BOSTON – Following an investigation into illegal treatment and recovery scams, two people have been charged with attacking people with substance use disorders, sending them to treatment centers in Florida and bought them bogus insurance policies in order to make a profit. .
Michael Hislop, 56, of Dorchester, and Timothy Hirsch, 38, formerly of Pelham, New Hampshire were charged Monday by a Suffolk state grand jury with theft over $ 250 (9 counts each), filing a false claim or claim for health care (9 accounts each) and Conspiracy (4 accounts each).
“People with substance use disorders deserve quality, safe and effective treatment options,” said AG Healey. “As the opioid epidemic continues to plague our communities, we are not going to let patients and their families be exploited and their pain worse. These indictments are an important step towards empowering those who benefit from this growing public health crisis. “
“This case illustrates the commitment of all agencies to tackle medical billing fraud that affects all citizens,” said Anthony M. DiPaolo, executive director of the Office of Insurance Fraud. “The Massachusetts Insurance Fraud Bureau places a high priority on combating this type of insurance fraud. The collaboration on this file is unprecedented.
The investigation found that, from March to June 2016, Hislop – a well-known person in the local recovery community – worked in partnership with drug addiction and drug treatment centers in Florida, where patients from the Massachusetts were drawn to and, at times, left without caring. Hislop was known as a “runner” and received a commission from Florida establishments for producing patients. Hislop is said to have recruited patients at substance use disorder meetings in Massachusetts and conspired with Hirsch, an insurance agent, to draft false and deceptive insurance policies on their behalf. The establishment in Florida would then bill the insurance companies for the treatments.
The insurance companies – Minuteman Health and Harvard Pilgrim Health Care – have paid a total of approximately $ 730,000 in insurance claims as a result of this program. The two companies have conducted separate investigations following an influx of claims from Florida treatment facilities for Massachusetts residents.
To obtain an insurance policy outside of the open enrollment period, you must have a “qualifying event” and moving from an out-of-state address to Massachusetts meets this requirement. According to the AG’s investigation, Hislop would provide Hirsch with an earlier out-of-state address for the claimant and Hirsch, in his capacity as insurance agent, would pass the policies.
Once the policies were issued, Hislop allegedly paid for the individual’s plane ticket to Florida and was responsible for paying the monthly insurance premiums. These premiums were not always paid, resulting in insurance policies expiring, and Florida patients were either kicked out of their facilities or rushed for treatment in a sober home. While some completed their treatment in Florida and returned to Massachusetts, in many cases people who left ended up relapsing and found themselves stranded in Florida with no way to return home.
According to the AG’s office, victims who signed up for these policies said they had never seen the claims with their purported signature, that the change of address was bogus, and that they didn’t even know it was ‘they were enrolled in these health insurance policies.
To safely access treatment services in Massachusetts, please contact the Massachusetts Addictions Hotline at 1-800-327-5050 or visit http://helpline-online.com. If you have MassHealth insurance, contact the Massachusetts Behavioral Health Partnership 1-800-495-0086 or visit www.masspartnership.com