Drug users, desperate to break addictions to heroin or pain pills, are pawns in a sprawling national network of insurance fraud, an investigation by STAT and the Boston Globe has found.
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 now so commonplace that brokers use a simple play on words to describe how it works: “Do you want to Blue Cross the country?”Related: The addict brokers: Middlemen profit as desperate patients are ‘treated like paychecks’
Patients from across the United States have been taken in by these profiteers capitalizing on the surge in opioid addiction. For Peter SanAngelo, hopeless and 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. He was even promised money for cigarettes.
Three months later, the 33-year-old died of a drug overdose.
“This whole thing began from a place of deception,” said SanAngelo’s 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 are themselves in recovery from drug addiction, are paid by marketers working for treatment centers eager to sign up patients with private insurance plans. 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.
HMOs and government insurance plans like Medicaid are shunned by treatment centers engaged in patient brokering because they either limit where treatment can be provided or pay much less than PPOs.
The patients are often enrolled through HealthCare.gov, the online insurance marketplace created by the Affordable Care Act that connects patients to insurers in dozens of states.
The brokers use phony addresses to sign up people immediately — a change of address is an exception to the usual limitation that customers can sign up only during the end-of-year open enrollment period — and to take advantage of the best-paying PPO plans in states in which they don’t live. The brokers, patients’ families, or marketers for the treatment centers pay the insurance premium. Within a few weeks, the insurer is billed tens of thousands of dollars for what is often subpar care.
Among the Blue Cross plans hit hardest by the fraudulent enrollments are ones in Pennsylvania, Delaware, and West Virginia. They include Pittsburgh-based Highmark Inc., the fourth-largest Blue Cross company in the country. Brokers have signed up out-of-state patients with the company using addresses of treatment centers in Erie, Pa., and Pittsburgh, according to information obtained by STAT and the Globe.
“We can confirm we are definitely seeing the issues you are identifying,” said Rachel Jones, the director of Highmark’s Financial Investigations and Provider Review unit.N
People from across the country are being enrolled with fake addresses and some individual brokers are enrolling multiple people at once, said Latrisha Oswald, a manager in the insurer’s fraud unit. Many are signing up for premium plans that provide out-of-network benefits with low out-of-pocket costs, she said. Highmark said it began investigating the enrollments with phony addresses last year and recently expanded its efforts to identify those bogus signups.
Many patients have no idea how their insurance coverage was obtained or that they are part of a scam. They are often told they are receiving free care — or that their insurance is being taken care of by the patient broker. Some find out their coverage is from a company in a state where they have never lived only when a billing problem arises or when the broker stops paying the premium. By then, they’re far from home, stranded without any insurance.
Michael “Hiss” Hislop grew up in Boston’s Savin Hill neighborhood, and once counseled gang members as a street worker for the city. He spent a decade mentoring people through Alcoholics Anonymous, after beating his own addiction to heroin and alcohol. He knew the ins and outs of the Massachusetts treatment world, and built a reputation as an ally whom struggling young addicts could rely on.
Then, at the beginning of 2016, he got involved in the brokering business. As he saw it, he said, he could make good money, while also helping people.
In a series of interviews, Hislop said he had been naive about the legality of patient brokering when he founded his company, Barnowl Treatment Options LLC, which arranged for 55 to 60 Massachusetts residents to travel to Florida last year for drug addiction treatment.
He admitted to receiving payments to place patients in centers in Florida, as well as enrolling some of them in Blue Cross plans in other states where they didn’t live. He said he sometimes paid their premiums, and also paid for airfare for people he sent to Florida, which in some cases can be considered an illegal inducement under state and federal health care law.
“We were blind to a lot of things when we were doing it, and then we stopped,” Hislop, 51, said. “That’s all I can do, what else can I do? If I have to accept responsibility for something, then I would have to do that as an adult, as a sober adult.”
Hislop said marketers for Florida-based treatment centers paid him $500 to $1,000 for each patient he sent their way, and he could make even more by sending groups of patients — $3,500 for three, for example. Hislop recruited patients that he or two people working with him knew, or people who were referred to him.
