent to us that Congress understands there is a problem with matching patient with the marketplace, but hasn’t yet focused on the source of that problem, which is insurance companies arbitrarily (and in my opinion, illegally) refusing to pay for mental health and behavioral health care, and local zoning authorities who continue to place NIMBY (Not In My Backyard) politics with the siting of necessary facilities.

If there was a nationwide, robust mental health in-network system where providers could actually get paid and that patients could more easily access, perhaps using Google to search for help would not be as critical.

We agree with Caron’s Doug Tieman on this point. By restricting all information to prospective patients, we are effectively making it that much more difficult to access care.

NOTE: During the Congressional hearing, AAC’s Cartwright kept lauding a Tennessee law which supposedly passed this year which addresses the issue of unscrupulous advertisers. In our read of that law, it is an absolute copy of Florida’s law that the Palm Beach County Sober Home Task Force drafted and the Florida legislature passed over a year ago.  Florida continues to lead the nation in not only best in class health care for people with Substance Use Disorders, but also in protecting those who may fall victim to opportunists taking advantage of this disjointed health care system.

Palm Beach Court Requests Clarification on Question of “Criminal Intent” Necessary in Patient Brokering Act

Palm Beach Circuit Court Judge Joseph G. Marx issued a somewhat confusing non-final Order this morning in the closely-watched case of State v. Robert Simeone, regarding whether the State must prove that the Defendant had the required intent to violate the Patient Brokering Act when paying case management fees to the sober home operator where his patients resided.

As I reported back on July 9th,  the Defendant moved to dismiss the prosecution on the basis that he entered into agreements to pay fees to sober home operators to provide case management services for his client, and not for referrals.

The State responded, in part, that even if the Defendant was paying for case management services, if those payments also induced the sober home provider to make referrals to the Defendant, then that violates the prohibitions in s. 817.505, Florida Statutes, the Patient Brokering Act.

But what was the Defendant’s intention?  What level of “intent” does the State have to prove?

The Court today said “we don’t know.”

The State is claiming that the Patient Brokering Act is a “general intent” statute, meaning the level of criminal intent that the State must prove is that the act occurred and the Defendant intended to take the action.

The Defendant is asserting that the State must prove more; that the State must prove that the Defendant specifically intended to pay for a referral or intended to use the business arrangement between the parties as a disguise to cover up a payment for a referral.

The State believes that it must only prove that the case management arrangement was either established or continued in order to keep the referrals flowing, which is a critical distinction; that if any purpose of that payment or benefit was to induce a referral or continue a de-facto referral relationship, that would be a violation of the Patient Brokering Act.

Stated differently, the State appears to be asserting (as cited in the motions and responses) that, if and when those case management fees stopped being paid (i.e., the Defendant no longer wanted the sober home operator to provide case management services) that the referrals would end; that both parties understood that; and therefore the case management relationship continued for purposes of continuing the referrals – the case management arrangement with the sober home provider would have ended if the referrals ended; and that this establishes the required level of “intent”  by the Defendant.

The Defense has responded that the State must prove (and suggests the State will be unable to prove) that this was the actual, specific intention of the Defendant – to pay for a referral – and that the State must prove that the Defendant specifically intended for the case management arrangement to be a disguise for referral payments.  The pleadings suggest that the Defendant believed, in good faith, he was only paying for case management services, and if the sober home provider chose to refer its residents to Defendant’s treatment center, that was only the byproduct of a professional, arm’s length business relationship that developed through time and that there was no “quid pro quo.”

The Court’s Order seems to suggest, it does know the answer of what “criminal intent” standard to apply and wants a higher court to chime in.

If the “general intent” standard is ultimately to be applied, the State would only need to prove the Defendant engaged in the case management services agreement with the sober home provider, in part, to obtain referrals, even if there were other legal aspects of that business relationship.

If the “specific intent” standard is the one that the courts ultimately rule upon, then the Defendant’s state of mind does come into play and the State would have to introduce either direct or circumstantial evidence of the Defendant’s criminal intent to provide a benefit to the sober home specifically in exchange for referrals.

