THE PROGNOSIS

Much of the 660-page opioids package President Trump could sign this week aims at expanding access to treatment and limiting opportunities for people to become addicted in the first place. But a five-page provision near its end seeks to protect drug-addicted Americans from a strange and particularly egregious kind of exploitation.

You might have read news reports over the past several years detailing how “patient brokers” essentially prey on people who need addiction treatment. These brokers cash in on patients by recruiting them to treatment centers in return for financial kickbacks from the providers themselves. Sometimes brokers will pay for patients' air travel or offer to cover their rent to entice them into detox facilities.

It will now be illegal on the federal level to provide or receive these types of payments for patients with private coverage, under the bill’s subtitle J, dubbed “Eliminating Kickback in Recovery.” These kickbacks are already illegal under federal health-care programs including Medicare and Medicaid, but up until now, there wasn’t any federal prohibition pertaining to private coverage.

Under the provision — originally offered by Sens. Marco Rubio (R-Fla.) and Amy Klobuchar (D-Minn.) — anyone found guilty of these arrangements could face up to 10 years in prison or as much as $200,000 in fines. The practice is particularly widespread in Florida, which is home to more treatment facilities than any other state.

Patient brokering is something House Energy and Commerce Committee leaders have been probing for a while. Last year, they wrote to health regulators in Florida, Arizona, California, Colorado, Massachusetts and Pennsylvania, asking them to explain how they regulate drug-treatment facilities.

In May, the members sent letters to eight private call centers, demanding they explain their role in connecting patients to recovery centers and how they get paid by the facilities.

In some cases, these brokers will help uninsured patients enroll in private coverage and pay their premiums until the plan’s treatment benefits are exhausted after two or three months. There have even been reports of brokers making drugs available to patients so they relapse and the cycle can be repeated.

And once these patients are in treatment centers — some of them illicit — the facilities have even worked to bill the plans at higher out-of-network rates that can total more than $10,000 per week. Sometimes, they submit fraudulent claims to the insurer for services that were never even rendered (outrageously expensive urine tests are a good example of this).

The tales of people targeted by these brokers are heartbreaking. Take the story of Lisa Daniels, whose son Jamie died from heroin laced with fentanyl after spending seven months in treatment programs in Florida.

Investigators later found that two of the three sober homes Jamie lived in had issued fraudulent claims to his Blue Cross plan, totaling more than $60,000 in charges for urine and blood tests. And the doctor he saw after moving into the second sober house had been watched by the FBI since at least 2013.

“These people befriend and lure individuals into specific sober homes with offers of gifts, or as in Jamie’s case, a promise of rent completely covered by insurance,” Daniels told Energy and Commerce Committee legislators at an April roundtable on the opioid crisis.

It was a similar story for Kenny Smith. He started off at a licensed treatment facility in Florida but soon got shuffled around to several different facilities, a pattern his mother Gail says lasted until his death four months later. The last place he stayed in was a sober living home run by Bradley Vercosa, a man recently arrested for patient brokering.

“Kenney got trapped in the ‘web’ of a treatment center and sober-living house scam,” Gail Smith said at the same roundtable.

There are some extensive media accounts of patient brokering, including this 2016 story by BuzzFeed’s Cat Ferguson and this 2017 piece by Stat News’s David Armstrong and Evan Allen.

States and localities are taking steps to crack down on the practice. Last month, Illinois Gov. Bruce Rauner signed a bill criminalizing the collection of finders fees and other predatory behavior. Palm Beach County, a part of Florida where sober living homes are particularly concentrated, has created a special task force to go after operators of treatment facilities.

But Congress’s recent and rare bipartisan action comes as a welcome relief to prosecutors who see on the ground how Americans  struggling with the tough problem of drug addiction can be so easily exploited.

“In today’s hyper-partisan world where very little seems to be get accomplished in Washington, this is a true victory that will save lives,” Palm Beach County State Attorney Dave Aronberg told the Sun Sentinel.

AHH, OOF and OUCH

AHH: The Food and Drug Administration has expanded its approval of who can get the HPV vaccine to include men and women ages 27 to 45 to reduce the number of cancers caused by the human papillomavirus.

Previously, the vaccine was just approved for people ages 9 to 26 and is “typically given in two doses several months apart for those who are 9 through 14, and in three doses for individuals 15 through 26,” our Post colleague Laurie McGinley reports." For those older than 26, the recommended regimen will be three doses."

“Most sexually active individuals in the United States will become infected with HPV in their lifetimes. In most cases, the virus is cleared by the body’s immune system, but when that doesn’t occur, HPV infections can lead to cervical, anal, vaginal, penile and throat cancers,” Laurie explains.

Research shows that even while the vaccine is most effective when administered before people become sexually active, it can also benefit an older group because “many adults have been exposed to some types of HPV, most have not been exposed to all nine types covered by the vaccine,” Laurie reports.

