WASHINGTON – U.S. Senator Maggie Hassan (D-NH), Ranking Member of the Senate Finance Subcommittee on Health Care, today launched an investigation into whether patients at for-profit methadone clinics encounter unnecessary barriers when seeking lifesaving methadone treatment for opioid addiction. Although the national companies that own for-profit methadone clinics in New Hampshire have argued that the status quo is best for patients, news reports and lawsuits have alleged that these same companies have engaged in fraudulent behavior and neglectful care. Senator Hassan is requesting information about patient outcomes, billing practices, and compliance from three companies: Acadia Healthcare, BayMark Health Services, and New Season – the parent companies of for-profit methadone clinics in New Hampshire.
This investigation is part of Senator Hassan’s overall efforts to expand access to medication-assisted treatment (MAT) like methadone and buprenorphine. MAT is considered the gold standard for opioid addiction treatment, as it helps people recover and significantly decreases the likelihood of relapse. Unlike with buprenorphine, which any authorized doctor can prescribe, current rules for methadone require patients to physically travel, often daily, to federally certified methadone clinics (also known as opioid treatment programs or OTPs). These barriers mean that many patients may need to frequently travel far from where they live to get the treatment that is best for them.
“Drug overdoses killed around 105,000 Americans in 2023 – and more than 400 New Hampshire residents – yet only 25 percent of Americans with opioid addiction receive medication-assisted treatment, the gold standard for opioid addiction treatment. Barriers to access for medication-assisted treatment, including methadone, may contribute to these outcomes,” wrote Senator Hassan in her letter to CEOs of for-profit OTP operators. “Studies show that travel time and distance to an OTP – even a distance of around five miles – can reduce patient retention in treatment. In rural states like New Hampshire, the distance between patients and the nearest OTP can require a two-hour drive.”
“For-profit OTP owners argue that [the current] system helps patients by promoting individualized therapy and counseling,” continued Senator Hassan. “Yet some of these same companies have allegedly defrauded the government and neglected their patients by billing Medicare and Medicaid for inadequate or even non-existent therapy or counseling.”
Senator Hassan then highlighted the disconnect between OTP industry claims and patient experiences, writing that “[l]arge for-profit OTP companies have generally opposed proposals – such as allowing qualified physicians to prescribe methadone outside of an OTP – that would address barriers that limit access to methadone treatment,” while some of these same companies appear to systematically ignore the requirements that they claim to support. For example, in December of last year, a New York Times investigation into Acadia Healthcare showed that the company systematically falsified patient records related to therapy and counseling – undermining the very justification that some OTPs use to oppose expanding methadone access while simultaneously defrauding the government and failing patients.
Senator Hassan’s letters to OTP owners request data from New Hampshire facilities, including revenue information, patient retention rates, staffing levels, counseling hours provided, and the provision of take-home doses.
Senator Hassan continues to work to combat the fentanyl crisis and expand access to evidence-based addiction treatment. Senator Hassan helped introduce the Modernizing Opioid Treatment Access Act, bipartisan legislation to improve access to medication-assisted treatment by allowing more addiction specialists to prescribe methadone. In 2022, Senator Hassan successfully passed into law her bipartisan Mainstreaming Addiction Treatment (MAT) Act to increase the number of medical professionals authorized to prescribe medication-assisted treatment. Last year, Senator Hassan and her colleagues sent letters to OTP operators requesting information about the impact of private equity ownership on access to methadone.
Click to see the letters Senator Hassan sent to Acadia Healthcare, BayMark Health Services, and New Season, or see below for the letter to Acadia Healthcare.
Dear Mr. Hunter:
I am writing to request information about access to methadone through opioid treatment programs (OTPs) in New Hampshire. Drug overdoses killed around 105,000 Americans in 2023 — and more than 400 New Hampshire residents — yet only 25 percent of Americans with opioid addiction receive medication assisted treatment (MAT), the gold standard for opioid addiction treatment. Barriers to access for MAT, including methadone, may contribute to these outcomes, as current rules require patients who receive methadone to physically travel to OTPs, often daily. For-profit OTP owners argue that this system helps patients by promoting individualized therapy and counseling. Yet some of these same companies have allegedly defrauded the government and neglected their patients by billing Medicare and Medicaid for inadequate or even non-existent therapy or counseling.
