Delray Beach's charming downtown, palm trees and waves attract locals, vacationers and, increasingly, drug users who come here to try to get off opioids. In some parts of the small Florida community, there's a residential program for people recovering from addiction — a sober living house or "sober home" — on nearly every block. Sometimes two or three.
On a block where resident Michelle Siegel was walking a dog recently, there are at least six sober homes. She says "you can usually tell" by the white vans and "no trespassing" signs out front.
"I have walked down the street sometimes and seen kids just passed out, face down on the ground," she says. "And you ask them if they're OK and they're like, 'Yeah, yeah, I was just tired. I was sleeping.' And you don't know whether you should get them help; whether you should leave them alone."
In South Florida, there's been runaway growth of these residential programs. As group homes for people recovering from addictions, sober homes are protected by the Americans with Disabilities Act and also the Fair Housing Act. Those federal laws have made it difficult for local communities to limit or otherwise regulate the facilities.
And the nation's epidemic of opioid abuse has created new opportunities for insurance fraud. Under federal law, health care insurance pays for the costs of recovery. That's led to a boom in residential programs to treat addiction, and also growth in deceptive marketing by some programs, fraudulent claims and what's known as patient brokering.
Aronberg says while there are many legitimate sober homes, there are also many others operated by unscrupulous providers. They tap into insurance money by offering free rent and getting kickbacks from outpatient drug treatment centers. Aronberg calls the practice of "patient brokering" a scheme.
"The outpatient treatment center van picks your residents up three times a week to go drug test them," he says, "which is then billed to insurance at very high rates."
Treatment centers bill insurance companies not just for drug tests but also for other services, like group counseling, massage and acupuncture. They share the money with the people supplying the patients, Aronberg says.
"In return," he says, "you as a sober home owner, you get a nice check for patient brokering — which is what you've done."
Although they're in Delray Beach for recovery, residents of sober homes can find easy access to heroin and other drugs. The city's fire rescue crews responded to more than 1,300 overdose calls last year — many at sober homes.
"We respond there sometimes repeatedly in the same shift," says Matt Pierce, an EMS captain. On one recent night, he says, "they responded to the same sober home two times within 10 minutes, both for overdoses."
With a cost of $2,500 for each EMS call, these overdoses have put a strain on the city's budget. Much worse is the human toll. Countywide, nearly 600 people died of overdoses last year.
It's a problem for Delray Beach and for people with addictions who are often lured by marketers to South Florida on false pretenses.
"They make the individual on the other line think that they're a doctor and they're diagnosing them," Aronberg says, "when, in reality, they're only reading from a script given to them by the treatment center which is paying them."
Rather than operating on a recovery model, Aronberg says, unscrupulous sober homes and treatment centers operate on a "relapse cycle," which bring clients back time and again for treatment that is covered by health insurance.
Neill Timmons has seen how reputable facilities can work — from both sides. "I'm in recovery myself," he says, "six years next month." Timmons runs four houses for sober living in another Palm Beach county community, Boynton Beach.
Like other reputable operators, he doesn't receive payments through arrangements with drug treatment centers. He says for someone going through recovery, landing in a good sober home can make all the difference. Of his residents, he says, "They're not certain ... if they want to stay sober the rest of their lives or return back to use. And they're struggling with what they need to do ... if they do want to stay sober."
A good facility, he says, "should really guide and give them some guidance toward recovery."
Timmons and others who run good facilities want more regulation. They're pleased by a law, recently signed by Florida's governor, that increases the penalties for patient brokering and deceptive marketing.
A study commissioned by Delray Beach, and released in May, found at least 250 sober homes in a town of just 60,000 — about a quarter of them operating under the city's radar.
The town's mayor, Cary Glickstein is no fan of the drug recovery industry and sober homes — or of the problems he says they've brought to his city. He runs down the list — "patient brokering, drug trafficking, human trafficking, prostitution. It's a Pandora's Box of problems that the unscrupulous operators bring to a community."
Glickstein is confident a new ordinance just adopted by Delray Beach will enable the city to crack down on sober homes. It requires them to be certified by an independent trade association and limits their presence to no more than one per block.
After adopting a similar ordinance, officials in Prescott, Arizona say the number of sober homes in their community is now a third of what it once was.