In August, data from the Centers for Disease Control and Prevention for 2017 showed HPV vaccination rates are rising. Still, HPV-related cancers have been rising too. In 2015, 43,000 people developed HPV-linked cancer, up from 30,000 people in 1999, according to the CDC.

OOF: Mike Braun, the Indiana businessman running to unseat Democratic Sen. Joe Donnellym has touted his ability to make a deal with health insurers at his own company as a model for the rest of the country.

The Republican candidate's campaign has even bragged that he provided coverage for preexisting conditions for his employees “before it was cool,” Politico’s Alice Miranda Ollstein reports ahead of the debate between Braun and Donnelly tonight.

But Alice details some of the concerns employees at Braun's company have expressed about the health coverage. “But while he may have kept premiums stable for a decade for his roughly 900 workers, deductibles are sky-high — meaning big out-of-pocket costs for anyone who gets sick,” she writes. “Employees of his company, Meyer Distributing, must spend $5,000 a year on health care before their bills are covered, and families pay double that, or $10,000 a year.”

Braun “also criticized Donnelly for allowing Indiana’s Obamacare marketplace to worsen,” Alice adds. “Donnelly in turn has attacked Braun for backing a lawsuit brought by conservative states that aims to kill Obamacare and its consumer protections for people with preexisting conditions…But Braun’s workers pay far more than most people who get their insurance through their jobs. Some former employees described the health benefits offered by their millionaire boss as ‘horrendous’ and ‘a joke.’’

OUCH: At least 89 percent of victims of rape and attempted rape later report some level of emotional and physical distress, which includes high rates of physical injury, post-traumatic stress disorder, depression, anxiety and substance abuse, our Post colleague Andrew Van Dam reports.

About nine out of 10 victims of sexual assault experience some level of distress, with 46 percent experiencing severe distress, Andrew reports, citing analysis by the Justice Department. Three-fourths of victims experience social and emotional issues following the incident, 58 percent are injured during the assault, and more than a third of assault victims are injured enough to require treatment.

Andrew highlights the data to show that “consequences of sexual assault fall overwhelmingly on the victims,” noting that less than 1 percent of these incidents end with a felony conviction for the perpetrator.

Most incidents of rape and attempted rape are not reported. And not only do “rape and sexual assault typically go unreported, but definitions also vary, and many of the mental and physical effects are slow to manifest and challenging to detect,” Andrew writes.

Data also shows that between 17 and 65 percent of assaulted women develop PTSD, and as many as 82 percent have problems with fear and anxiety, according to relevant studies. And between 13 and 51 percent are diagnosed with depression.

TRUMP TEMPERATURE

— Brett M. Kavanaugh was confirmed as the 114th Supreme Court justice on Saturday and sworn-in hours later, bringing an end to a “vitriolic battle over his nomination and solidifying a conservative majority on the court,” our Post colleagues Seung Min Kim and John Wagner report.

“As a throng of angry demonstrators stood on the steps of the Capitol, the Senate finalized on a near party-line vote of 50 to 48 what will certainly be one of President ’s most enduring legacies: two Supreme Court justices in two years in an increasingly polarized nation,” they write.

Trump touted the victory during a rally in Kansas on Saturday night, per our colleagues Tracy Jan and Gabriel Pogrund.

“I stand before you today on the heels of a tremendous victory for our nation, our people and our beloved Constitution,” Trump said. “It could be three, it could even be four, it could be a lot … And if you allow the wrong people to get into office, things could change . . . You don’t hand matches to an arsonist, and you don’t give power to an angry left-wing mob.”

Here’s a look at where some of the closely watched swing votes ended up:

Sen. Lisa Murkowski (R-Alaska) was the lone Republican senator to oppose Kavanaugh’s confirmation to the high court. During the vote itself, while Murkowski initially voted no, she requested that her “final vote be recorded as 'present' as a courtesy to Sen. Steve Daines (R-Mont.), a Kavanaugh supporter who was away from the Senate for his daughter’s wedding,” our colleagues report. The president told The Post in a Saturday phone interview that Murkowski would “never recover” from her vote. “As the rest of her party celebrated Kavanaugh’s ascent to the nation’s highest court after a tumultuous nomination jolted by allegations of sexual misconduct, Murkowski reflected on what she said was a wrenching decision that had kept her from eating and sleeping well,” our colleagues Sean Sullivan, Paul Kane and Philip Rucker write.

Soon after Sen. Susan Collins (R-Maine) announced on Friday she planned to support Kavanaugh, a crowdfunding site raising money to defeat her in 2020 crashed. “The site was back online a little less than two hours later,” our colleagues Kristine Phillips and Eli Rosenberg report. “By Sunday morning, the campaign that vows to support Collins’s future opponent had surpassed $3.3 million — not an insignificant amount for a political race in a state with among the smallest populations in the country (1.3 million).” Meanwhile, Collins was singled out for praise from the president. “I think what Susan Collins did for herself was incredibly positive,” Trump told The Post, per Philip. “It showed her to be an honorable, incredible woman. I think she’s got a level of respect that’s unbelievable. I really mean it.”

