Montana Auditor Stops $9.5 Million More in Fraudulent ACA Payouts

Montana — ObamaCare Fraud: State Auditor James Brown helped prevent roughly $9.5 million more in unsupported payouts by a health insurer impacted by an Obamacare fraud scheme that targeted Montana’s native communities. To date, the Auditor’s Office has helped stop more than $55.6 million in unsupported payouts associated with the scheme.

The treatment and billing scheme abused an Affordable Care Act (ACA, also known as Obamacare) provision allowing tribal members to enroll year-round with no waiting period. The fraudsters exploited victims by:

Convincing members of Montana’s native communities to disenroll from Medicaid or other existing health coverage;

Enrolling them in Obamacare plans using fake information;

Transporting them across state lines for alleged addition treatment, and;

Billing Montana insurers for treatments that never occurred, were inadequate, unnecessary, or provided at inflated costs.

The fraud scheme impacted two Montana insurers – PacificSource and Mountain Health Co-Op – for which 160 rescissions have been approved, totaling $55.6 million. There are at least 216 suspected rescission cases across the two insurers, amounting to more than $60.8 million in claims charges.

“Every dollar that we stop in fraudulent billing is a dollar saved for Montana consumers and taxpayers. Fighting fraud is a critical part of keeping life affordable,” Auditor Brown said.

The agency’s ongoing investigation revealed that “body brokers” targeted homeless shelters on or near tribal reservations, promising vulnerable persons free luxury rehab, as well as 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.

Investigators found that 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.

“This fraud scheme is particularly despicable. I’m determined to not only prevent the fraudulent billing, but to help hold the perpetrators fully accountable,” Auditor Brown added.

Montanans should be suspicious of unsolicited offers of treatment or recovery services, pressure to switch insurance coverage, promises of free transportation to out-of-state facilities, and unfamiliar individuals with large vans visiting communities.

For more information on the agency’s work and resources related to Montana’s native communities, visit csimt.gov/indian-country-resources/.

Nevada — El Nino Flooding: Forecasters across Nevada are predicting a “super” El Niño to roll through during the fall and winter months. Flood preparedness and prevention should be top of mind for residents, as we acknowledge Nevada Flood Awareness Week (November 8 to November 14). The Division of Insurance (“The Division”) and the Office of Emergency Management (“NV OEM”) are urging Nevadans to create a plan of action now, because the increased rainfall could cause major flooding across the state, especially near recent burn scars.

Last month, Southern Nevada saw flash flooding due to Tropical Storm Rachel, while northern areas were issued flood watches or advisories. Thunderstorms in June brought a series of flash flooding and mudslides throughout the Washoe and Storey County area. The flooding impacted numerous homes and prompted emergency shelter-in-place orders for Hidden Valley. If this winter is wetter than normal, Nevadans can take steps now to be ready.

Insurance Commissioner Ned Gaines encourages Nevadans to evaluate their flood risks and explore flood insurance options. Standard homeowners’, renters’ and commercial insurance policies do not cover flood damage. Even in the event of a federal disaster, aid is typically provided in the form of low-interest loans which must be paid back and are likely to only cover a portion of your costs. However, the comprehensive portion of your auto coverage could cover damage to your vehicle.

Consumers should keep in mind that several insurers offer a private flood policy. The Division suggests contacting your insurance agent or visit FloodSmart.gov to learn more about available flood insurance options and locate a participating provider. Consumers may also obtain flood coverage through the National Flood Insurance Program, but it takes 30 days for the policy to activate, and most plans only cover up to $250,000.

NV OEM Chief Brett Compston recommends being 30 Days Ready for any emergency, as large storms may also bring extended power outages, evacuations, or require families to remain at home for days at a time. Pack emergency kits for your home and car, including flashlights, extra food, water, and warm clothes. For a full list of items to pack, visit oem.nv.gov/30-days.

Should forecasters warn of an upcoming storm, follow the National Weather Service, local officials and the media to stay up to date on the latest conditions.

The Nevada Office of Emergency Management’s mission is helping Nevada prepare for, respond to, and recover from emergencies and disasters by building a more resilient Nevada through coordination and partnerships. Visit oem.nv.gov for more information.

For more information about the Division of Insurance and its services for consumers and industry professionals, visit doi.nv.gov (link: https://doi.nv.gov/).

Nevada Division of Insurance Flood Insurance Information

https://bit.ly/4iJpxel

Contact Us:

Carson City office:

Phone: (775) 687-0700 | Fax: (775) 687-0787

Consumer Compliance & Licensing Fax: (775) 687-0797

1818 E. College Pkwy., Suite 103

Carson City, NV 89706

Las Vegas office:

Phone: (702) 486-4009 | Fax: (702) 486-4007

3300 W. Sahara Ave., Suite 275

Las Vegas, NV 89102

Call Toll-free: (888) 872-3234

Email: insinfo@doi.nv.gov