Addict brokers profit from desperate patients

https://www.statnews.com/2017/05/28/addict-brokers-opioids/

Inside The $35 Billion Addiction Treatment Industry

Days after he relapsed on heroin last summer, Patrick Graney received an offer that was too good to turn down.

How would he like to get treatment in a beach town with a hipster vibe in South Florida — with all expenses paid, including airfare from his Massachusetts home? Graney didn’t have to think long. He was on a flight south the next day. Two months later he was dead.

The arrangement — according to interviews with Graney’s mother and girlfriend and saved Facebook messages he sent — was brokered by Daniel Cleggett, a flamboyant figure, and some would say a pillar, in the Boston-area drug recovery community. A former addict who has spent nearly a quarter of his life in jail, Cleggett has turned entrepreneur in the burgeoning treatment industry for people addicted to opioids such as heroin and prescription painkillers.

He presides over an expanding empire of treatment facilities in Massachusetts, but he has also helped recruit addicted young people from Massachusetts for drug rehab centers in South Florida, according to the patients’ families and others who know Cleggett and are familiar with the arrangements. Two of these young men, including Graney, died from overdoses in hotel rooms in the oceanside resort communities where they were sent for treatment.

Cleggett has pulled off a stunning and rapid turnaround for a man who was once homeless. He now drives a sleek, black Mercedes-Benz CLS 400 that retails for more than $65,000, and enjoys cruising his boat around Boston Harbor. Recently, he posted pictures on Facebook of him at opening day at Fenway Park in seats steps from the field, and attending a boxing match at a casino.

The 31-year-old Cleggett refers to himself on Facebook as a former “lunatic, outlaw addict” — but one who has been sober for five years and is now committed to helping others follow his path. In a brief telephone interview, Cleggett said he had no role in Graney going to Florida for treatment — despite the messages to the contrary Graney sent. He declined to answer any questions about brokering in general or his role in helping other people travel to Florida for treatment.

“I help people all day, every day. That is what I do,” he said. “I had nothing to do with whatever place he went to.”

Cleggett is just one player, albeit a prominent one, in a murky network of middlemen, often referred to as marketers or brokers, who recruit and arrange transportation and insurance coverage for desperate young men and women from the Northeast and Midwest.

Patient brokers can earn up to tens of thousands of dollars a year by wooing vulnerable addicts for treatment centers that often provide few services and sometimes are run by disreputable operators with no training or expertise in drug treatment, according to Florida law enforcement officials and two individuals who worked as brokers in Massachusetts. Cleggett refused to say whether he was paid to find customers for Florida treatment centers.

The facilities are tapping into a flood of dollars made available to combat the opioid epidemic and exploiting a shortage of treatment beds in many states. As center owners and brokers profit, many patients get substandard treatment and relapse.

The role of patient brokers in steering addicts to out-of-state treatment centers is now coming under scrutiny from law enforcement, including Massachusetts Attorney General Maura Healey, according to a spokeswoman for her office. “These recruitment operations take advantage of the desperation of people struggling with addiction to refer them to treatment centers not based on their best interest, but in order to get a commission,” Healey said in a statement. “Patients need to access safe and effective recovery options instead of being treated like paychecks.”

Such arrangements can be illegal in some cases under federal and Massachusetts law if facilities pay brokers to bring them patients and if patients are given inducements, such as free travel or insurance, to enroll in a particular treatment center.

Two people engaged in the business of recruiting addicts for Florida facilities said there are scores of people recruiting patients in Massachusetts and neighboring New England states where rates of opioid abuse are high. They spoke on the condition they not be identified for fear of prosecution.

Brokers are primarily paid in two ways, they said. One is a per-head fee — ranging from $500 to $5,000 — for each patient who successfully checks into a treatment center. In other cases, brokers get a monthly fee from a particular facility but must meet a quota of patients to collect payments as high as tens of thousands of dollars.

A change of scenery and pleasant weather are enough to entice some people to head to Florida to detox, the brokers said. However, most can’t afford it, so they are offered “scholarships,” with the patients paying nothing for their travel or treatment.

In addition to sometimes paying for patients’ flights, brokers often help them obtain private insurance, and then pay the premiums on their behalf until treatment benefits are exhausted after 60 to 90 days. The Florida centers frequently bill the private insurers at higher, out-of-network rates that can easily total $10,000 or more a week.

“They get down there, and it’s nothing more than a puppy mill for insurance billing,” said Eric Spofford, founder and CEO of Granite Recovery Centers in New Hampshire, who has learned of the brokering from the region to Florida centers from patients at his facility. “There’s no investment in helping them get better.”

