Two years ago, Donald Ahlgren faced a dilemma common among the legions of drug addicts just out of detoxification programs: He needed an affordable place to live that wouldn’t reject him because of his past.
To his surprise, he had his pick of places.
These low-budget rooms were typically in apartment buildings or houses, and tucked in some of the most recession-plagued neighborhoods of Boston and nearby suburbs. Landlords advertised them as “sober homes,’’ an informal term used for rentals marketed to recovering substance abusers. Residents are warned about mandatory urine testing — typically three times a week — and zero-tolerance rules, but also promised a supportive you-can-do-it environment.
“For a time, I was wanted,’’ recalled Ahlgren, 28, a North Reading native who had spent years in and out of drug rehabilitation programs and the courts.
Yet he quickly realized that many of these places did not seem to care much about preventing relapses. For all the attention to urine testing, Ahlgren said, he and other tenants sometimes got high on the side and then found, to their surprise and relief, that landlords did not evict them after “dirty’’ results.
Ahlgren soon discovered the dark side of this little-known niche of the drug world: Recovering addicts were cash cows for a financial alliance between sober homes and private drug-testing labs. Landlords needed the labs to show they were serious about sobriety, largely to get referrals to fill their rooms. And the labs needed access to lots of indigent substance abusers whose drug-screening tests qualified for lucrative Medicaid reimbursements worth millions of dollars a year.
These business relationships troubled Ahlgren and also drew the scrutiny of prosecutors, who now allege that a number of labs and sober homes engaged in fraud and abuse of Medicaid, the government’s health insurance program for the poor. On Friday, one major lab agreed to pay $20 million to settle state charges that it improperly billed for testing in sober homes.
Prosecutors have said that, as labs aggressively competed to sign up addicts for testing some resorted to bribing sober home operators for exclusive access to their tenants. Several lab executives — including a Brookline doctor who treated Ahlgren — have also been indicted in schemes that, among other things, required addicts to undergo excessive urine testing — much more frequent than is typically recommended by substance abuse specialists.
The crackdown came too late for many struggling addicts like Ahlgren, who succumbed again to the grip of narcotics. He would eventually get clean, though only after going to extremes: He almost begged to be put behind bars again to escape from a world where all that anyone seemed to care about was his Medicaid card.
“It’s a big game,’’ he said. “It’s all about the money.’’
An effective program
After being released from a detoxification program in the summer of 2010, Ahlgren told his mother he was ready to change. He wanted to stop his OxyContin and heroin cravings, which had begun when he was in high school and had driven him to burglarize houses to pay for the drugs.
Though skeptical at first, Anne Marie Hallahan, a day-care teacher, knew her son had worked hard to get sober and she began seeing a sparkle in his eyes that reminded her of his happier days as an award-winning black-belt karate competitor.
He expressed an interest in sober homes, realizing that it wasn’t best for him to live any more with family and friends. When Ahlgren’s mother agreed to subsidize the rent — about $150 a week for a shared room — Ahlgren told her that she would not regret it. He promised he would eventually find work and become independent.
“I want you to be proud of me,’’ he said.
A drug treatment counselor recommended a sober home called New Horizon House. The house, in a residential section of Quincy, was part of a scattered complex of a half-dozen properties in Boston and Quincy, which Carl Smith, the 66-year-old landlord, had converted into sober homes for some 90 recovering substance abusers.
Sober homes are similar to halfway houses, providing shared bedroom space and communal living areas — and occasionally meals — for a weekly fee. Their numbers grew over the past decade as landlords found this specialized corner of the rental market profitable. But the homes are unregulated, and, other than ensuring that their properties meet building safety codes, landlords do not have to provide any special services or enforce any rules.
Still, most require urine testing, which is typically paid for by insurance. For instance, Medicaid pays about $100 to $200 for each urine screen, as long as a doctor signs a form saying the test is medically necessary.
“We certainly don’t want people who are using drugs in the house,’’ Smith, a former convict with a degree in mental health counseling, said in a court deposition. “We want people who are there to be in a recovery program.’’