The Court today said, it is not sure, and needs a higher court to chime in.

The answer may not come for quite some time.

Confusion Over Sober Home Certification Spurs Misinformation Campaign in Florida

Prior to 2016, there was no law in Florida governing the relationship between sober homes and treatment programs.  Certification of recovery residences was voluntary, under the premise (and misunderstanding of legislative staffers in the State’s capitol in Tallahassee) that sober living and treatment programs were entirely separate creatures.

In other states, that may be the case and sober living has historically enjoyed an autonomy (such as the reputable Oxford House International charter model) which led to multitudes of success stories of people finding their own path to recovery and sustained sobriety.

But as Florida cemented itself as a “treatment destination”, the concept of the “sober home “ or “recovery residences” began to turn from an altruistic endeavor to a concern over where and how to house patients while they were in treatment.

By coming to Florida for treatment, patients clearly need a place to stay when not in clinical session. Under the “Florida Model” of outpatient services favored by insurance carriers and as adopted by Florida law under the “Partial Hospitalization” (PHP) level of care, housing is to be provided by the treatment provider.

For many years, the PHP model worked quite well and it simply made sense that a patient needed to be provided a place to sleep that was safe, secure, and drug/alcohol free. “Recovery support services” within the home were never required.

These homes, referred to as the “Community Housing” component of a “Day or Night Treatment with Community Housing” license, may or may not provide any form of peer-supported living. It is at the discretion of the provider.

And that is where the problem comes in, as far as the Fair Housing Act is concerned. Such a home is, by all definitions, a “house,” but is it a “boarding house?” A “dormitory?” A “hotel for addicts” while in treatment?

The Fair Housing Act (FHA) only protects “dwellings.”  It also protects the right of all persons to “choose their own ‘home’.”

The FHA does supersede local zoning codes that wrongfully differentiate between homes for people related by blood or marriage and homes where people live “as the functional equivalent of a biological family” that has a known therapeutic benefit.  The FHA and ADA, however, does not allow a Recovery “Bed & Breakfast” to exist wherever it wants to.

For the past 40+ years in Florida, there have been and continue to be numerous “stand alone” sober living environments (many in Delray Beach, for instance) that have faithfully served as the lifeline between newfound sobriety and living a life in recovery, surrounded by a “recovery community”.  The NY Times even lauded Delray Beach for being “an oasis of sobriety” for long-term sober living and support, calling Delray Beach a Recovery Capitol [“Delray Beach, a funky outpost of sobriety between Fort Lauderdale and West Palm Beach, is the epicenter of the country’s largest and most vibrant recovery community, with scores of halfway houses, more than 5,000 people at 12-step meetings each week, recovery radio shows, a recovery motorcycle club and a coffeehouse that boasts its own therapy group.”].

Those were “recovery residences” to be rightfully protected by the FHA.

But as the Pill Mill Epidemic became replaced with the Opioid Epidemic across the country, people quickly flocked to Google and other informational websites to try to find out what “sobriety” was and where to find it.

Newly-christened addiction treatment entrepreneurs, due in large part to the Great Recession of 2008, began snapping up residential real estate across Southeast Florida in order to provide these supposed “sober living homes” to meet the growing demand.

Then, with the passage of the Patient Protection and Affordable Care Act of 2010, the requirement that insurance carriers pay health care benefits to include addiction treatment fueled the growth of the industry. However, the barrier to entry was (and remains) rather low, and the housing component remains a necessary part in order to have somewhere to “keep” patients while not providing them with clinical services.

Thus, the “Sober Home” problem began as boarding houses for people brand-new to recovery replaced reputable sober living.

In addition, some newer providers of PHP level of services decided to market their housing as the selling point for coming to South Florida; clinical services were secondary, if mentioned at all. To that point, the only requirement to enjoying such a [free] life of leisure was attendance at the housing provider’s off-site clinical treatment location.

