| FOR IMMEDIATE RELEASE Date: November 9, 2026 Contact: Ethan Holmes [email protected] |
| November 9, 2026 FOR IMMEDIATE RELEASE HELENA, Mont. — 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/. ### 840 Helena Avenue, Helena, Montana 59601 (main fax) 406.444.3413 I (securities fax) 406.444.5558 (insurance consumer services fax) 406.444.1980 I (legal fax) 406.444.3499 (phone) 800.332.6148 or 406.444.2040 I (email) [email protected] I (web) www.csimt.gov |
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