One referral source, Hislop said, was Daniel Cleggett. In May, STAT and the Globe published an article about widespread patient trafficking that detailed allegations that Cleggett, a high-profile recovered addict who runs treatment centers in Massachusetts, had helped broker addicted people to out-of-state treatment centers. Cleggett has previously denied any involvement in brokering. He did not respond to requests to comment on Hislop’s allegations.
Hislop said Cleggett referred between 15 and 25 patients who were flown to Florida, and he paid Cleggett up to $1,500 a patient.
Hislop said he mostly delegated the insurance end of his brokering business to Elizabeth Mooney, a Boston woman who had worked at a Florida treatment facility. Mooney acknowledged working for Hislop.
She said patients were actually enrolled in Blue Cross plans by licensed insurance brokers who worked with the Hislop organization, and she would find fake Pennsylvania addresses for patients by searching the web for sober homes and treatment centers in that state. Patients were also signed up using their out-of-state relatives’ addresses, she said.
“This whole thing began from a place of deception. Peter had an honest desire to get better and they had an honest desire to make money.”SAMANTHA HERRING, PETER SANANGELO’S COUSIN
Mooney said she made $600 every other week working for Hislop and at the time didn’t think she was doing anything illegal. Hislop also said he didn’t think it was illegal to use fake addresses.
Both Hislop and Mooney said they left the broker business in late 2016 after realizing that much of what was happening — the out-of-state insurance signups, the flights they were paying for, the per-patient payments from marketers — might be illegal.
“I quit, I quit with no job and nothing, no notice,” Mooney said. “I was four months with no job.” She now works as a regional coordinator for the state-funded Massachusetts Organization for Addiction Recovery, a nonprofit advocacy group.
Of the 55 or so people Hislop sent to Florida treatment centers, he said only about 10 achieved sobriety.
The story of Peter SanAngelo, documented in text messages found on his cellphone, illustrates how the insurance scheme works. By the summer of 2016, SanAngelo was at a low point after cycling in and out of treatment programs in Massachusetts. He was jobless and was staying on the couches of friends and family. That’s when he learned that Hislop could get him into treatment in Florida.
Hislop sent SanAngelo a text message on July 12 giving him a choice between two centers in Florida. Both were co-ed, Hislop noted. SanAngelo’s cousin Samantha Herring provided copies of the text messages on SanAngelo’s phone, which she obtained from the Delray Beach, Fla., police last month.
One of the centers – LakeHaven Recovery Center in Pompano Beach — showcases resort-like photographs and amenities on its website. There is a picture of a pool next to a lake, surrounded by palm trees. Another shows two empty lounge chairs on a white-sand beach. The center offers cognitive behavioral therapy, as well as 12-step treatment programs and the opioid-blocking medication Vivitrol.
“I dont need money at these places right?” SanAngelo texted Hislop.
“No your. Good,” Hislop responded, while adding another sweetener: “I send people down money for smokes etc.” One reason for providing those amenities was that Hislop and his crew only got paid if patients stayed in treatment for a certain number of days — usually at least 21. “They had to be a billable client,” Hislop said in an interview. “They had to stay.”
SanAngelo was “good” because Mooney and Hislop were setting him up with insurance through Capital Blue Cross in Harrisburg, Pa., using the address of a drug treatment facility in Allentown, Pa. He’d previously been covered by Medicaid. Hislop instructed SanAngelo how to respond if anyone in Florida asked him about the Pennsylvania address.
“That was your address in pa at the sober house you where at for 6 months before you relapsed ok so just keep it in your phone in case you need it ok,” Hislop wrote. SanAngelo had to keep the address in his phone because he was unfamiliar with it. He had never stayed at that location or sought treatment in Pennsylvania, according to family and friends.
Mooney posed as his girlfriend in a telephone call to Capital Blue Cross customer support, in an attempt to get access to his account, according to text messages she sent SanAngelo.
Capital Blue Cross, in which SanAngelo was enrolled, said it could not discuss individual cases because of privacy concerns.
