Body Brokering is Human Trafficking. The Dark Side of Drug and Alcohol Rehab.

Author: A. Ant, CADC-II, Licensing & Accreditation Expert

Photo: A counselor leads a group therapy session in a licensed treatment program.

TRIGGER WARNING: The following article contains detailed depictions of drug abuse, human trafficking and overdose deaths. Please engage with care.

Alex Strickling was 22 years old and in treatment in Florida when someone he met inside the facility began texting him about a better deal in California. The recruiter offered two hundred dollars to get established, cigarettes, a gym membership. He also gave Alex an instruction, which CBS News reported in 2018: fail your urine test, so the new California rehab can justify admitting you. Alex did what he was told. He relapsed on purpose, for money, on the advice of a man who was paid per head. Days later he died of an overdose in a motel room a few miles from a Beverly Hills rehab.

His father, Rich Strickling, put it about as plainly as a grieving parent can. “There was somebody whispering in his ear,” he told CBS. And about the call every parent of a person in active addiction half expects: “Somewhere I was building some type of wall waiting for the day that it happened to my son, but nothing prepares you for that.”

That’s body brokering. It isn’t a billing irregularity or an aggressive marketing practice. A young man was told to poison himself so a stranger could collect a commission, and it worked.

How the Machine Actually Works

The scheme follows a pattern, and once you’ve seen it you start spotting it everywhere.

It starts with insurance, because insurance is the only thing in this transaction anyone actually wants. A broker finds someone with a substance use disorder who has no coverage or bad coverage, and gets them onto a generous commercial PPO plan. Sometimes the broker pays the premium directly. Sometimes a facility pays it through a third party or a bogus nonprofit. The person becomes valuable the moment that policy activates.

Not everyone gets recruited. Brokers work a profile, and the profile is built out of desperation plus good insurance. They want the person sleeping in a car, the person three days out of a detox unit, the person who relapsed last weekend and has not told their family yet. California’s AB 2614, the Body Brokering and Patient Referral Integrity Act, describes the same profile in flat legislative language: people who are unhoused, recently discharged from treatment or insured by private plans, recruited “not on medical necessity, but by the value of their insurance coverage,” then “shuffled between facilities to maximize billing.” Vulnerability isn’t a side effect of this business. It’s how they pick their targets.

The hunting grounds are wherever people in early recovery hang out. Brokers work AA and NA meetings, detox units, hospital discharge areas, sober houses, online recovery groups, and the coffee shops across the street from treatment centers in Delray Beach, Costa Mesa and Phoenix. A lot of them are in recovery themselves, or were, which is exactly why the approach lands. Around South Florida people started calling them junkie hunters and body snatchers, and the nicknames stuck because they fit. Think about where Alex Strickling met his recruiter: inside a licensed treatment facility. Operators should sit with that one the longest.

Next, the payment. Cash, a phone, an airline ticket, sometimes rent or gift cards or drugs. The person is recruited into a facility that bills the policy at the highest level of care it can justify, usually detox or residential, along with urine drug testing that can run into thousands of dollars per specimen. The broker collects a fee. In the accounts of families and prosecutors, that fee runs anywhere from five hundred dollars to several thousand per admission, and the richer the policy, the higher the price.

And here’s the part that kills people. A writer named Alice described the cycle in a blog post for the Partnership to End Addiction. Brokers, she wrote, “troll AA meetings, coffee shops in popular rehab towns” and “offer to share these kickbacks with patients or entice them with substances to leave an existing facility.” She wrote that patients become “a highly sought-after commodity,” and separately that it is “very difficult for them to break away from this cycle.”

Alan Johnson, the chief assistant state attorney who built Palm Beach County’s sober homes prosecutions, said it in one sentence that has been quoted ever since. “The business model is not recovery. The business model is relapse.”

This isn’t a fringe practice run out of a van. In September 2020 the Department of Justice announced a national takedown that included a dedicated Sober Homes Initiative: more than a dozen defendants charged over more than $845 million in false and fraudulent claims, involving physicians, facility owners and the patient recruiters the government itself calls body brokers. The conduct described included kickbacks for referrals, medically unnecessary testing, therapy sessions billed but never delivered, and patients cycled through facility after facility.

The individual cases read the same way. Federal prosecutors in California indicted an Orange County sober living operator in April 2024 for paying $174,600 to body brokers between April 2020 and October 2021. According to the indictment he negotiated over encrypted messaging, priced each patient by their insurer and expected length of stay, papered the payments with sham consulting contracts, and refused to pay out unless the patient stayed at least 21 days. Twenty-one days. A person with a sell-by date, like a piece of meat.

Why This Is Trafficking and Not Just Fraud

People get uncomfortable when you use the word trafficking here, and I understand why. Trafficking usually brings to mind a shipping container or a massage parlor. But look at what’s happening instead of what you picture.

