California and Oklahoma are greater than 1,000 miles apart. Within that time-frame, there are a whole lot – if not 1000’s – of addiction treatment programs.

“And yet in the last few years alone, thousands of alleged Oklahoma residents have died were smuggled across the country to California under the guise of procurement (substance use disorder). Treatment,” claims a suit filed Dec. 11 in federal court against two Orange County rehab facilities, South Coast Behavioral Health and Rad Life Recovery of Costa Mesa, and others.

RELATED: Addicts got here from far-off to Southern California to get sober but died

“This surprising migration is not the result of quality treatment. Rather, it is being driven by an army of fraudsters who have overrun certain parts of California’s substance use disorder (SUD) treatment industry to take advantage of suspected Oklahomans, many of whom are members of Native American tribes.”

“These SUD providers employ a variety of deceptive tactics,” the lawsuit states. “They hire 'body brokers' to hunt down potential patients in return for kickbacks. Body brokers work with insurance agents to fraudulently enroll people in insurance plans. Once registered, patients are sent across the country to receive “treatment” whose important goal is to counterpoint the care providers, body brokers, insurance agents and others involved within the programs.

“There are unlawful kickbacks at every level. In fact, many patients receive cash, free “treatment” and accommodation themselves, which unfairly influences their alternative of provider and entices them to stay under the control of a specific provider in order that their insurance can proceed to be billed. It is becoming increasingly difficult for good, high-quality providers to operate in an industry awash with kickbacks and de facto bribes.”

The lawsuit also names Excellence Recovery and Everything in Excellence Recovery of Arizona, in addition to three people connected to the alleged scheme, Cari Passmore, Brett Pershall and Randall Eisworth. Pershall, who had an address in Santa Ana, said he was within the means of hiring an attorney and wouldn’t comment. Phone messages, emails and text messages to the others on Monday weren’t immediately returned.

In an approach familiar to supporters of SCNGs Rehab Riviera Blue Cross Blue Shield of Oklahoma said within the lawsuit that after insurance advantages are exhausted, providers “kick patients to the side of the road, leaving these vulnerable individuals to fend for themselves thousands of miles from home.”

These defendants are among the many worst perpetrators of this tactic, the lawsuit says, and so they have received greater than $36 million in improper payments from Blue Cross Blue Shield of Oklahoma alone. The insurer is suing for fraud, negligent misrepresentation, unjust enrichment, intentional interference with economic/contractual relationships and conspiracy under the Racketeer Influenced and Corrupt Organizations Act.

'Lie'

The lawsuit alleges that the plan worked like this:

South Coast Behavioral Health used body brokers Passmore and Pershall to lure patients west. They identified potential clients through social media and word of mouth and promised them free addiction treatment.

Of course, this treatment was not free, but was paid for by medical insurance. Oklahoma insurance agent Eisworth obtained the policies and asked addicts to offer details about their annual income, employment status and residency in order that they could be eligible for Blue Cross Blue Shield plans and government subsidies.

One member, identified as “A,” told Eisworth that she had a job that paid well below the federal poverty level. But that made her eligible for Oklahoma's Medicaid program, a low-reimbursement public insurance plan (which wouldn't cover treatment outside of Oklahoma, “let alone anywhere in the country in California,” the lawsuit says).

Eisworth asked her to create a fake monthly income statement showing that she was self-employed and that her income totaled greater than $18,000 a 12 months – high enough to avoid Medicaid but low enough to qualify to have private insurance with far more generous reimbursement rates. Added to this were cost-sharing discounts and a tax subsidy that reduced A's monthly insurance bill from greater than $500 to lower than $100 US dollar fell.

A staggering two-thirds of the a whole lot of Blue Cross Blue Shield members treated on the South Coast were enrolled at Eisworth, the lawsuit says.

After completing their “free” inpatient treatment, the members went to the sober living facility related to the body broker who found them, the lawsuit says. People lived in these houses free of charge so long as they allowed South Coast to bill their insurance. South Coast split these insurance payments with the brokers.

