Muddy Waters: The Ethics of the Kickback


The concept is simple: interventionists and treatment providers work for their clients using the highest ethical standards to ensure that they receive the most appropriate and beneficial treatment possible. And yet somewhere along the way, the waters became muddied.

Many treatment centers, in an effort to fill beds, went to those on the front lines with people in the throes of their addiction—interventionists—and made the pitch: if you send clients our way, you will be financially compensated.

Win-win, right? Actually, no. On the surface, perhaps this seems harmless enough. Plenty of people receive kickbacks in the form of marketing fees, referral fees, or affiliate compensation. Entire businesses, from essential oils to jewelry, are built on the concept.
So what’s the big deal?

In a nutshell: interventionists and behavioral health professionals harbor the responsibility to direct clients to treatment that will save their lives. And yet, as counter-intuitive as it sounds, treatment can actually end a person’s life if it isn’t the very best treatment option for him or her. The unique constellation of details that comprise a person’s biological, mental, emotional, and interpersonal experience all contribute to an addiction that is equally complex and multifaceted. Simply, there is no one-size-fits-all treatment.

Therefore, for interventionists or behavioral health professionals to agree to send all (or even a majority) of their clients to one treatment center removes the element of thoughtful consideration of which center is truly best-suited to their client’s specific needs. And, in certain tragic cases, this has led to the deaths of clients who were placed in the wrong treatment center for their particular needs. Historically, money often clouds vision, and interventionists and behavioral health professionals simply cannot afford to be myopic while holding in their hands the health and wellbeing of their clients.

Whereas physicians must adhere to Stark law, which prohibits physician referrals of designated health services for Medicare and Medicaid patients if the physician (or an immediate family member) has a financial relationship with that entity, the practice of interventionists and behavioral health professionals working with treatment centers for referral fees is not yet illegal and, therefore, does not carry the consequences to deter them.

However, the waters are getting murkier by the minute and until such a law is enacted, interventionists and all behavioral health providers’ code of ethics should steer their consciences toward making the right choice regardless of the threat of punishment. Until interventionists consistently hold themselves to the same standard of ethics as physicians, the interventionist profession as a whole will suffer, and never be given the appropriate level of respect or clinical acceptance the pioneers in the field have worked so hard to establish.

There are few professions in which it is more important to hold its members to the highest ethical standards. Doing so not only ensures that individuals and families seeking an intervention will receive the best possible care, but it also instills within them the confidence that their safety and recovery is the sole focus of their interventionist—rather than who will best line their pockets.

As a result of countless conversations with political leaders, federal agents, law enforcement professionals, media insiders, industry pioneers, and most importantly, the addicts and their families, we have developed the following Ethics Pledge to align fellow interventionists and all potential addiction treatment referents with ethical best practices. Our hope is that by reevaluating the harmful path that referral and questionable marketing fees inevitably sets them on, interventionists will choose to put their clients’ needs and wellbeing ahead of their own.

At the very minimum, we propose that they fully disclose in writing to potential clients their financial affiliations with any treatment centers prior to accepting any payment for services rendered. In this way, we increase our profession’s transparency and accountability, which, in the end, benefits everyone.

Since introducing this pledge, we have received overwhelming interest and support as fellow interventionists and addictions treatment professionals recognize and agree that we can indeed do far better for our clients and for ourselves.

The simple purpose of this pledge is to create a perpetual list of ethical professionals that families in crisis can more accurately vet by asking one simple question, “have you signed the Hayes-Davidson Ethics Pledge?”

If the answer is yes, then you can be certain that you’re working with someone that has agreed to put ethics, integrity, and patient safety in front of their own financial gain.

If the answer is no and the interventionist or behavioral health provider is not willing to sign the ethics pledge, it’s this simple: keep looking.

What is most shocking to families that have learned, after the fact, that their interventionist benefitted financially from referring their loved one, is the fact that the “referral fee” came from the family’s or patient’s pocket. The kickback is typically a percentage of the patient’s confirmed financial commitment to the facility. The referent is “double dipping” by being paid for their services by the family, then collecting from the family again in the form of an undisclosed percentage of the patient’s outlay of cash to the facility or the patient’s insurance coverage. Either way, families are always shocked to learn that piece of information after the fact, and they should be—it’s grossly unethical.

For those in the industry willing to sign the pledge, we have built a standalone site that will exist in perpetuity until our industry no longer needs this extra level of ethical exposure. Every individual who has signed the pledge will be listed on the site so that potential clients can verify their commitment to ethics and reform. Moreover, each individual who has signed the pledge will receive a watermarked, pledge-confirmation stamp, which he or she can proudly display on their marketing materials and website. From now on, all a potential client needs to do is see the pledge-confirmation stamp near a professional’s name to know they are committed to the ethical standards all patients deserve.

While the Hayes/Davidson Ethics Pledge is not an accreditation, certification, governing body, or policing agency, it is most certainly a self-reporting, independent resource designed for families and professionals to quickly identify those in the industry willing to stand up for imperative ethical standards and professional integrity.

The Hayes-Davidson Ethics Pledge:


Muddy Waters: The Ethics of the Kickback

A respectable and ethical interventionist/treatment provider is there to guide the patient and their family through the treatment process and provide support the entire way. He or she should teach the family how to set appropriate boundaries and maintain them before, during, and especially after an intervention or recognition of a behavioral health issue. Intervention and treatment are parts of the process, not individual events.

An ethical and respectable interventionist/treatment provider will stand by the patient and his or her family’s side throughout the entire process and under no circumstances should ever benefit financially from the patient’s treatment provider at any point during the process. While this may not yet be illegal, it is profoundly unethical. Whether they are called marketing fees, referral fees, affiliate compensation, or anything similar, they are indeed nothing more than kickbacks and ultimately muddy the ethical waters we have all fought so hard to protect.

There are countless intervention and treatment professionals out there, and we must keep in mind that all treatment decisions motivated by financial gain are potentially life-threatening, unethical, and illegal under several circumstances. By signing the Hayes-Davidson Ethics Pledge, you are committing to the following:

As a respectable and credible interventionist/behavioral health professional, I commit to upholding the ethics of our industry, the treatment community, and the families we serve, by pledging to never benefit financially from a patient in the form of unethical compensation. I acknowledge that accepting financial compensation (referral fees, marketing fees, or kickbacks) from referents is not only unethical, illegal under several circumstances, and highly suspect in the eyes of the federal government, but it also poses a threat to the patient’s and their family’s optimal treatment when financial compensation becomes a factor in determining a patient’s best course of treatment. If I am to benefit financially in the form of referral fees, marketing fees, kickbacks, and the like, I will let the patient and family know in writing before recommending the provider or facility that is compensating me. I acknowledge that withholding financial compensation disclosures from a patient or family is unethical, and I will do my part to make sure the industry is ethically sound by pledging to be ethical, respectable, and a true agent for industry reform.

I, Joyce Sundin, have signed this pledge and adhere to these principals.