This new reality caused local elected officials to plea to the federal government to revisit the Fair Housing Act and the Americans with Disabilities Act, stating that those laws never intended for residential neighborhoods to become de facto hospital districts for persons just released from post-relapse Detoxification services and newly placed into PHP programs. At a minimum, they argued, there should be some modicum of standard for such housing no different than Assisted Living or any other form of supervised group living arrangement.  Stated otherwise, the FHA and ADA do not trump those regulations; why does sober living associated with a treatment program get a free pass?

To begin to bring some level of objectivity to the field, the Florida Association of Recovery Residences (FARR), a sister-organization to the National Alliance of Recovery Residences (NARR), began to seek voluntary certification of sober living residences so that the established homes could differentiate themselves from the new upstarts.

And by 2015, the Florida Legislature elected to formalize that process by directing DCF to identify an entity to credential Recovery Residences.  While voluntary in nature, all licensed treatment providers could not make any refer to a sober living residence if that home was not certified.

Being the only game in town, FARR applied to be the credentialing agency and was thereafter delegated the authority to serve in that administrative capacity.

However, the problem of unregulated sober homes only continued to flourish, as the clear nexus between the locations of overdose deaths and unregulated “sober homes” became abundantly clear.

More had to be done, and faster.

By 2016, the Florida Legislature asked the Palm Beach County State Attorney’s Office to begin conducting a fact-finding mission to determine, fairly and objectively, what was actually “happening on the ground.”

The results were mind-blowing.

After a Grand Jury investigation and report from the separate Sober Homes Task Force Proviso Committee found rampant fraud and abuses of patients by the treatment, housing and marketing industries, further laws were recommended and ultimately adopted.

These new laws, adopted in 2017, sought amongst other protections to clarify unequivocally that treatment centers and sober living residences were regulated by different entities, and that any referral to any sober living residence by a treatment center, whether owned by the treatment center or not, was now to be regulated.

As of July 1, 2018, all sober living residences to which treatment centers were to make a referral of any type had to be certified.

In order to address the long-standing relationship between treatment providers and housing components under the PHP level of care, the Florida Legislature gave all providers until July 1, 2018 (a full year) to become certified.

The reason for the year-long delay was for purposes of fundamental fairness – treatment providers needed to both have their sober living residences certified by FARR as well as secure the services of a Certified Recovery Residence Administrator (CRRA) through approval  by the Florida Certification Board.

Even then, the statute provides that DCF may only begin fining violations as of June 2019.

Still, notwithstanding the well-publicized passage of this law in early 2017 and its signature by Governor Rick Scott by May of that year, many providers continued to claim confusion, based upon misinformation circulated by “consultants” or typical “word of mouth” rumors which are all-too-rampant in the addiction treatment space.

Still, many providers DID follow the law and sought FARR certification long before the deadline of July 1st.

One such provider was Amethyst Recovery Center in St. Lucie County, Florida.

However, Amethyst was ultimately denied FARR certification for its recovery residences, clearly compromising its ability to continue its PHP program.

In response, attorneys for Amethyst filed what is referred to as a “Petition for Declaratory Statement” with DCF, seeking clarification as to whether the housing component of a PHP program must be FARR certified.

Most recently, DCF issued a clearly worded notice on May 29, 2018 to all providers, reaffirming the plain language of the statute that any referral to made to any non-FARR certified recovery residence after July 1, 2018 would be a violation of state statute.

While the outcome of Amethyst’s Petition is now in the hands of DCF, and maybe ultimately the courts, the law has not been suspended, particularly at the local level, where various cities now require FARR certification as a condition of obtaining local zoning approval.

So why are we even commenting on this issue if it is so apparently undecided?

Candidly, we take great offense at the apparent opportunism that some are exhibiting, claiming the “confusion” is due to “random, misleading emails from organizations within the drug and alcohol treatment industry” as to whether PHP housing must be FARR certified, which confusion has been “fueled by the new questionable laws that were passed.”

Such statements are not only wrong, they are irresponsible.

It doesn’t take a lawyer to know that the Florida Legislature said what it meant, and meant what it said. Either one is living under a rock, or is in denial about the state of affairs of sober living in Florida and the country as a whole.

