Auditor Announces Company Impacted By Fraud Scheme

Montana State Auditor and Commissioner of Securities and Insurance James Brown helped to stop more than $5 million in unsupported payouts by Mountain Health Co-Op, a second health insurer impacted by an Obamacare fraud scheme previously exposed by the auditor’s office. The treatment and billing scheme targeted vulnerable native communities in the Treasure State.

The scheme abused an Obamacare provision allowing tribal members to enroll year-round with no waiting period by: 1) convincing members of Montana’s native communities to disenroll from Medicaid; 2) enrolling them in Obamacare using fake information; 3) transporting them across state lines for alleged addiction treatment; and 4) billing Montana insurers for treatments that never occurred, were inadequate, unnecessary, or at inflated costs.

Brown’s office has already helped to halt more than $40 million in payments by another health insurer, Pacific-Source, which was impacted by the same fraud scheme. In total, more than $60 million in savings has been identified for the two insurers.

“My agency launched a second front in our fight against these fraudsters, who thought they could get rich quick by abusing and defrauding Montana’s native population,” Brown said. “We will continue to claw back wrongful claims and show fraudsters that they won’t get away with their manipulative, deceitful crimes in the Treasure State.”

The agency’s ongoing investigation revealed that “body brokers” targeted homeless shelters on or near reservations, promising vulnerable persons free luxury rehab, transportation, housing and cash incentives. Some victims were provided alcohol or drugs during transport or at the time of medical evaluation to keep them compliant.

Victims were housed in substandard conditions, shuffled around different facilities, and abandoned far from their homes without resources to return, potentially contributing to the scourge of missing and murdered indigenous persons.

For more information, visit csimt.gov/indian-country-resources/.