Montana stops additional $9.5 million in ACA fraud targeting tribal communities
HELENA, Mont. – The Montana State Auditor’s Office reports it has recently stopped roughly $9.5 million in Affordable Care Act fraud targeting Montana’s Native communities. The latest round of stopped fraudulent payments brings the total to more than $55.6 million since the state began investigating the issue. “Through our work, what we've done is we've actually stopped these payments from going out so that we're not even having to go to the fraudulent pillars, if you will, and try to get that money back,” said Montana State Auditor James Brown. “We identified it, and we've stopped it on the front end. So for every dollar of fraud that we prevent, that's a dollar in savings to the Montana consumer, which helps to make Montana more affordable.” The scheme involved treatment and billing abuse of the Affordable Care Act, also known as the ACA or Obamacare. The fraudsters would convince tribal members to disenroll from Medicaid or other existing health coverage, then enroll them in ACA coverage using fake information, transport the individuals for treatment in other states, and then bill Montana insurers for treatments that never occurred or were unnecessary to inflate costs. The ACA has provisions that allow federally