When Graney, who grew up in Milton, Mass., was in Florida last summer, he repeatedly cited Cleggett as the person who arranged for his treatment in messages to four different people obtained by STAT and the Globe.

In a message to a friend on July 22, Graney wrote that after discussing with Cleggett the possibility of treatment in Florida “he had me on a plane the next day” and that it was “all free.” Two days later, Graney wrote to another friend that his treatment was free and “this kid clegget” got him insurance, misspelling Cleggett’s name. Graney then added, “they get paid 4 sendin kids down here.”

On Aug. 3, when a third friend asked him about his treatment in Florida, Graney wrote, “Yea Danny Clegget hooked it up all free.” The next day, he wrote to an acquaintance who runs sober homes in Florida. Of his insurance, Graney said, “sum1 back home sent me down here…but I didn’t pay for it.” When asked who sent him, he responded “Danny clegget.”

In a message to a fifth person, sent just hours before he died, he mentioned a second person who was involved in the arrangement of his treatment in Florida. The identity of that person could not be confirmed.

Graney’s mother, who provided the Facebook messages, and Graney’s former girlfriend said in interviews that Cleggett arranged free transportation and insurance for Graney.

Cleggett insisted in the interview that he didn’t pay for any expenses related to Graney’s treatment in Florida, including airfare and insurance — and that he had nothing to do with Graney traveling there. He refused to say whether he was working with another broker who paid those costs. Asked about Facebook and text messages with Graney, Cleggett said, “Your facts are not true.”

He said Graney was a friend and added, “It’s very unfortunate what happened with Pat.”

The relocation to Florida did little for Graney. He was bounced out of a treatment facility, and two months after arriving, he was homeless and trying to find help on his own. He fatally overdosed in a Delray Beach hotel room with a stranger he met hours earlier at a detox center that turned him away.

“My son would still be alive today if he didn’t get on that plane to Florida,” said Graney’s mother, Maureen.

Earlier this month, at a meeting of a community group that gathers regularly to discuss solutions to the opioid crisis, Cleggett sat slumped and expressionless at the front of a room in the Holbrook, Mass., town hall. Burly with close-cropped hair, he was dressed casually in a long-sleeve checked shirt.

Cleggett is a frequent presence at such meetings. An ex-con and a businessman, he can talk the language of inmates locked up on drug-related charges and of state officials working on solutions to the opioid epidemic.

He listened for about an hour while one speaker after another talked about finding sobriety and helping others. Finally it was his turn to speak. All eyes were on Cleggett as he leaned forward over the dais and began to tell his story, loud and rapid-fire.

He told the group that he was jailed for the first time when he was 14 and spent seven of the next 12 years locked up. He was homeless. He abused alcohol and drugs.

Law enforcement records offer additional details of a long and violent criminal history. After his first brush with police at age 14, the charges were dismissed, but over the next decade, dozens more followed. On at least three occasions, he led police on high-speed chases, hitting other cars in one and careening dangerously close to pedestrians in another, court documents show.

One chase, when he was 20, occurred just hours after he was released from jail after serving a six-month sentence for assault and battery with a dangerous weapon, according to court documents.

In his mid-20s, Cleggett went to a retreat modeled on the 12-step Alcoholics Anonymous program. The treatment clicked. He was soon managing a sober house in Maine where addicts in recovery lived together. Those experiences prompted him to open similar treatment facilities in Massachusetts, he told the group in Holbrook. He now operates five facilities with 100 total beds, he said.

He recently opened a 12-step retreat in a large home in Wakefield near a lake. He has a sober home in Weymouth and two other facilities in nearby Quincy. There are many people who credit Cleggett and his facilities with helping them get sober.

Cleggett paused, seeming to fight back tears, when talking about friends dying and his current work.

“If these kids got the help I got,” he told the group, “it didn’t have to be this way.”

Patrick Graney’s struggle with opioids began at his junior prom at Milton High School in suburban Boston. A friend offered him OxyContin, and his life changed instantly. He was quickly hooked on the drug and dropped out of school halfway through his senior year.

Graney was a gifted athlete — a star pitcher in Little League and a high-scoring hockey player. He had a thick Boston accent and a quick wit. As he descended into a decade-long addiction to opioids, his appearance changed as he put on weight and drifted from halfway houses to homelessness.

Court records reveal a record shared by thousands of others addicted to opioids: drug and theft charges, short stints behind bars, and in and out of treatment programs.

Somewhere along the way, Graney met Cleggett, when they were both using drugs and occasionally seeking treatment. After Graney started using drugs again last year, Cleggett sent him numerous text messages offering to arrange treatment for him in Florida, said Graney’s former girlfriend, Kerri Jones. He also offered to help get Jones treatment in Florida, she said, and he had previously arranged for her relative to get treatment there.