A person is recruited, then transported, often across state lines and frequently on a ticket the recruiter bought, then harbored in a bed the recruiter arranged. And it is all done through fraud and coercion against someone whose disease makes refusal extraordinarily difficult, for the financial benefit of a third party. What’s being sold is the person: their body, their urine, their blood, their policy number. When the commodity stops producing revenue, the person is made to relapse so they can produce revenue again.

Federal prosecutors usually charge these cases as patient brokering, kickbacks, wire fraud or money laundering, because those statutes are easier to prove and carry real prison time. That’s a prosecutorial choice, not a moral verdict on what happened. Officials investigating the largest scheme yet found have not been shy about the nature of it. Arizona Attorney General Kris Mayes, discussing the state’s sober living fraud, told Fox 10 Phoenix in January 2024, “We are aware of national and international criminal connections,” and that she expected the fraud total to pass a billion dollars. The Arizona Center for Investigative Reporting later reported that the state agency acknowledged the fraud may have cost as much as $2.5 billion. And because this is real money, more and more brokers are created, even as you read this article.

What happened in Arizona is the clearest example anyone has of what this practice does when it becomes “industrial.” Recruiters brought Native people to Phoenix from reservations in Arizona, New Mexico and Utah, promising help with drinking or drug use, and delivered them into sober living homes that the state had no real authority over. Clinics billed the American Indian Health Program, which had no rate cap, for treatment that was inflated, minimal or entirely fictional. Some providers billed $60,000 for a single session. And with little oversight, the fraud was immense.

The Arizona Center for Investigative Reporting and ProPublica counted the cost in January 2025. Using Maricopa County medical examiner records, they identified at least 40 Native American residents of Phoenix-area sober living homes who died from drug and alcohol use between spring 2022 and summer 2024, while the state worked out what to do about a fraud it already knew was happening.

One of them was Jeffrey Hustito, 43, from Zuni Pueblo in New Mexico. He went to Arizona for help with alcohol. He was moved from place to place. He died on December 27, 2022, in a Glendale sober living home after smoking fentanyl. His sister Katherine told the reporters, “I thought everything would be OK.” His father Anders said what anyone who loved him would say after reading the invoices: “He just got worse over there.” When Anders asked how residents of a sober home could be drinking, the owner’s answer was that since they have an alcohol problem, they let them drink a little bit to calm down.

Arizona’s Medicaid agency has since put 266 providers under payment suspension for credible allegations of fraud and has served more than 11,500 displaced people through a humanitarian response that included hotel placements and out-of-state transports. Thousands of people were dumped when the money stopped. That is what a supply chain looks like when it is shut down mid-shipment.

Nobody Counts the Bodies

You asked how many lives this costs? The short answer is no one knows, and the reason no one knows is part of this devastating scandal.

No death certificate says body brokering. It says fentanyl. It says acute combined drug toxicity. The broker who bought the ticket and told the kid to fail his UA doesn’t show up in the vital statistics, and no federal agency maintains a count of people who died inside or immediately after a brokered placement. Arizona reporters had to piece the 40 deaths together by hand from medical examiner records, because the state wasn’t tracking them.

Here’s what we can say with real numbers. CDC provisional data estimate 69,973 overdose deaths in the 12 months ending December 2025, down from 81,313 in the 12 months ending December 2024. Against that backdrop, engineering a relapse isn’t a paperwork offense. It’s the single most dangerous thing you can do to a person with opioid use disorder, because tolerance falls during abstinence and the dose they used to take becomes the dose that kills them.

The clinical research on that window is blunt. A cohort study of 61,819 detoxification episodes in Massachusetts, published in Addiction in 2020 by Walley and colleagues, found opioid-related mortality of 1.42 deaths per 100 person-years among people who received no treatment after withdrawal management, 1.06 for those who went to residential treatment without medication, and 0.52 for those who received medication. The authors also found that the risk of opioid overdose death was not reduced in the month after leaving residential treatment when no medication was involved. Put that next to the brokering cycle and it looks bad. The scheme repeatedly pushes people through the highest-risk transition in all of addiction medicine, deliberately, for a fee. And it withholds the one intervention that lowers the death rate, because medication-assisted patients stay put and stable patients don’t generate new admissions.

One number points the other way, and any honest article about this has to include it. Palm Beach County, the place that gave the country the phrase sober home fraud, built a task force and prosecuted. WPTV reported in October 2025 that the effort has produced more than 120 arrests and over 110 convictions, and that overdose deaths in the county have fallen roughly 60 percent from three years earlier, outpacing statewide trends. Jim Tichy, who runs a recovery facility in Delray Beach, remembered the earlier years this way: “When this first erupted, there was nothing but body bags coming out of this area.”

