How Drug Users Are Ensnared in Insurance Fraud

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Drug users, desperate to break addictions to heroin or pain pills, are pawns in a sprawling national network of insurance fraud, the Boston Globe reports, in collaboration with STAT. They are being sent to treatment centers hundreds of miles from home for expensive but often shoddy care that is paid for by premium health insurance benefits procured with fake addresses. Patient brokers are paid a fee to place insured people in treatment centers, which pocket thousands of dollars in claims for each patient. They often target certain Blue Cross Blue Shield plans, because of their generous benefits and few restrictions on seeking care from out-of-network treatment programs. The fraud is so commonplace that brokers use a play on words to describe how it works: “Do you want to Blue Cross the country?”

Patients have been taken in by these profiteers capitalizing on the surge in opioid addiction. For Peter SanAngelo, homeless after a decade of heroin use, the promise of free insurance and luxury rehab in another state was a lifeline. A patient broker used a phony address to enroll the Massachusetts man in a Pennsylvania Blue Cross plan and bought him a plane ticket to Florida. Three months later, the 33-year-old died of a drug overdose. “This whole thing began from a place of deception,” said his cousin, Samantha Herring. “Peter had an honest desire to get better, and they had an honest desire to make money.” Patient brokers, some of whom themselves in recovery from drug addiction, are paid by marketers working for treatment centers eager to sign up patients with private insurance plans. The most attractive plans to exploit are “preferred provider organizations.” These plans often impose few limits on where people with addiction can seek treatment and often actually pay more for rehab provided out of their coverage area.

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