Quick summary: Check that a mental health or addiction treatment programme is licensed for the specific service and address, and that its level of care matches the patient’s needs. Verify accreditation, insurance network status and staff credentials independently rather than relying on treatment providers’ marketing claims. These checks can help families avoid unsuitable care, misleading practices and financial or clinical risks when arranging treatment.

Most families start looking for treatment in a hurry, usually on a phone, often straight after a crisis. The websites look polished. The admissions line answers on the first ring, and everyone seems to accept your insurance. Almost nobody explains what the paperwork behind a programme actually means.

I spend my working days on the other side of that paperwork. I help behavioural health programmes get licensed, accredited and set up with insurers. This is what I’d want my own family to check. The examples are American, mostly from Oregon, because that’s where I work. The logic travels.

A licence is narrower than you think

A state licence isn’t a general seal of approval. It covers a specific organisation, at specific addresses, for specific services.

In Oregon, outpatient mental health and substance use programmes that receive public funding must hold a Certificate of Approval from the Oregon Health Authority (OHA). Many private programmes hold one too. Under the Oregon administrative rules, each certificate lists the approved locations, the service rules the programme may operate under, the expiry date and any conditions attached. The same rules say a certificate is no substitute for the separate licence required for residential facilities.

So a clinic approved for outpatient counselling can’t simply open a residential house down the road. New services and new locations need their own approval. OHA certifies outpatient programmes for up to three years and licenses most residential programmes every two years, according to its licensing and certification information. Ask to see the current certificate or licence. Then check the address and expiry date yourself.

Watch for a level-of-care mismatch

Addiction services in the US are usually described using the ASAM Criteria. They sort care into four broad levels, from outpatient through to medically managed inpatient, with decimals marking finer steps in between.

Detox shows why this matters. OHA approves withdrawal management programmes for particular levels, such as clinically managed residential withdrawal (3.2-WM) or medically monitored inpatient withdrawal (3.7-WM). Someone at risk of severe alcohol withdrawal needs medical cover to match.

So don’t stop at “Are you licensed?” Ask the full question: “Are you licensed, at this address, for the level of care my relative has been assessed as needing?”

Licence, accreditation and network status are three different things

Marketing blurs these constantly.

Licensing is the legal minimum, and the state sets it. Accreditation is voluntary. It comes from independent bodies such as CARF and The Joint Commission, which reviews accredited organisations at least every three years. Both have public search tools. Check that the accreditation covers the programme and site you’re considering, not a sister location.

Network status is separate again. OHA states plainly that being licensed or certified does not guarantee eligibility to serve Oregon Health Plan (Medicaid) members. For private insurance, call the number on the back of the card. Ask whether the programme is in network for that specific service. Don’t rely on the admissions team to tell you.

How to check in Oregon

OHA publishes a statewide substance use services directory. It describes itself as a courtesy rather than an official record, and it asks people to verify a programme’s approval by calling the Behavioral Health Division on 503-945-5772. That call is worth making.

Nationally, SAMHSA points people to FindTreatment.gov, which lists state-licensed providers of mental health and substance use treatment.

Then check the people. Oregon’s Mental Health Regulatory Agency links to licence lookups for mental health professionals, including psychologists, professional counsellors and marriage and family therapists. Addiction counsellor certifications can be checked on the MHACBO registry. Other states have equivalent boards.

Why the marketing deserves scrutiny

There’s a history here. In December 2017, Palm Beach County State Attorney Dave Aronberg described the “Florida Shuffle” to a congressional committee. It began with deceptive marketing and inducements such as a free one-way plane ticket. Then came insurance-billed treatment, a sober home and, too often, relapse and another round of billing, according to his written testimony to Congress.

A few months earlier, Google had begun pulling ads from rehab searches after finding what it called misleading experiences, as reported by The Verge. Today, US addiction treatment advertisers on Google must be certified by LegitScript. LegitScript offers a free website certification status checker to see whether a website is certified.

The problem hasn’t gone away. In May 2023, Arizona suspended Medicaid payments to more than 100 behavioural health providers over alleged fraudulent billing. Officials described bad actors exploiting Tribal communities, according to the state’s Medicaid payment suspension announcement. The state’s Medicaid agency says it has since suspended more than 300 providers, as detailed in its Sober Living Fraud information.

Paying for patients is also a federal crime. The Eliminating Kickbacks in Recovery Act of 2018 bans kickbacks for referrals to recovery homes, treatment facilities and laboratories. Penalties run up to $200,000 and ten years in prison per occurrence. The law applies to private insurance, not just government programmes, as set out in the relevant federal definitions. If a programme offers a free flight and free housing, treat that as a warning sign.

Red flags

• A helpline that won’t give you the facility’s name and address
• Offers of free travel, rent or other perks for attending
• Pressure to commit today
• Vague answers about staff credentials or who the medical director is
• A sober home presented as treatment. Recovery housing can help, but it’s housing. It isn’t clinical care

Questions worth asking

• What level of care are you licensed for at this exact address, and when does that licence expire?
• Are you accredited, and does it cover this site?
• Who assessed my relative’s level of care, and using what criteria?
• Are you in network with my plan for this service?
• Do you offer, or coordinate, medication for opioid or alcohol use disorder?
• What happens at discharge, and who arranges aftercare?

Good programmes are used to these questions and answer them without fuss. The ones that get defensive are telling you something too.

Easton Hallock is managing partner of Saint Health Group, which helps behavioural health organisations with licensing, accreditation and compliance.