Opioid addicts get promises of free coverage for treatment that turns out to be subpar or worse

Peter SanAngelo died of a heroin OD
after his phony insurance was cancelled
and he was forced to leave the treatment
center. (Facebook photo)

An investigation by The Boston Globe and its medical and science news outlet, Stat, found that some drug users seeking help for opioid addiction are "pawns in a sprawling national network of insurance fraud." It works like this: Treatment centers pocket thousands of dollars in claims money from insurance companies for each patient, so they pay patient brokers a fee to find addicts who have insurance. The brokers, eager to make more money, promise people free or cheap insurance so they can get addiction treatment. Opioid users in rural areas have much less access to treatment and are easy pickings for such a pitch. The brokers then sign them up for high-payout plans using a phony address and refer them to the treatment center.

The fake address exploits a loophole that allows people whose address changes to sign up for coverage without waiting for the end-of-year open enrollment. "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," Evan Allen and David Armstrong report. "For them, the most attractive plans to exploit are PPOs — which stands for 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." Patients are often enrolled through the online insurance exchange created under the Patient Protection and Affordable Care Act. HMOs and government plans like Medicaid are "shunned" by treatment centers that use patient brokers, because they limit the geographic area where treatment can be provided or don't pay out as much as PPOs.

The geographic factor is important. Because PPOs plans pay more for out-of-coverage treatment, brokers have an incentive to send patients far from home. The treatment centers that engage in patient brokering often offer shoddy or nonexistent care, so they benefit when patients' friends and families are less likely to be able to check in on them. Some patients don't realize they've been the victim of fraud until a billing problem arises or the broker stops paying the monthly premiums. And, stranded far from home, some patients keep using.

One Massachusetts woman who was sent to a Florida treatment center said that patients openly used drugs, and that she was required to give urine samples several times a day just so the center could bill her insurance for them. "The whole thing was one big insurance scam," she told the Globe. "I was there trying, actually trying, to do the right thing. It was tough being in an environment like that." Another Massachusetts man, Peter SanAngelo, died of a heroin overdose after being sent to a Florida treatment center by a broker. When his phony insurance was canceled for nonpayment, he left and tried to make it on his own in Florida, but was found dead soon after.

Blue Cross Blue Shield confirms that insurance fraud by patient brokers is a problem and they're investigating.