But putting all of that aside, what everyone is missing is the most obvious – certification is an additional burden placed upon treatment providers that compromises their ability as to where they can house their patients, for which insurance refuses to pay.

Since that housing is not reimbursed by insurance, any additional regulatory burden comes out of the treatment center’s bottom line.

But the other side of the argument is even more pressing – the FHA and, by compliment, the ADA, guarantees “fair” housing choices for those who desire to live in a  sober living environment.

PHP patients, by the very nature of PHP housing as well as Res. 5 housing, inherently do NOT choose their own housing. No differently than a hospital patient does not pick and choose which bed to be placed in after surgery.

Moreover, the FHA and ADA only protect “dwellings” which term has a specific federal definition under those laws.

A treatment provider has no inherent federal protections to select a single-family home in a residential neighborhood as a place to house their patients while the residents are in a Partial Hospitalization level of care.

Under long-standing and prevailing law developed under the Fair Housing Act, treatment providers do not enjoy superior rights to zoning laws to house their patients wherever they choose, any more than Hospitals or Institutions do.

However, a “Recovery Residence” does enjoy higher protections, because it can be objectively determined that peer-supported community based living is taking place both inside and outside of the home.

While I understand and an sympathetic to what Amethyst and similar providers are concerned with, their challenge of the law may be causing them to walk right into a trap.

Here is the issue, boiled down to a plain reading of the statutes and rules:

397.311(26)(a)3, Fla. Stat. – “Day or night treatment with community housing” means a program intended for individuals who can benefit from living independentlyin peer community housingwhile participating in treatment services for a minimum of 5 hours a day for a minimum of 25 hours per week.

397.311(37), Fla. Stat. – “Recovery residence” means a residential dwelling unit, or other form of group housing, that is offered or advertised through any means, including oral, written, electronic, or printed means, by any person or entity as a residence that provides apeer-supported, alcohol free, and drug-free living environment.

Rule 65D-30.0081(1) – “Day or night treatment with community housing is appropriate for clients who do not require structured, 24 hours-a-day, 7 days-a-week residential treatment. This component allows clients to live in a supportive, community housing location while participating in treatment.”

Without FARR certification, what objective criteria are we going to use to demonstrate that a treatment center is providing peer community housing, rather than simply providing a “boarding house” to patients while in treatment?

A decision by DCF that PHP or Res. 5 housing need not be FARR certified would give local governments the ammunition they need (and have been desperately waiting for) to say that those “medical boarding houses” can no longer exist in single-family residences or even multi-family zoning districts, but rather may only be in zoning districts for transient housing for medical patients.

A Recovery Residence can be a person’s “home” even if residency is temporary such as at a PHP level of care, but only if the home can meet specific standards proving that unrelated cohabitation is necessary for therapeutic reasons, and which proof can be objectively qualified and quantified.  The US Department of Justice and the Department of Housing and Urban Development agree on this point.

Perhaps most realistic, I do not know of a civil rights attorney in the nation who is going to go into battle over whether PHP housing has the right to exist in any residential neighborhood if there is no ability to demonstrate through evidence that the cohabitation is necessary for therapeutic reasons. Certification of FARR Level 3 and 4 housing creates a rebuttable presumption that the resident medically benefits from such sober living. Simply housing patients in a home while because they need a place to stay while in clinical treatment does not meet that standard.

Perhaps it should. But under the law, it does not.

There is a saying that “bad facts make bad law.” Providers who object to housing oversight and meeting minimum housing standards are further entrenching policymakers that the industry itself is not mature enough to be trusted and that it places profit above patient protection.

On the other hand, those familiar with the Parity Act need to find a way to take a stand that sober living is the “yin” to clinical treatment’s “yang” and the refusal to pay for credible recovery residential services is no different than paying for medical treatment but not the necessary post-surgical residential rehabilitation care.

Either way, within the treatment and housing space, it always seems that the realities of the demands of free market enterprise to conflicts with healthcare policy on an all-too-frequent basis.  Perhaps recently announced collaboration between SAMHSA and NARR will drive the federal government to bring some sanity to an otherwise insane industry without making access to care inaccessible. But in the meantime, the law is what the law says, not what we want it to be.