The text messages mention two insurance brokers who apparently arranged SanAngelo’s coverage. Mooney sent SanAngelo an image of an email from Joshua Longo, a Pennsylvania insurance broker who operates a website called www.wanthealthinsurance.com, to Eric Lee Branch, a Boston-based insurance broker. Mooney told SanAngelo that Longo is “the broker u went through” to get insurance.
Longo said in an interview that Branch reached out to him last year through a mutual connection and twice sent him lists of about 10 to 15 people who needed insurance. In a text message provided by Longo, Branch told him all of the people involved “are all moving and loosing coverage in there current state.”
Longo said he had no idea that any phony addresses, such as in the case of SanAngelo, were being used. Branch couldn’t be reached for comment.
When SanAngelo left for Florida in mid-July, he went to LakeHaven, though it’s unclear how long he stayed. He left after his Blue Cross policy was canceled for non-payment, according to family and friends. It’s unclear why the payment was stopped.
James Magner, a Boston native who is the admissions director at LakeHaven, said SanAngelo made a “decision to go in his own direction.” He said the facility does not “kick people to the curb” if their insurance lapses. He also said that he did not know Hislop and that his facility does not engage in patient brokering.
Magner said there has been an influx of young people with generous private insurance in South Florida.
“These kids now with their insurance is like American Express black cards,” he said. “They can go from room to room. They can go anywhere. They bounce around, couch hopping from one center to another. They are everywhere.”
In South Florida, the fraud can seem like an open secret. Hislop said it was the marketers and brokers in Florida who advised him that signing people up for insurance with fake addresses was legal, and brokered patients said that treatment center staff either ignored obvious signs of fraud or helped perpetuate it.
Tyler Kagiwada of Middleboro, Mass., traveled to Florida for treatment last December. The 30-year-old went through a patient broker, who set him up with a Blue Cross plan and a fake home address in another state, he said. He never saw any paperwork, he said, and did not have documentation of his insurance.
Soon after he arrived in Florida, the treatment center staff told him his insurance had run out. His broker had stopped paying the premium, he said. But almost immediately, the staff came through with a miraculous solution: His father, they claimed, had sent the money.
There was just one problem: Kagiwada has never met his father.
The treatment center, Kagiwada surmised, had paid his premium because it was a drop in the bucket compared with what they could bill his insurance provider. He was getting drug-tested three to five days a week, at hundreds of dollars a sample, he said. He declined to name the center or the broker.
A Massachusetts woman brokered to Florida earlier this year said she was also enrolled in a Pennsylvania insurance plan. The woman did not want to be identified because she is fearful of retribution for sharing her story.
She was already on her father’s health insurance, she said, but the person who arranged her trip gave her “a whole new insurance plan” — complete with a new home address in Pennsylvania.Related: STAT forecast: Opioids could kill nearly 500,000 Americans in the next decade
When she got to the treatment center in Hollywood, Fla., she said she realized the intake staff knew her address was a fake, and just didn’t care. When they asked for her street address, she had to fumble through her phone for it.
“I know we’re drug addicts and we’re a little crazy,” she said. “But who doesn’t know their own street name?”
The treatment center she went to was a mess, she said. Patients openly used drugs without being kicked out, and men came into the house to have sex with women. She was required to give urine samples up to three times a day just so they could bill her insurance for the tests, she said.
“The whole thing was one big insurance scam,” she said. “I was there trying, actually trying, to do the right thing. It was tough being in an environment like that.”
Junius Nottingham Jr., managing director of the anti-fraud unit at the Blue Cross Blue Shield Association representing 36 Blue Cross companies, said in a statement, “We are aware of these types of schemes and have taken action against them by investigating suspicious claims and reporting them to local and federal government authorities and ending contracts with fraudulent brokers.”
SanAngelo stayed in Florida after he left the LakeHaven treatment facility. He landed a job as the manager of a sober home in Delray Beach operated by Sunrise Sober Living. He had only been sober himself for several weeks.
On the morning of Oct. 16, 2016, a woman in Delray Beach reported a gold-colored van parked in her driveway. Inside, police found the lifeless body of SanAngelo slumped over in the driver’s seat. The van belonged to Sunrise, according to an employee who talked to police, and was leased from a treatment center called Harmony Outpatient Center.
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