As the United States continues to battle the opioid epidemic and rising rates of substance use disorder (SUD), the role of treatment providers is more critical than ever. However, a recent wave of legal actions has exposed a troubling issue: addiction treatment billing fraud. Some providers may be exploiting both the healthcare system and vulnerable patients for profit.
Two significant fraud cases — one involving Crossroads Treatment Centers, a major multi-state SUD provider, and another involving Recovery Connections Centers of America (RCCA), operated by a previously convicted businessman — have sparked concerns about oversight, ethical practices, and systemic abuse in the addiction treatment space.
Crossroads Treatment Centers to Pay Nearly $864K Over Alleged Medicaid Fraud
From 2016 through mid-2023, four facilities owned by Crossroads Treatment Centers, headquartered in Greenville, South Carolina, allegedly knowingly submitted false and fraudulent claims to Virginia Medicaid. According to the U.S. Department of Justice, these facilities billed for complex and comprehensive medical appointments when they were actually performing routine SUD treatment check-ins.
The U.S. government and the Commonwealth of Virginia have now reached a $863,934 civil settlement with Crossroads. As part of the agreement:
- The U.S. will receive approximately $357,000
- The Commonwealth of Virginia will receive more than $507,000
The federal investigation was sparked by a whistleblower complaint filed under the False Claims Act — a law that allows private individuals to sue on the government’s behalf when they believe fraud has occurred. The whistleblower in this case, a former Crossroads director of network management and contracting, will receive $60,671 from the federal share and an undisclosed portion from Virginia’s recovery.
The four facilities identified in the case include:
- Crossroads Treatment Center of Petersburg P.C.
- ARS Treatment Centers of New Jersey P.C.
- Crossroads Treatment Center of Greensboro P.C.
- Starting Point of Virginia P.C.
These clinics billed Medicaid for appointments that, by law, should have included at least two of three components:
- A comprehensive medical history
- A comprehensive medical examination
- A highly complex medical decision
In reality, these components were missing, and the sessions in question did not meet the criteria. Yet, they were still billed at higher rates — effectively misusing taxpayer dollars and inflating healthcare costs.
“Providers may bill only for the services that they actually provide,” said Brian Boynton, principal deputy assistant attorney general for the Department of Justice’s Civil Division.
Despite the settlement, Crossroads has declined to comment publicly on the matter. The company, which operates more than 100 facilities across nine states, offers a range of services including medication-assisted treatment (MAT), peer support, counseling, and care coordination. In 2022, it was recapitalized by private equity firm Revelstoke Capital Partners and Canadian investment group Caisse de dépôt et placement du Québec (CDPQ) — a move that had aimed to fuel its national growth.
This case highlights the rampant issue of addiction treatment billing fraud, where certain providers intentionally misrepresent the services provided to secure higher reimbursement rates. It also raises questions about the level of oversight in the addiction treatment industry and whether such fraudulent practices are more widespread.
Recovery Connections Centers of America: Millions in Fraud and Prior Convictions
Earlier this month, another SUD provider made headlines for all the wrong reasons. Michael Brier, owner of Recovery Connections Centers of America (RCCA) in Rhode Island, pleaded guilty to multiple fraud charges related to defrauding Medicare, Medicaid, and private insurers of millions of dollars.
Brier, who has a prior conviction for tax evasion, admitted to billing for 45-minute counseling sessions when patients often received only 5 to 10 minutes of treatment. He also submitted fraudulent applications to Medicare, deliberately concealing his criminal record and role in the business.
As part of his plea agreement, Brier faces:
- 6 to 10 years in prison
- 3 years of federally supervised release
- More than $3.4 million in restitution
- The forfeiture of luxury assets including:
- $1 million in funds
- A beachfront condominium in Panama
- A Mercedes-Benz and a Lexus
In addition, RCCA itself has pleaded guilty and now faces:
- A maximum fine of $500,000 or twice the fraudulent gain
- Up to five years of probation
Sentencing for both Brier and RCCA is scheduled for November.
This isn’t just about financial fraud — it’s about patients being deprived of the time and care they need. For individuals struggling with substance use, inadequate treatment can mean relapse, overdose, or even death. When providers cut corners, it’s not just illegal — it’s dangerous.
The addiction treatment billing fraud by RCCA illustrates a growing problem in addiction care: some providers are intentionally inflating treatment times and services to collect more funds. This kind of behavior undermines the trust that patients and the public place in the healthcare system and raises concerns about integrity in addiction treatment billing.
A Widespread Problem in a High-Stakes Field
Both the Crossroads and RCCA cases have put a spotlight on a deeper problem within the SUD treatment sector: the potential for abuse in billing practices, especially in a field flush with federal and state dollars aimed at tackling the opioid crisis.
“Submitting false claims to Medicaid undermines the integrity of the program and wastes valuable taxpayer dollars,” said Tamala E. Miles, special agent in charge at the Department of Health and Human Services Office of Inspector General (HHS-OIG). “Working closely with our law enforcement partners, HHS-OIG remains committed to investigating providers who allegedly defraud federal health care programs.”
For many, these enforcement actions serve as a warning to the broader healthcare industry — particularly within the behavioral and addiction treatment sectors — that addiction treatment billing fraud will not be tolerated. But they also raise difficult questions:
- How many other providers are engaging in similar practices without detection?
- Are government oversight systems strong enough to catch and prevent such abuse?
- And most importantly, what happens to the patients left behind?
What Comes Next?
The Crossroads and RCCA cases are unlikely to be the last of their kind. As the federal government continues to pour billions into combating the addiction crisis, accountability must be prioritized. Whistleblowers, investigators, and prosecutors will play a vital role — but systemic changes may also be needed to ensure ethical care delivery and proper use of funds.
For now, patients, families, and communities deserve better — and it’s up to providers, regulators, and investors alike to deliver care with integrity, transparency, and compassion. We must all remain vigilant to prevent the growing issue of addiction treatment billing fraud from undermining the progress we’re making in addressing the addiction crisis.
If you or someone you know is struggling with substance use, help is available. Reach out to the Substance Abuse and Mental Health Services Administration (SAMHSA) helpline at 1-800-662-HELP (4357) for free, confidential support 24/7.
