Even as the healthcare industry grapples with opioid abuse of epidemic proportions, scammers are illegally recruiting patients and using fake addresses to enroll them in out-of-state plans with generous substance abuse treatment benefits.
And insurance companies—especially Blues plans that have few restrictions on care from out-of-network treatment programs—get enormous bills for what’s often substandard care.
It’s a “sprawling national network of insurance fraud,” according to an investigation by STAT and the Boston Globe.
It starts with treatment centers looking to sign up patients with private insurance, especially those with plans that pay for out-of-network care. They hire patient brokers, who use phony addresses to get around enrollment period limits and sign up patients, often through Affordable Care Act exchanges. Brokers and treatment center marketers sometimes pay for the premiums and give patients cash.
“Within a few weeks, the insurer is billed tens of thousands of dollars for what is often subpar care,” the article notes.
Among the Blue Cross plans hit hardest by the fraudulent enrollments are ones in Pennsylvania, Delaware and West Virginia, the publications report, including Pittsburgh-based Highmark.
Executives at Highmark and the Blue Cross Blue Shield Association confirmed that they are aware of the problem and are working with local and federal authorities on it.