Enforcement saves lives here. That’s a measured outcome in a county that tried it, not a talking point.

How to Spot It From the Outside

If you’re a parent, a spouse, a sponsor or a discharge planner, the warning signs aren’t subtle once you know them. Most of them involve money flowing toward the patient, which never happens in legitimate care.

Someone offers to pay for the health insurance policy of a person who is about to enter treatment, or arranges coverage in a state they don’t live in. A recruiter offers cash, a phone, rent, cigarettes or drugs in exchange for admitting. A program offers to waive the deductible and copay entirely and puts nothing about it in writing. Travel is free and arranged fast, often to Florida, Southern California or Arizona, with a ticket bought by someone the family has never spoken to. Insurance gets verified before anyone has conducted a clinical assessment, and the level of care recommended matches the benefit rather than the need.

Other signs show up after admission. Your person is urine tested every day or nearly every day, and the bills are enormous. They never step down through levels of care, they just move sideways to a new facility every few weeks. They relapse on a predictable schedule, always shortly before or after an authorization ends. A new acquaintance is arranging all their moves. The sober home requires residents to attend one specific outpatient program, and the two are owned by people who are somehow always together. Nobody will tell you who their counselor is.

One rule covers most of this: in real treatment, money flows from the patient or their insurer to the provider. If anything at all is flowing backward to the patient, something’s wrong.

How to Spot It From Inside a Program

If you run a program or sit in compliance, the exposure usually arrives dressed as marketing. I’ve reviewed a lot of referral arrangements over the years, and the illegal ones rarely announce themselves. They look like consulting agreements.

The first red flag is an outreach or business development contractor paid per admission, or on a percentage of collections instead of a salary. Round-number consulting invoices that move in lockstep with census should worry you too, and so should lead purchasing from call centers where you can’t tell who actually spoke to the patient. If one referral source sends you patients who all carry the same unusually rich out-of-network policy, ask why. Ask the same when someone else paid the premium. And look hard at urine testing frequency nobody can tie to a written clinical protocol, or any pressure from ownership to keep people at a higher level of care than the ASAM Criteria support.

The penalties aren’t small. The federal Eliminating Kickbacks in Recovery Act, 18 U.S.C. § 220, makes it a crime to solicit, receive, pay or offer remuneration for referring a patient to a recovery home, clinical treatment facility or laboratory. Unlike the Anti-Kickback Statute, EKRA reaches private insurance and not only federal programs. The penalty is a fine of up to $200,000 and up to ten years in prison per occurrence, which means per patient.

Then there are the states. Florida Statute 817.505 makes patient brokering a third-degree felony with a $50,000 fine, escalating to a second-degree felony with a $100,000 fine when 10 to 19 patients are involved and a first-degree felony with a $500,000 fine at 20 or more.

Other states have followed. North Carolina enacted the Stop Addiction Fraud Ethics Act in 2023 (SL 2023-141), effective January 1, 2024, making patient brokering a Class G felony under G.S. 90-113.152. In February 2025 Addiction Professionals of North Carolina launched a public campaign to support enforcement of the law. Sara Howe, the association’s CEO, said: “It’s one thing to pass legislation…it’s another to make sure we enforce it and it does good work. So this is the first step.” In California, AB 2614 is a 2026 bill on patient brokering. I could not confirm its current status from the Legislature’s website, so check there before relying on it.

Some professional associations take a stand on this as well. The NAATP Code of Ethics, which binds NAATP members, states: “Patient brokering is prohibited. No financial rewards, substantive gifts, or other remuneration may be offered or received for patient referrals.” It also prohibits buying and selling patient leads, including phone calls.

Who to Tell, and What Each One Can Actually Do

Report to more than one place, since none of these bodies covers the whole problem on its own. Law enforcement can bring charges and regulators can close the doors. Accreditors can pull the credential that makes the billing possible, and insurers can cut off the money.

Who	What they handle	How to reach them
FBI	Interstate schemes, organized rings, health care fraud, trafficking	tips.fbi.gov, or your local field office
HHS Office of Inspector General	Fraud touching Medicare, Medicaid and other federal programs	1-800-HHS-TIPS (1-800-447-8477), tips.oig.hhs.gov
State Attorney General or Medicaid Fraud Control Unit	State kickback and patient brokering statutes, Medicaid fraud	Your state AG’s fraud division. In Arizona, AHCCCS at 602-417-4045
Local State Attorney or District Attorney	Brokering charges, sober home task forces where they exist	County prosecutor’s office
State licensing authority	License revocation, unlicensed operation, complaint investigations	The agency that licenses SUD treatment in that state
The Joint Commission	Accredited organizations: quality and safety complaints	patientsafetyreport@jointcommission.org, 800-994-6610, fax 630-792-5636, One Renaissance Blvd, Oakbrook Terrace, IL 60181
CARF International	Accredited providers: complaints against conditions of accreditation	(866) 510-2273 and the public feedback form at carf.org
The insurer	Billing fraud, premium payment by third parties, lab abuse	The special investigations unit listed on the back of the card
National Human Trafficking Hotline	Recruitment, transport and coercion of a person for someone else’s profit	1-888-373-7888, or text 233733, 24 hours

