LAWRENCE, Mass. — A doctor offering treatment for substance abuse is accused of improperly charging patients cash as a condition of getting his help with recovery from addiction. 25 Investigates uncovered the allegations in a complaint filed with the Massachusetts Board of Registration in Medicine.
According to state law, doctors offering treatment for "substance abuse disorder" to patients on public insurance, known as MassHealth, must accept that insurance as "payment in full" -- meaning patients can't be charged extra for something already covered by MassHealth.
The complaint filed with the state says that's not what was happening at the office of Dr. Miguel Verdaguer in Lawrence.
"You have to pay for the urine test or you don't get the prescription," former patient Brian Morton told 25 Investigates. Morton says he has relied on the addiction-fighting drug, Suboxone, to stay clean.
Morton said Verdaguer was charging $50 cash for the routine urine test drug screening, but recently lowered the price to $20.
"He basically said to me, you don't pay it, you don't get your prescription," said Morton who showed 25 Investigates his MassHealth card.
In a statement to Boston 25 News, a MassHealth spokesperson wrote: "Providers' solicitation of money or anything of value for covered substance use disorder treatment is strictly prohibited.”
Dr. Verdaguer agreed to an interview with 25 Investigates in April, but declined after Investigative Reporter Eric Rasmussen arrived at his office.
On the phone, however, Verdaguer defended his policy of charging MassHealth patients cash for urine tests.
"If you bill MassHealth for the test, they pay you five dollars. That's not enough for the cup," said Verdaguer. "I'm losing money with the urine tests... I'm not the bad guy here."
The doctor also provided documents showing he's been able to get other insurance providers to cover up to $30 per test, which Verdaguer says must be monitored and collected by a trained medical assistant in a specially designated bathroom.
Late Monday, Verdaguer also sent Boston 25 News a form which he says Brian Morton signed, agreeing to pay for the urine test.
Experts in public health say requiring a urine test as part of substance abuse treatment is not unusual, but they still question the practice of charging cash.
"If patients can't get access to their medicines, they revert to street drugs," said David Rosenbloom, Professor of Public Health at Boston University. "This doctor may have a problem with billing and reimbursement, but you can't take it out on the patients."
Last fall, the Attorney General's Office announced the indictment of a Dorchester doctor for charging cash for suboxone treatments. Other doctors have been forced to reimburse patients hundreds of thousands of dollars after similar allegations.
MassHealth would not comment on any specific case, but in its statement wrote: "Depending on the type of allegation, MassHealth either conducts the investigation or refers the issue to the appropriate investigatory entity."
The Attorney General's Office would not confirm or deny whether it's opened an investigation into Dr. Verdaguer's practice.
Verdaguer said he would consider reimbursing all of his patients who've paid cash, but only if MassHealth first pays him back for, what he says, are the full costs of the urine tests.
Cox Media Group