“The way it was explained to both of us is that it is a fresh start in a new state,” she said of Cleggett’s pitch. She said Cleggett sent photographs of a facility that looked like “a five-star resort.” There were daily yoga sessions, she said he told them, and clients were given money to go the movies.

Cleggett told them everything would be paid for, Jones said. They would be in a private insurance plan — not Medicaid, the government insurance program the two had used in the past and that pays far less for treatment than commercial insurers. If anyone questioned them about their insurance, Cleggett told them to say they were unsure about the details or they were covered by their parents’ plans, she said.

About three-quarters of the rehab center patients with private insurance like Graney are coming to Florida from out of state, according to law enforcement officials in Palm Beach County. The Affordable Care Act, which both mandates payment for drug treatment and makes private insurance easier to obtain for young people, has created a pot of money that’s being exploited by unscrupulous treatment centers, according to those officials.

“There will always be people dying of drug overdoses, but it doesn’t have to be exacerbated by laws intended to get people healthy that have been misused to cause more deaths,” said Dave Aronberg, the state attorney for Palm Beach County, who created a task force to investigate abuses in the treatment industry that thrives in his area.

Graney’s mother said her son told her that Cleggett was arranging free travel and insurance for his treatment in Florida. He sent her a copy of a text message from Cleggett asking for his date of birth and other information so he could book his travel. Graney then sent his mother another message from Cleggett providing the details of his flight on American Airlines from Boston to Fort Lauderdale the next day.

Graney had been in and out of facilities in Massachusetts. When he was 19, Graney’s parents borrowed $10,000 to send him for treatment at a beachfront rehab in southern California. Nothing stuck.

His family focused on keeping him alive, hoping one day he would decide that he had enough with drugs, or find a treatment facility that worked for him.

Maureen Graney was suspicious of the Florida arrangement, but there was little she could do to stop her son from going.

In the end, the lure of Florida was an illusion. A van was waiting when Graney arrived at the airport and he was brought to a treatment facility called Florida Recovery Group in Delray Beach, according to insurance records as well as friends and family.

The plan was for Jones, Graney’s ex-girlfriend, to follow him there a few days later. Graney told her not to bother, she said. The facility was not what he expected, he told her. He said he was sticking it out so he wouldn’t upset Cleggett.

After a few weeks in Florida, Graney relapsed. He connected with a high school friend from Milton, who was also struggling with opioid abuse, and a girl from Massachusetts. They had no place to stay and slept on the beach. Graney then made a telephone call and was picked up by a man in a sedan, who took him back to Florida Recovery Group, according to Maureen Graney.

Although he was back at the facility, there were problems with his insurance. Graney messaged Cleggett via Facebook on Aug. 24 to find out what was going on.

“Hey Watsup buddy,” Cleggett responded when Graney reached out.

“They ask me about my insurance today cause theres no payment on it,” Graney replied. Cleggett told him he would look into it and later told him, “All set bud.”

He wasn’t. Graney’s insurance was terminated.

Jan Goodman, the CEO of Florida Recovery Group, confirmed that Graney was a patient there, after Maureen Graney signed a privacy waiver allowing him to speak to Graney’s case. He said in a statement that Graney received “an excellent level of care.” The center does not allow people to be kicked out for lapsed insurance and Graney stayed from Aug. 24 to Sept. 7, with the understanding he would pay for his treatment later, Goodman said.

Graney was ultimately discharged after it was reported that he brought heroin into the facility and gave it to another patient, who overdosed, Goodman said.

He said he had never heard of Cleggett and that the Florida Recovery Group does not use patient brokers. The center has no history of complaints filed with Florida’s Department of Children and Families.

On Aug. 29, Graney asked Cleggett via Facebook if he could send him bus money to come home. Two weeks later, when Graney was still in Florida, his mother began working to get her son home. She planned to buy him a ticket on a Greyhound bus leaving at 12:35 p.m. on Sept. 10. First, she had to find him a place to stay and booked him a room for the night of Sept. 9 at the Residence Inn in Delray Beach.

Patrick Graney, however, was struggling.

A friend of his from Boston, who spent time in jail and detox with him, was also in Florida and saw Graney around this time. Graney was in bad shape, he said, and had recently drunk kratom, a plant that is often brewed and produces opioid-like effects.

On the evening of Sept. 9, Graney went to a Delray Beach detox center seeking help. He was turned away because no beds were available, according to a police investigation of his death. He then checked into the hotel room, bringing along a man and a woman he met at the detox center. At 2:12 the next morning, the man called 911 to report Graney was unconscious on a couch with a brown liquid coming from his mouth.

