Montana Uncovers More Alleged Insurance Fraud Targeting Tribes

A second health insurance company doing business in Montana has been caught up in a massive fraud scheme that allegedly targeted Native American communities, according to State Auditor and Commissioner of Securities and Insurance James Brown.

Brown announced this week that his office helped stop more than $5 million in questionable insurance payouts by Mountain Health Co-Op.

The company is the second insurer affected by what investigators describe as a sophisticated operation that exploited federal Affordable Care Act ("Obamacare") enrollment rules intended to benefit tribal members.

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The fraud allegedly occurred across state lines.

According to the Auditor's Office, the scheme convinced Native Americans to drop their Medicaid coverage before enrolling them in Affordable Care Act plans using false information.

Victims were then transported to out-of-state addiction treatment centers, where insurers were allegedly billed for treatment that either never happened, wasn't medically necessary, or was grossly inflated.

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Earlier this year, Brown's office announced it had helped halt more than $40 million in payments by PacificSource related to the same investigation. Combined, investigators say they've identified more than $60 million in potential savings between the two insurance companies.

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Homeless shelters, body brokers and false promises.

State investigators say so-called "body brokers" targeted homeless shelters on or near Montana reservations, luring vulnerable people with promises of luxury rehab, free transportation, housing, and even cash. In some cases, officials allege victims were given drugs or alcohol during transport or while being evaluated.

According to the Auditor's Office, some participants were shuffled between treatment facilities, housed in poor conditions, and eventually abandoned far from home without transportation or resources to return.

Brown said the investigation remains active and urged Montanans to watch for warning signs, including unsolicited offers for addiction treatment, pressure to change insurance plans, promises of free trips to out-of-state facilities, or unfamiliar vans recruiting people in their communities.

The Auditor's Office says it will continue pursuing fraudulent claims and working to recover improperly paid funds.