When advantages dried up, members were often terminated abruptly. After that, the lawsuit says, “they suddenly find themselves on the streets with no money left to afford housing or everyday necessities, let alone an expensive trip home.” If you set these already vulnerable people in Putting you in such desperate circumstances only increases the likelihood of relapse.”

This happened back in 2020 and thus far, “they continue to prey on individuals seeking to enroll in Oklahoma plans and have taken additional actions to infiltrate Oklahoma,” the lawsuit states.

In addition to locations in Costa Mesa, Huntington Beach, Newport Beach and Irvine, South Coast Behavioral Health's website also lists a location in Oklahoma City.

Blue Cross Blue Shield of Oklahoma isn’t the one insurer affected by this “extortion activity,” the lawsuit says. The well-intentioned Affordable Care Act increased coverage for addiction treatment and access to enrollment, the lawsuit said, creating an environment ripe for this particular sort of fraud. According to the lawsuit, Oklahoma has the fifth highest addiction rate in America — greater than 16% of the population.

“The combination of a state plan that provides robust out-of-state benefits and a large population in need of treatment provided a perfect target for profiteers like defendants,” it said.

Deja vu?

Last month, Blue Cross and Blue Shield of Oklahoma told the Southern California News Group that it should stop paying for all addiction treatment in California, with limited exceptions, starting Jan. 1.

Following that call, about 1,000 people left facilities linked to embattled treatment operator Nathan Young. Former Young Network patients said they were enrolled in Blue Cross Blue Shield of Oklahoma insurance although they never lived within the state and sometimes without their knowledge.

Young and employees are being sued by insurer Aetna in a fraud case just like this one. Young filed a countersuit against Aetna, saying the insurer was simply attempting to avoid paying the amounts owed.

This all reflects the battle between Health Net and the now-defunct Sovereign Health that began in 2016. Health Net won $45 million in damages and interest against Sovereign.

In this case, Blue Cross Blue Shield of Oklahoma said in its lawsuit that it’s in search of damages “sufficient to punish the defendants and to deter other similarly situated persons from engaging in similar conduct in the future.”

After this scenario has been repeated for thus a few years, one might wonder if such damage really exists.

CAPITOLA – Stacy Souza works primarily from her home in Capitola's Jewel Box neighborhood, only a minute or two from the Cliff Drive commentary deck, which overlooks the town's iconic — albeit recovering — wharf and the majestic Pacific Ocean, continuously swaying backwards and forwards with various intensity.

To prevent any appearance of cabin fever, Souza takes her eight-year-old German Shepherd, Otto, for no less than one walk a day through the cliff area.

“There are a lot of bikers, joggers and dog owners like me,” Souza told the Sentinel during a recent late-morning outing. “We all have our community. It's like, 'Hi, how are you?' We know different people and we wave.”

But Souza and her fellow panorama lovers may sooner or later have to seek out a brand new route – identical to the numerous cars that clog the streets every single day during rush hour.

Parts of the large coastal cliffs – city authorities estimate their height at 12 to 18 meters – are constantly eroding and ending up within the sea. City planners consider that those responsible must take motion to stop a destructive landslide scenario that will not be a matter of whether it can occur, but when.

“Nobody is going to spend money on it,” Capitola Public Works Director Jessica Kahn said in a report presented to the Capitola City Council last month. “But it's definitely something that's going to happen in the future.”

Kahn said the bluff is currently eroding at a rate of about 6 inches per yr, although large storm events can speed up that pace. Most recently, a series of atmospheric river storms and tidal surges within the winter of 2023 caused significant erosion, particularly at the bottom of the bluff beneath two parking lots at either end of the road. The storms also damaged an old 10-foot-high soil nail retaining wall near the highest of the bluff that was inbuilt 1997.

In addition, if a seismic event were to tear off a big a part of the cliff, this is able to not only pose a danger to pedestrians and motorists, but could also affect larger parts of the population because essential infrastructure facilities similar to sewage and water pipes laid within the slope can be destroyed.

In light of recent events, the town has accomplished a comprehensive current condition report as a part of its Cliff Drive Resiliency Project, which analyzes a 900-foot section of the road and bluff. The city has already received grants to get the project underway, however the City Council must determine which direction it desires to go.