The stranger attempted CPR until paramedics arrived. It was too late. Graney was dead from what the medical examiner later determined was acute cocaine intoxication. He was 30 years old.

The sunny getaway promoted by Cleggett and other brokers is hardly paradise. Palm Beach County is so packed with addiction treatment facilities that many call it the “Recovery Capital of America.”

At the Dunkin’ Donuts on Atlantic Avenue in Delray Beach, white vans carrying patients to treatment facilities pull in and out of the parking lot throughout the morning. People spill out of the vans, grabbing a quick cigarette break or a cup of coffee. They reload and head off to rehab centers in bland office parks, far from the white sand beaches and trendy restaurants and galleries.

Officials estimate that Delray Beach alone — a city of 16 square miles with 67,000 residents — has more than 800 treatment facilities. And within five miles of the city, according to one rehab operation, there are hundreds of Alcoholics Anonymous meetings every week.

Cities such as Delray Beach are a draw for out-of-state residents seeking recovery because they are walkable, the weather is warm, and the people are friendly. It’s a perfect place to come get sober — or get rich off those trying to do so.

“It’s where the money is,” said Aronberg, the state attorney. “This is a hotbed of corruption.”

The problem had become so pressing by 2016 that the state appropriated $275,000 to create a task force in Palm Beach County to go after corrupt operators, including those engaged in patient brokering. Earlier this month, two sober home owners investigated by the task force were sentenced to prison as part of a money-laundering scheme. Patients at those homes were allegedly given drugs, and female patients were sexually exploited.

Numerous centers are run by people with little expertise in substance abuse treatment or with questionable backgrounds — staffed by people like Dr. Evan Zimmer, listed in a court record last year as medical director of Bright Futures Treatment Center in Boynton Beach. That’s where Cleggett arranged for Evan McLaughlin of Plymouth, Mass., to go for treatment, according to McLaughlin’s mother, Tina, who said she paid for his travel and insurance.

Tina McLaughlin grew up with members of Cleggett’s family in Braintree, Mass. Her son was admitted on June 10, 2016, under Zimmer’s medical direction, according to a document filed as part of a heroin possession case against McLaughlin in Massachusetts.

Zimmer, a psychiatrist, had his medical license suspended for three years beginning in 2012 after numerous complaints he was possibly under the influence of drugs and alcohol, according to state medical board records.

It was the second serious sanction from the medical board. His license was revoked in 1985 after Zimmer was charged with driving under the influence of drugs following an accident, and was subsequently found to have written prescriptions in the names of patients he had no record of treating. Police found hundreds of prescription pills in his vehicle, including Valium and Percocet. He received a new license in 1991, according to board records.

Zimmer said his own experiences with addiction make him a better practitioner. He said he didn’t know how McLaughlin ended up in Florida, but added he is opposed to patient brokering. The facility’s management did not respond to a request for comment. Bright Futures has no history of complaints with the state Department of Children and Families.

Tina McLaughlin said her son initially did well after arriving in Florida. He had struggled with an opioid addiction since he was prescribed painkillers as a teenager following a hockey injury that fractured his neck. By the time he was 16, he was shooting heroin.

McLaughlin said her son was managing two sober homes, where people in recovery live together, and had just signed a contract to be a marketer for a rehab facility. She described that job as “doing what Danny does.”

“As far as I knew, he was doing great,” she said of her son.

Just after Thanksgiving in 2016, Evan McLaughlin relapsed without warning, his mother said. His body was discovered by a housekeeper in a Boynton Beach hotel room on Dec. 1. On a countertop, police found two syringes and a burnt spoon. The medical examiner determined he died from an overdose of carfentanil, a particularly dangerous opioid originally developed as a tranquilizer for large animals such as elephants.

Zimmer said McLaughlin didn’t comply with treatment in Florida and was using steroids. “The writing that was on the wall for Evan would have been on the wall regardless of where he was,” said Zimmer. “It was about who he was rather than where he was.”

Tina McLaughlin doesn’t blame Cleggett for her son’s death at age 24 and remains friendly with him.

Cleggett literally wears his spirituality as a sleeve. His right arm has a tattooed image of Jesus nailed to the cross. His entire back is tattooed with an elaborate illustration of Satan and Jesus arm-wrestling.

At the Holbrook meeting last month, he said he will be sober five years this summer and credited his success to following the 12-step program and finding God. He named his company A Vision from God LLC, and he is an active member of Life Community Church in Quincy and recently helped the church move into a new building.

“I used to be just a junkie convict and I handed my life over to God,” he told the group. When the meeting ended, he walked outside and drove away in his Mercedes.

 

 

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