BREAKING NEWS – Google Reinstates Ads for Addiction Treatment Centers, With Pre-certification by LegitScript

Google will start accepting ads for addiction treatment centers again, Reuters reports. The company suspended the ads in September after The Verge reported that Google ads were being used to direct people to shady addiction treatment centers and away from legitimate facilities. Starting in July, treatment centers can run ads on Google but only after they’ve been vetted by LegitScript, a firm that also verifies online pharmacies.

Google told Reuters Monday it would resume accepting ads from U.S. addiction treatment centers in July, nearly a year after it suspended the lucrative category of advertisers for numerous deceptive and misleading ads.

According to the just-released revised advertising policy press release from Google:

In May 2018, Google will update the Healthcare and medicines policy to restrict advertising for recovery-oriented services for drug and alcohol addiction. This policy will apply globally, across all accounts that advertise addiction services.

Here are some examples of addiction services that will be restricted under this new policy:

  • Clinical treatment providers for drug and alcohol addiction, including inpatient, residential, and outpatient programs
  • Recovery support services for drug and alcohol addiction, including sober living environments and mutual help organizations
  • Lead generators and referral agencies for drug and alcohol addiction services
  • Crisis hotlines for drug and alcohol addiction

Outside the United States, ads for addiction services are currently not allowed.

In the United States, advertisers will need to be certified by LegitScript as addiction services providers before they can advertise through AdWords.

Not all drug and alcohol addiction services are eligible for LegitScript Certification.

Those not eligible for certification, such as sober homes and referral agencies, are not allowed to advertise for drug and alcohol addiction services on Google.

LegitScript charges a fee for processing and monitoring applicants, but fee waivers may be available in certain circumstances.

According to John Horton, CEO of LegitScript:

All of us at LegitScript are really excited about this new program. In many ways, it’s a natural extension of the work we’ve done for years to make the rogue internet pharmacy problem — a driver of prescription drug abuse and other problems — smaller. One of the most pernicious problems our country faces today is opioid addiction and other substance abuse. In the midst of this crisis, some opportunistic addiction treatment providers have been cashing in on patients’ recovery efforts and insurance billing opportunities. The worst of these have not only failed to provide treatment, but have encouraged ongoing drug abuse in patients trying to break the habit.

At the same time, addressing opioid addiction rates requires effective drug treatment strategies: patients and their families need to know which treatment providers are credible and legitimate, and which ones should be avoided. We hope that our program will help provide patients and our partners (like Google) information about which programs provide genuine treatment and which are, in essence, scams.

An important note about cadence: during the first three months, we’re going to intentionally take it slow. Irrespective of how many applications we receive, we’ll probably only certify about 20 to 30, simply so that we can make sure and get the process right. After that, we’ll ramp up the speed. (This goes into the “lessons learned” bucket from our existing healthcare merchant certification program.) This also works well with Google’s timeline, since they have indicated they will actually begin allowing these advertisers in July.

To learn more about LegitScript Certification and submit an application, visit LegitScript’s website.

US advertisers that are certified by LegitScript must also be certified by Google before they can begin advertising.

Advertisers with LegitScript Certification can request certification with Google starting in July, when the form is published.

Interest in treatment for abuse of opioids and other prescription drugs has soared in recent years amid what authorities have described as a nationwide epidemic.

Scammers found that Google ads were an easy way to defraud treatment-seekers in an industry in which regulations vary greatly by jurisdiction, authorities and patient advocacy organizations have said.

Google suspended alcohol and drug treatment advertising on search pages and millions of third-party apps and websites in the U.S. in September, the week after tech publication The Verge posted a lengthy story about scams. Google expanded the prohibition globally in January.

The move cut off at least $78 million annually worth of advertising in the U.S. alone, research firm Kantar Media estimated.