Experts agree that methadone, when taken consistently and as prescribed, is a highly effective form of MAT, given its unique efficacy in decreasing the likelihood of relapse. However, unlike with other medications used for MAT, doctors must prescribe, and patients must usually consume, methadone at an OTP. Studies show that travel time and distance to an OTP — even a distance of around five miles — can reduce patient retention in treatment. In rural states like New Hampshire, the distance between patients and the nearest OTP can require a two-hour drive. Reporting also suggests that some OTPs “rely on controlling and punitive strategies that make it harder, not easier, for patients to maintain their recovery.” These practices, together with the limitations and restrictions inherent to the OTP model, mean that “people who use drugs are often driven away from methadone treatment or never seek it in the first place.”
Large for-profit OTP companies have generally opposed proposals — such as allowing qualified physicians to prescribe methadone outside of an OTP — that would address barriers that limit access to methadone treatment. Industry representatives have argued that requiring patients to go to OTPs for methadone promotes the provision of essential therapy and counseling. “All of the evidence for the safety and efficacy emanates from methadone treatment delivered…with physicians, nurses, and counselors working together to provide whole of person care,” wrote the then-CEO of BayMark Health Services (BayMark) in a 2024 letter to Congress. Similarly, the CEO of Acadia Healthcare (Acadia) wrote that the effectiveness of the OTP model rests on “[c]omprehensiveness, including the combination of medication-assisted treatment with integrated individual therapy, group counseling, and coordination of treatment with other medical and psychological needs.”
For-profit OTPs, however, have a financial incentive to maintain the status quo. After Medicare and Medicaid began covering methadone in 2020, OTP profits at Acadia, the largest OTP operator in the United States, increased 30 percent. Acadia’s 165 OTP’s have generated $1.3 billion in revenue since 2022. Most other OTPs are operated by for-profit companies, including private equity firms that, despite earning a large amount of revenue from taxpayer-funded insurance programs such as Medicaid, do not make financial information public and have typically declined to discuss their work on the record. However, industry analysts state that an individual OTP with just 100 patients can generate up to $6.5 million in revenue annually.
In addition, some for-profit OTP companies appear to systematically ignore the requirements that they claim to support. OTPs owned by these companies have allegedly falsified patient mental health records and engaged in other misconduct that enabled them to fraudulently bill insurance and increase revenue. For example, a whistleblower lawsuit from a former assistant medical director of an OTP in North Carolina alleges that Acadia systematically falsified records for at least a year beginning in September 2020, fabricating notes for certain therapy sessions in their entirety. This is consistent with more recent reporting by the New York Times, which found that Acadia “employees in 17 states said supervisors and peers had taught them to cut corners by recycling old language from therapy notes or treatment plans without meeting with patients.”
BayMark, the second largest OTP operator in the United States, has faced similar allegations. During the pandemic, the federal government gave OTPs additional flexibility to provide patients with take-home doses — up to four weeks of medication in many cases. A lawsuit by a former director of a Georgia OTP, however, alleged that in late 2021, the company without explanation began requiring its Medicare and Medicaid patients — and only those patients — to return to the clinic on a weekly basis. This allowed the OTP to bill the government for as many as three additional visits per month, even though “patients generally [did] not receive any additional treatment” besides filling their prescriptions. The plaintiff ultimately agreed to dismiss her case, but her allegations are consistent with accounts from industry veterans. “During Covid, we gave a lot of take-homes, and we lost a lot of money doing it,” Nick Stavros, the CEO of Community Medical Services, told STAT News. “The providers who did the right thing were punished, and the providers who did the wrong thing profited.”
The Subcommittee seeks to better understand the impact of the OTP model on patient access to methadone; patient treatment outcomes; and potential waste, fraud, and abuse in federal health care programs. Given the variation in OTP regulations and Medicaid billing practices across states, the Subcommittee presently seeks information specific to OTPs in New Hampshire and requests responses no later than September 16.
From January 1, 2024, through March 31, 2025, please provide data about methadone MAT provided by OTPs at each of the facilities listed in Schedule A, broken down by month:
Additionally, from January 1, 2024, through March 31, 2025, please provide data about methadone MAT provided by OTPs at each of the facilities listed in Schedule A, as of the first day of each quarter:
Additionally, for OTPs at each of the facilities listed in Schedule A, please provide:
From January 1, 2024, to March 31, 2025, please provide the following documents for each facility listed in Schedule A:
The most current version of the following documents for each facility listed in Schedule A:
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