Don’t write off the accreditors. The Joint Commission and CARF can’t arrest anyone, but they can open a review, show up, and take away the accreditation that many payers require before they’ll contract. For a facility whose entire model depends on billing out-of-network at high rates, losing that credential is often faster and more lethal to the scheme than a criminal case that takes three years. Both take complaints from patients, families and staff, including people who don’t work at the organization.

Document before you report. Screenshot the texts, save the Venmo or Cash App history, and write down names, dates, the addresses of the homes, and the facilities and labs named on the explanation of benefits. Hang on to the EOBs especially. A single one showing $8,000 in urine testing in a week is the kind of thing that makes an investigator pick up the phone.

If You Are the Person Being Sold

Read this part slowly. The shame attached to it is what keeps the scheme running.

You are not the criminal here. You were the product. If someone bought your insurance, paid you to admit, told you to use so you would test dirty, and then handed you off to the next place, you were recruited and used. The people doing it knew exactly what they were doing, and they knew your disease made it hard to say no. That’s coercion. Taking the money doesn’t make it your fault, and neither does relapsing. Prosecutors in these cases go after brokers and operators. Patients are treated as victims and witnesses.

Here’s what helps, roughly in order of urgency. Get out of the arrangement physically, and don’t get into the car with the person arranging your moves. Carry naloxone and tell someone you trust where you are. If you’re in immediate danger, or someone is holding, moving or threatening you, call 911. The National Human Trafficking Hotline at 1-888-373-7888 is staffed around the clock and will talk to you confidentially.

For treatment that isn’t part of the racket, call SAMHSA’s National Helpline at 1-800-662-HELP (4357). It’s free, confidential, open 24 hours a day in English and Spanish, and it doesn’t take referral fees from anyone. If you’re in crisis, 988 is the Suicide and Crisis Lifeline. Ask any program you’re considering three questions: who pays my premium, does anyone get paid for bringing me here, and do you offer buprenorphine or methadone. The answers will tell you most of what you need to know.

Save everything before you leave: the texts, the payment records, the name of the person who recruited you, the name of every facility you were sent to. You may not feel ready to report today. Keep the evidence anyway, because in a year you might, and because what you hand over may be what finally lets an investigator connect the facility that used you to the twenty other people it used.

And if you’re reading this because someone you love is caught in the cycle, the hardest thing I can tell you is also the most useful. The relapses may not be a failure of willpower. They may be a scheduled part of somebody’s revenue plan, and that changes what you do next. You stop trying to argue them into willingness, and you start documenting who is moving them and calling the people listed in the table above.

What Legitimate Programs Owe the Rest of Us

Every ethical operator in this field pays a tax levied by the ones who do this. It shows up as payer skepticism, as prior authorization hell, as legislators who write rules for the worst actor they read about, as families who arrive at your admissions desk already convinced you are running a scam. The people who did this to Alex Strickling and Jeffrey Hustito took something from your program too, though obviously not the thing they took from those families.

The compliance posture that protects you isn’t complicated, but it has to be real. Pay marketing and outreach staff a salary, on a W-2, with no compensation tied to admissions or collections. Put every referral relationship in writing and test it against EKRA before you sign, not after. Document medical necessity through a clinical assessment before anyone verifies benefits, and make the level of care match the ASAM determination even when the authorization would have supported more. Tie urine testing frequency to a written protocol with a clinical rationale, and audit the volume monthly. Find out who owns the sober homes that refer to you. And give staff a way to report a concern that doesn’t route through the person they’re worried about, then take the first report seriously. There’s always a first one, and it’s usually right.

Both major accreditors examine business ethics, marketing practices and admissions criteria during survey, and your state licensing agency will ask about them the first time a complaint lands. If you want to see how your documentation would hold up, our free self-assessment is a reasonable starting point, and the state licensing guides cover what each state expects.

Frequently Asked Questions

Alex Strickling’s father said there was somebody whispering in his son’s ear. Seven words, and that’s the whole thing. Somewhere between the family that put a kid on a plane and the invoice that got paid, a person decided that a human being in the worst year of their life was inventory. Palm Beach County showed that prosecuting these people moves the death rate. Arizona showed what happens when a state watches the billing anomalies for two years and doesn’t. The rest of us decide which of those two we’re going to be, one referral agreement and one complaint at a time. If you’re a provider and you want a second read on your referral relationships, marketing agreements or admissions documentation before someone else reviews them for you, reach out through our contact page.