Most advertisers can buy ads through Google with few hurdles to clear. But Google has adopted additional vetting for locksmiths, garage-door repairers, drug makers and online pharmacies following public pressure. Google has said it also will begin seeking more documentation from political advertisers this year.

The addiction treatment rules apply to in-person facilities, crisis hotlines and support groups.

LegitScript will evaluate treatment providers on 15 criteria, including criminal background checks and license and insurance verification. They must also provide “written policies and procedures demonstrating a commitment to best practices, effective recovery and continuous improvement,” according to LegitScript, which will charge $995 upfront and then $1,995 annually for vetting.

The National Association of Addiction Treatment Providers and the National Center on Addiction and Substance Abuse support the standards, John Horton, chief executive of LegitScript, said in an interview last week.

A vetting process for sober-living houses and non-U.S. treatment centers has yet to be set, he said.

Horton acknowledged the “extra step” may frustrate rehab centers.

“It’s unfortunate, but this is one way the market gets cleaner and people get the help they deserve,” he said.

Marcia Lee Taylor, chief policy officer of the Partnership for Drug-Free Kids, to whom Google has donated advertising space, said earlier efforts to certify treatment services have failed because there was no “business incentive to answer all these invasive questions.”

Tying access to the world’s biggest online advertising system to certification makes applying worthwhile, Taylor said.

The new rules do not affect free business listings on Google Maps, which also have been susceptible to fraud. Google said it is continuously developing ways to combat Maps spammers.

More about this new model will be part of my presentation “Public Policy and the Law of Marketing Treatment Programs” at the 2nd Annual Treatment Center Executive & Marketing Retreat hosted by the Institute for the Advancement of Behavioral Healthcare in Hilton Head, SC, April 30 – May 1, 2018.

Reduction of Mental Healthcare Workforce Contrasts with Need

According to ModernHealthcare.com, the U.S. healthcare sector added 22,400 jobs in March, an improvement from February and roughly in line with its average monthly gain over the past year. The largest decline in the healthcare sector took place within residential mental health facilities, which shed 4,100 jobs, according to the U.S. Bureau of Labor Statistics’ newest jobs report released Friday. That’s after those facilities made 700 new hires in February. Ambulatory healthcare services continued its steady growth in March. That sector saw the most new hires within healthcare: adding 16,200 jobs. Hospitals added 9,900 jobs, an improvement from 9,300 new jobs in February. Within the ambulatory sector, dentists’ offices added 4,400 jobs, physicians’ offices added 3,700, outpatient care centers added 3,500 and home healthcare.

Any why is this?

Three main reasons:

  1. Difficulty of Marketing/Brand Recognition – Unlike more traditional forms of healthcare, assisting a patient with selecting a mental health/substance use disorder provider is not as easy as making a referral to a local provider. It is inherently constrained by the refusal of insurance carriers to provide robust IN-NETWORK benefits and providers and by local zoning authorities hindering and obstructing the siting and growth of such facilities. You can’t employee people if you can’t open your facility (and keep it open).
  2. Failure to Pay – You can’t pay the army of employees you need to do this right if you don’t have steady, predictable income, unless you want to staff your facility with interns and unqualified people with little to no experience. I believe our citizens deserve better.
  3. Workforce – People have never flocked to this segment of healthcare as a professional or occupation due to lack of education, lack of ability to make a living, and stigma. In the early days of mental health care, psychiatrists themselves were criticized by their medical school peers as not practicing “real medicine.” On top of that, only the wealthy could afford such services. With insurance only now beginning to pay, the reimbursements are so low that a healthcare provider is stuck with offering volume care over quality. Providers are simply unable to pay competitive salaries and therefore the already limited mental healthcare workforce is going elsewhere.

Why It Took Google So Long to End Shady Rehab Center Ads

Google has been in our news circle (and yours) a lot lately regarding its announcement that it was going to scale back AdWord campaigns (for how long, we do not know) for the addiction treatment industry.

To date, numerous stories have been written. The one story that has not been written (until now) was the “why” it has taken Google so long to acknowledge its role and moral responsibility within this space (which was also my topic of my presentation, “Public Policy and the Law of Marketing Treatment Programs,” at the recent National Conference on Addiction Disorders in Baltimore, MD).

