Categories: Health Law,

According to law enforcement sources, a primary indication that a pain management clinic is an illegitimate “pill mill” is that the clinic does not accept insurance or receives cash, check or credit card payments from the majority of their patients. The specific allegation is that drug addicts and traffickers buy drugs with cash, and medical services generally are not.

While it is true that a drug diverter will use cash, so too do many chronic pain sufferers. There reasons are many, one is that many chronic pain sufferers are unemployed due to the disability that requires the chronic pain treatment.  After COBRA benefits expire, they are uninsured .  The choice of paying for health insurance or paying for medications is unfortunately an easy one given the necessity.  A 2007 study by the Center for Studying Health System Change found that Rising prescription drug costs and less generous drug coverage likely contributed to the growth in nonelderly Americans–from 10.3 percent in 2003 to 13.9 percent in 2007–who went without a prescribed medication. 

The clinics that treat chronic pain patients find that many insurances do not cover chronic pain treatment or limit the providers who may be paid for such services.  Since Florida law, under the Health Care Clinic Act, requires any non-physician owned practices that submit claims to insurance companies to obtain a separate license and because that license can be somewhat difficult to obtain, many pain management clinics did not accept insurance; if they did, they could be charged with a crime.

The pain management law passed last year now requires non-physician owned pain management clinics to obtain that health clinic license.  However, clinic owners that did not routinely submit claims to insurance companies find that the process requires additional employees and operations.  In many medical practices, the preparation, submission and follow up regarding claims is a substantial part of the budget and requires the use of employees knowledgable in reimbursement practices.   If most of your patients are uninsured, it is not particularly logical, from a business standpoint, to set up the business to do insurance claims.

Curiously, the State of Florida, while deriding medical practices that operate on a cash payment system, is currently engaged in litigation with the United States to strike the Health Care Reform Act, in which the State has asserted a right of its citizens to choose not to have insurance.