Herald Times on 2/17/2018 by Laura Lane and Abby Tonsing
Local detox center’s charges for urine tests much higher than probation department’s
That sea of gold has trickled its way to southern Indiana, where an addiction treatment facility wants to open a detox center with a drug testing lab.
When Bloomington’s Indiana Center for Recovery tests clients for intoxicants every Monday, Wednesday and Friday, the urine gets sent via overnight mail to a lab the center’s parent company owns in Florida, where it’s screened for 23 substances. The lab charges insurance companies $2,300 per sample.
When the Monroe County Probation Department tests probationers for alcohol and drugs at random times once a week, the samples travel by overnight mail to an independent lab the county has a contract with in Arizona. The urine is screened there for 10 or 12 substances. The cost is $25 per sample.
Why the disparity?
When asked about the cost and nature of urine analysis conducted at his United Clinical Laboratory in West Palm Beach, Florida, owner Kirill Vesselov refused to comment, responding in an email message “this information is proprietary and confidential.”
People on probation pay for their own drug tests, so Monroe County Chief Probation Officer Linda Brady shops around, keeping the cost low to help out her clients. “Our goal is not to make money on it,” she said. “Our goal is to break even, so the drug testing pays for itself.”
Vesselov is the registered agent for both The Haven Detox LLC and United Clinical Laboratory, both in West Palm Beach. He’s the president and CEO of the Indiana Center for Recovery, a for-profit addictions treatment center running out of two offices and one residential building in Bloomington. Vesselov bought the former Hoosier Energy headquarters and hoped to open an inpatient detox center and drug-testing lab there.
Bills obtained by The Herald-Times list The Haven’s charges for drug tests and also the cost of room and board at the detoxification facility.
Patients referred there stay a week to purge their bodies of drugs and alcohol. Then they move on to an intensive residential treatment program for two or three months.
Invoices that divulge expenses incurred by a 23-year-old Bloomington man who stayed seven days at the West Palm Beach detox facility last summer show how lucrative urine testing can be. United Clinical Laboratory billed his insurance $13,760 for a comprehensive blood test and to analyze the man’s urine during that week.
The lab fees after insurance were just $12 more than the bill for his semi-private room, for which the family was charged $13,748 after insurance paid $5,116. During a Monroe County Board of Zoning Appeals meeting about the proposed local detox center, Vesselov estimated the cost of seven days at one of their detox centers at $2,500 to $3,500.
During the last week of January, the Indiana Center for Recovery’s residential outpatient treatment program on West First Street in Bloomington had 44 clients being drug tested three times a week. If each test was billed to insurance companies or private-pay clients at $2,300, the possible income for Vesselov’s lab for those tests that week would be $303,600.
That’s more than the Monroe County Probation Department charged for all 7,632 urine panels people on probation took in 2017. They cost $25 a test; last year’s total was $190,800. The urine is sent via FedEx Monday through Friday to Cordant Health Solutions’ criminal justice lab in Flagstaff, Arizona.
Insurance companies pay a portion of urine-testing costs. The amount varies greatly, given the kind of coverage, deductible costs and other circumstances.
Explanation of Benefits documents for the Bloomington man who spent a week at Vesselov’s The Haven show that his insurance through Anthem Blue Cross and Blue Shield paid a small portion of the drug tests’ cost.
The drug screen checks for 23 substances, at a cost of $100 each. Insurance reimbursed 21 of the tests at $4.96 each. One was reimbursed for $10.09 and another for $29.75.
The total amount charged for his Aug. 13, 2017, urine test was $2,300. Allowable charges for insurance? Just $144. That amount was applied to the policy’s deductible, and the family got billed the other $2,156.
Even though the man was an inpatient at the detox facility, his urine was tested for 23 intoxicants three times during his seven-day stay. He was being treated for alcoholism.
In January, the New York Times reported that Medicare pays a maximum of $80 per urine drug screen. The story focused in part on a South Florida lab that was billing $1,980 for initial urine screens and another $4,000 for more detailed confirmation tests the government reimburses at $117 to $254.
Neither The Haven nor the Indiana Center for Recovery accept Medicaid or Medicare patients. They take people with insurance or those whose families can afford to pay on their own. The recovery centers reserve some beds to treat indigent clients who cannot afford to pay or those deemed worthy of “scholarships.”
Representatives from The Haven and the Indiana Center for Recovery would not answer questions about the cost of urine drug tests at their Florida lab, nor would they say which 23 intoxicants are tested for and why the tests are so frequent.
The lawyer who represented the businesses during a Feb. 7 Board of Zoning Appeals hearing, where they were denied a variance for a detox center and drug-testing lab north of Bloomington, also did not respond to questions.
Executives with the businesses also would not elaborate, or say anything about whether they are pursuing another local site for the detox center.
Before she was elected to county government as a commissioner, Amanda Barge worked eight years as an outpatient therapist at Centerstone, a not-for-profit mental health-based agency with offices throughout Indiana. Administering urine tests to her clients was part of the job, so she knows how it works.
“My reaction is shock, and my reaction is concern,” Barge said when told about billing records indicating $2,300 charges for urine screens given every other day.
“If they really are testing for 23 substances, that sounds excessive to me, problematic in and of itself,” she said of the testing’s frequency.
“Doing a urine screen is good for a baseline. If your treatment is good, you don’t need to urine screen someone every other day. Doing a urine screen is a sign that you don’t necessarily trust somebody,” said Barge, who organized an opioid addiction summit in Bloomington last fall. “Every other day sounds pretty excessive.”
Ted Padich is an investigator in Florida for the Palm Beach County State Attorney’s Office, working with the Sober Homes Task Force. He said the cost and frequency of urine tests conducted at Vesselov’s Haven Detox in West Palm Beach and the Indiana Center for Recovery’s residential treatment center on West First Street are cause for concern.
“There are some red flags there,” Padich said.
He said Vesselov paid nearly $1 million in cash last year to buy the Reliance Treatment Center in North Palm Beach when the former owner left Florida. The addiction recovery center is now owned by The Recovery Team Inc., a for-profit corporation with Vesselov as the officer and registered agent.
It makes sense, Padich said, for treatment centers to conduct urine tests on site. Inexpensive cups with litmus paper detect certain substances, and positive tests can be sent out to a certified lab for further testing to confirm the presence of drugs or alcohol.
The Monroe County Probation Department’s Steve Malone oversees drug court for offenders battling addiction. As participants progress through the program, the frequency of drug screening lessens. His department administers “instant cup” tests for more intoxicants than the standard 10-panel urine screen includes, Malone said.
Each instant test costs a probationer $10. If the urine tests positive, the sample is sent to Cordant’s Arizona lab for a $20 confirmation test.
Padich said that as the detox industry in Florida grew and flourished, the cost of urine screens began to increase.
“About 2013, enterprising business people started taking advantage as they got reimbursed by insurance companies,” he explained. “They would charge $20, then $50, and then it was $100. Then it became a thousand. Then, thousands.”
He said costly and extensive urine testing often is unnecessary, especially if a patient is closely monitored. Padich questioned the need for frequent drug tests at facilities such as the Indiana Center for Recovery, where patients are not allowed to leave on their own and are checked on by a staff member every 15 minutes during the first month of treatment.
Simple tests could be done, he said, then sent for confirmation at a lab equipped with a machine called a mass spectrometer if they are positive. “Sending out every urinalysis, why would that be medically necessary?” the investigator asked.