Ranking member of the Senate Finance Subcommittee on Health Care, Sen. Maggie Hassan (D-NH), is heading an information probe into the practices and patient outcomes of major for-profit methadone clinics: BayMark, Acadia and New Season. 

Opioid treatment programs (OTPs) are a major focus of the inquiry. While they are a primary source of methadone initiation for patients seeking medication-assisted treatment (MAT) for opioid use disorders (OUDs), OTP clinics also come with stringent barriers to access. Despite some improvements in access and efforts at the federal level to reduce barriers, many remain in place, including high costs, stigma, regulations and zoning restrictions.

Traditionally, these clinics required patients to visit daily to obtain methadone treatment. However, the Centers for Medicare and Medicaid Services (CMS) and the Drug Enforcement Administration (DEA) have taken steps to modernize methadone access by expanding prescribing privileges and pharmacy dispensing and allowing take-home methadone prescriptions in some cases.

Despite the need for increased access since only 25% of adults with OUDs receive treatment, many large for-profit OTP providers like BayMark, Acadia and New Season, among others, have historically been against broadening access for methadone prescribing outside of these clinics – something Hassan calls out directly in the inquiry.

“For-profit OTPs, however, have a financial incentive to maintain the status quo,” Hassan wrote in an Aug. 26 letter to each of the providers. “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.”

The probe also comes as the federal government seeks to crack down on waste, fraud and abuse in the health sector, something Acadia and BayMark have both separately been accused of in recent years.

In 2022, a False Claims Act suit was filed against BayMark, but then ultimately dismissed voluntarily by the plaintiff. Acadia has faced similar scrutiny due to falsified records and multiple lawsuits related to care and misconduct in its treatment facilities.

Hassan directly addressed and sent the letters outlining the inquiry to the CEOs of each company: Christopher Hunter of Acadia Healthcare, Marshal Salomon of BayMark Health Services and Jim Shaheen of New Season.

“We can confirm that we received a letter from Senator Hassan and look forward to sharing more details about our Comprehensive Treatment Centers,” an Acadia Healthcare spokesperson told Behavioral Health Business. “As a national leader in opioid use disorder treatment, we take our responsibility to our patients and the communities we serve extremely seriously, and we are committed to expanding access to lifesaving care to confront the opioid and substance use epidemic.”

BHB also reached out to BayMark and New Season to request comment on the new probe into their OTP practices, but did not receive a response.

The correspondence requests a response by Sept. 16 from each company on monthly data , including total revenue, number of clients, time metrics – quarterly and point-in-time staffing data and client data regarding new clients admitted, number in treatment, take-home methadone dose days, counseling hours and case management. It also asks the companies to produce documents of OTP accreditation, medication policies, quality assurance procedures, grievance processes and audited income statements.

According to Hassan’s letters, the inquiry from the Senate 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.”

Currently, efforts are focused solely on obtaining these metrics for OTPs located in New Hampshire. It is unclear whether the subcommittee’s actions will expand in scope to OTPs in other states.

Due to the nature of the ongoing investigation, a spokesperson from Hassan’s office told BHB they could not comment on what the next steps may be once the subcommittee receives the requested data and documents.

Senate Finance Committee leaders also did not respond to BHB’s questions about what this effort may mean more broadly in terms of reform or possible legislative changes to OTPs moving forward.