Michael Smith and his fellow reporters from Bloomberg Businessweek have taken on that task in their story: “Why It Took Google So Long to End Shady Rehab Center Ads”.

It became inherently obvious that Google knew how much money it was making from advertising in this space when they had a presence in the exhibition hall at an addiction conference that I attended a year ago.

In May, scores of people on the front lines of America’s opioid crisis packed the National Association of Addiction Treatment Providers conference in Austin to listen to a Google contractor named Josh Weum. Google LLC doesn’t have anything to do with treating addicts, and the company didn’t send Weum there to talk about helping people get clean. He was explaining how to use Google to cash in on America’s $35 billion addiction treatment market.

Specifically, Weum was part of a panel discussion on ethics. But his job was to promote Google’s giant digital marketing business, and for 14 minutes he threw around such terms as desktop immersion, conquesting, multiscreen dynamic, and PPC (pay per click). At the heart of Weum’s pitch was the product that has made Google’s parent, Alphabet Inc., the second-most valuable company in the world: the AdWords keyword auction system. Through this system, addiction treatment providers (like any other advertisers) bid for search words. If they win, their ads sit atop the free search results; any time someone clicks on an ad, Google gets paid. Weum’s message was simple: AdWords is the most efficient way to the addicts who can afford treatment. “Google is here to help you, as far as growth,” Weum, who gave his title as AdWords ambassador, told the crowd of owners and operators of addiction treatment facilities.

As I sat there, I found the lack of congruence with what I was hearing with what I had been experiencing in the real world to be troubling, how unethical treatment providers, and in some cases criminals, use AdWords to exploit addicts. As we were already well aware, a recent article by writer Cat Ferguson in Verge further described how treatment operators use Google to deceive vulnerable patients about treatments, facilities, and even the locations of their clinics. Some advertisers posed as caregivers but were really call centers that sold leads on patients to the highest bidder.

So as I sat at NAATP listening to this sales pitch by Google (and for those who know me well), I was fidgeting in my seat and could not bite my tongue much longer:

As the discussion wound down, Jeffrey Lynne, a lawyer in Boca Raton, Fla., had heard enough. Lynne, who specializes in advising addiction treatment centers, stood up and accused Google of not only enabling a dirty business but actively profiting from it. “Google has a fundamental responsibility to stop making money hand over fist by jacking up these ad prices because of an algorithm,” Lynne said, drawing applause from the crowd. “We need you to step up to the plate,” he said. “Because people are using you to human-traffic our children.”

Google reps have since said the company is zeroing in on 70,000 addiction-treatment-related keywords.

“It will be both complicated and expensive—if Google successfully cuts off shady operators, it’s going to cost the company money. But then, no one ever said it was easy getting clean.”

Google Regulates Fraudulent Addiction Marketing

After months if not years of industry leaders complaining about the gamesmanship in addiction treatment center marketing, and the findings by a Grand Jury in Palm Beach County, Florida, the nation’s search engine leader, Google, has finally clamped down on what has been found to be substantive marketing abuses by internet-savvy providers.

It is sad, however, that what is otherwise a very viable (if not the only) ability to find a treatment programs that match needs has become a “no man’s land” of mines and traps for the unwary.

For now, we believe that Google is simply “putting the brakes” on a runaway problem until they can resolve the problem that has been created.

We have been warning the industry that this was coming for weeks, if not months. We have been helping clients with alternative advertising avenues. Some have gotten ahead of this curve. Others, well, have not.

The exceptional article from Cat Ferguson of The Verge can be found here.

The article from the NY Times can be found here.

And, of course, video of our polite unsolicited “confrontation” with the Google rep at the 2017 NAATP Leadership Conference can be seen here (Pt.1Pt. 2).

At the end of the day, the overriding public policy in healthcare is that our nation wants patients to voluntarily and intelligently choose their healthcare providers. That is absolutely the case in addiction healthcare, where an overwhelming number of patients travel for treatment.