“We are not only repairing the erosion, but we are also looking into implementing a comprehensive coastal protection project for this section of road,” Kahn said.

Options on the table

After the 2023 storms, the town secured $9.25 million in everlasting restoration funds from the Federal Highway Administration and contributed one other $1.25 million as a neighborhood grant, in accordance with Kahn. However, those federal funds should not available ceaselessly and the project have to be ready for a construction funding application by September of next yr. The California Coastal Commission has also contributed $500,000 toward a project.

“The project will likely cost more, but the total cost will not be known until a final plan is in place,” Kahn recently wrote to the Sentinel, adding that the town continues to hunt additional funding opportunities.

The path ahead of us takes three routes: protect, adapt, retreat.

The approach to orderly withdrawal, which was utilized in a recent Employee reportis easy. It means taking no motion while outages proceed to occur on the cliff, potentially resulting in the closure of Cliff Drive and diversion from the locally designated emergency route.

Option 2 gives the town time to make short-term adjustments, similar to repairing the eroded sea caves at the bottom of the cliff, while long-term measures, similar to potentially converting Cliff Drive to a one-way street heading west, are considered.

But it was the third – and most costly – option that received probably the most vocal support in council. Although the small print of the ultimate project have yet to be worked out, the aim is to preserve the road in its current state and supply improved facilities for cycles and pedestrians. This could include constructing a brand new wall with anchors anchored deep into the center of the cliff, rock face protections and creating recent lookout points and improved coastal access.

Capitola Deputy Mayor Yvette Brooks said throughout the meeting that the “protect” option makes probably the most sense to her, assuming funding efforts are successful.

“We know there have been several natural disasters,” Brooks said. “We see the impacts and we know we have to do something.”

Councillor Joe Clarke felt that this selection was far superior to all others.

“We need to protect it as best as we can,” Clarke said. “Option 3 seems to me to be by far the best.”

Kahn added that the town held a town hall meeting on the situation in February within the Jewel Box neighborhood, attended by about 20 people. The overwhelming feedback from that group, she said, was that “if it's affordable and feasible, the city should do something about the erosion on that bluff.”

Robert Stevens, a representative of CSW/ST2, which was hired by the town last October to supply design services, added that his team had a “very productive meeting” in regards to the various options with the Coastal Commission, which must approve the project.

“I think there is a way forward,” he said.

Expert comments

“Because of the nature of the rock and the nature of the fractures, it’s just difficult to protect this area,” Griggs told the Sentinel.

The cliffs, which extend about three miles from Pleasure Point right down to New Brighton State Beach, are composed primarily of Purisma bedrock, which is geologically relatively young at 2 to 4 million years old and rests on a soft layer of mudstone.

The Purisma is understood for its jagged structure – like a broken windshield – that might be undermined by crashing waves or, perhaps more critically, by rainwater from the neighborhood seeping into the cracks. And with climate models pointing to more extreme periods of dry summers and rainy winters, the erosion process could speed up.

Although Griggs will not be entirely convinced, based on his own local knowledge and historical photographs, that motion must be taken to guard the cliff yet, he agrees that the concrete armoured wall, as might be seen at Pleasure Point, is the “simplest” solution.

But in the long term – and he admitted that there are different definitions of this – there is no such thing as a easy answer.

“Sea levels will continue to rise, storms will continue to occur, and we will not be able to hold the fort everywhere,” Griggs said. “There may be places that we believe are worth protecting.”

Kahn said there are opportunities for public involvement within the resilience project, including a yet-to-be-launched online survey and a pop-up booth on the Sunday Art on the Beach event on July 21 in Capitola Village. More intensive outreach will begin once the council officially selects a preferred plan, she added.

Meanwhile, Souza, who was unaware of the town's efforts, will proceed to walk the scenic spot every day and hopes to proceed doing so for years to come back.

“It's a world-class view,” she said. “I don't see why we shouldn't protect it.”

Originally published: July 10, 2024 at 5:38 am