Sen. Joe Manchin III (D-W.Va) was the only Democrat who voted to approve Kavanaugh’s nomination. But Senate Majority Leader Mitch McConnell (R-Ky.) insisted the GOP still plans to challenge the West Virginia senator in the midterm elections. McConnell said his vote was “the right thing to do,” during an interview on CBS’s “Face the Nation,” but added he’s “still a Democrat, and we’re trying to hold the majority.”

HEALTH ON THE HILL

— Meanwhile, Sen. Mazie Hirono (D-Hawaii) explained how she believes Kavanaugh’s confirmation to the high court would undermine Roe v. Wade.

She suggested during an interview on ABC News's "This Week" that the addition of Kavanaugh to the bench wouldn’t mean the Supreme Court would overturn the law outright but its actions would instead "nullify" the landmark abortion ruling. Many Democrats opposed Kavanaugh from the outset over concerns that he would help roll back abortion rights. 

"I actually studied his cases, and I read his, particularly his dissents, which are very telling, very much against reproductive choice," Hirono said. "Of course it matters if [justices] go over there and actually overturn Roe v. Wade, which I doubt they’re going to do… The states are very busy passing all kinds of laws that would limit a woman’s right to choose. It’s those things that will go before a justice.”

She added: “They will nullify it pretty much.”

MEDICAL MISSIVES

— Millennials may not be bothering with primary-care physicians.

A survey taken by the Kaiser Family Foundation of 1,200 adults found 26 percent don’t have a primary-care doctor, Sandra G. Boodman writes for Kaiser Health News. And broken down, the survey found this was even more so the case for younger groups. It found 45 percent of 18-to-29 year-olds did not have a primary-care provider, compared with 28 percent of 30-to-49 year-olds, 18 percent of 50-to-64 year-olds and 12 percent of 65-year-olds and older.

Ateev Mehrotra, an associate professor in the Department of Health Care Policy at Harvard Medical School, explained to Sandra that younger patients are “unwilling to wait a few days to see a doctor for an acute problem, a situation that used to be routine.”

Instead, according to the report, some patients are choosing urgent-care clinics for certain ailments, such as a cold or the flu.

“For decades, primary-care physicians have been the doctors with whom patients had the closest relationship, a bond that can last years,” Sandra writes. “But some experts warn that moving away from a one-on-one relationship may be driving up costs and worsening the problem of fragmented or unnecessary care, including the misuse of antibiotics.”

— And here are a few more good reads from The Post and beyond: 

AGENCY ALERT
It’s a major win for Akcea, after the FDA declined to approve another of the company’s drugs, Waylivra, based on the same technology.
Stat
President Trump boasts that he has “mostly obliterated Obamacare.” His health secretary is taking credit for making the law work better than ever. Who’s right?
The New York Times
INDUSTRY RX
Roughly 6% of U.S. health care spending goes toward medical devices
Axios
The awarding of the Nobel Peace Prize to a Congolese surgeon brings rare global attention to a region surging for decades with rebel conflict that now threatens efforts to contain a deadly Ebola outbreak.
Associated Press
To Your Health
Trump and key GOP senators have suggested Christine Blasey Ford misremembers her attacker. Cognitive researchers say that's extremely unlikely.
Avi Selk
On Leadership
New charges alleging sexual harassment jumped by more than 12 percent over 2017, to more than 7,500.
Jena McGregor
Energy and Environment
“There is no documented historic precedent” for the sweeping changes required to hold the planet’s warming to just 1.5 degrees Celsius (2.7 degrees Fahrenheit), the U.N. Intergovernmental Panel on Climate Change found.
Chris Mooney and Brady Dennis
STATE SCAN
"We’re not interested in allowing people to go and smoke marijuana just for the heck of it."
Politico
REPRODUCTIVE WARS
Acts of Faith
Police are investigating the incident caught on video during an antiabortion demonstration.
Alex Horton
Anti-abortion forces behind a November ballot initiative are focusing on costs in the progressive state.
Politico
DAYBOOK

Coming Up

  • The FDA holds a meeting of the Oncologic Drugs Advisory Committee on Wednesday.
  • The FDA holds a meeting of the Anesthetic and Analgesic Drug Products Advisory Committee on Wednesday.
  • The Alliance for Health Policy holds an event on aging in America on Wednesday.
  • The American Enterprise Institute holds an event on “Nurse practitioners and America’s primary care shortage” on Oct. 15.
  • The Brookings Institution holds an event on “Crafting public policy to address the nation’s opioid epidemic” on Oct. 15.
SUGAR RUSH

A man hit a female protester in Toronto with a roundhouse kick during an antiabortion rally:

SNL mocks Republicans celebrating Kavanaugh confirmation: