Out-of-state substance use treatment facilities have been carrying out a deceptive scheme targeting Native people in Montana, resulting in up to $55 million worth of fraudulent health insurance claims, according to State Auditor James Brown. A monthslong investigation alleges insurance agents tied to the facilities traveled to tribal reservations in Montana, where they sought people struggling with substance use, encouraged them to sign up for a health care plan on the Affordable Care Act marketplace, and helped them do it.
Soon after enrolling, those same people would be transported to treatment centers in other states, primarily California, under the premise they’d receive substance use treatment covered by their new insurance plan. Instead, the facilities failed to provide adequate treatment while sending insurance claims to the tune of $9,000 a day, per patient, to PacificSource, one of the three companies that sells health care coverage on Montana’s marketplace. Between 2019 and 2023, Native Americans in Montana died by drug overdoses at three times the rate of white people, according to state data.
PacificSource alerted the state auditor’s office in January 2025 about the suspected fraud. So far, the Centers for Medicare and Medicaid Services has agreed to throw out $23 million billed to PacificSource, representative of 80 claims. They are still reviewing dozens more claims worth up to an additional $30 million. According to State Auditor James Brown, “This scheme wasn’t a mistake. It wasn’t compassion.” Native Americans can enroll in the Affordable Care Act marketplace at any time of the year, a unique provision that Brown’s office says was exploited in the scheme. The auditor’s office could pursue fines against insurance agents who knowingly signed people up for fraudulent plans or were unlicensed in Montana.
This article is an AI-assisted summary. All facts and figures are drawn from the original report: https://www.milescitystar.com/news/montana-auditor-out-of-state-providers-targeted-native-people-in-55m-insurance-scheme/article_406c0aa6-f4ac-559f-853f-95f5f26740e7.html