At least 80 Native Americans in Montana victimized in health care scheme
[January 24, 2026]
By NORA MABIE/Montana Free Press
Montana State Auditor James Brown announced Tuesday that his office had
identified and worked to remedy a health care fraud scheme that targeted
Native Americans.
In a Thursday phone interview with Montana Free Press, Brown and members
of his staff said fraudsters visited reservations in Montana and
pressured people, particularly those who appeared unhoused, to sign up
for Affordable Care Act plans with the promise that they’d receive free
rehab treatment at a high-end facility in another state, and in many
cases, California. They also provided transportation.
Brown’s staff said people affected by the scam reported feeling immense
pressure, almost amounting to coercion, to comply. Once people arrived
at these fraudulent treatment centers, their condition was reported as
needing emergency attention, which means insurance companies by law
cannot deny treatment, according to Brown’s office. Fraudsters would
then bill insurance companies for treatments that did not occur, were
not needed or, according to a news release from Brown’s office,
“performed at greatly inflated prices.” In one instance, Brown’s office
told MTFP, fraudsters billed more than $900,000 for treatment for one
person.
Brown and his staff said perpetrators took advantage of several gaps in
the health care system. First, while non-Natives must enroll in
Affordable Care Act plans during a specific time of year, provisions
allow members of federally recognized tribes to sign up anytime. In the
case of this fraud scheme, that provision meant fraudsters had more
opportunity to approach and coerce Native Americans to enroll in
Affordable Care Act plans.
Second, Montana has three Affordable Care Act insurance providers, and
one of them, called PacificSource, covers Montanans for out-of-state
treatment. That meant fraudsters in other states could bill a Montana
insurance provider for care administered elsewhere.
Third, Brown’s staff said, people have figured out how to get around
certain eligibility requirements in the federal system. They pointed to
a recent Government Accountability Office report that found significant
fraud risks in the advance premium tax credit, a program that lowers
monthly health insurance costs for eligible people buying plans in the
Health Insurance Marketplace. The report found that the federal
Marketplace “approved coverage for nearly all of GAO’s fictitious
applicants.”
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Brown said federal entities approved the rescission of 80 fraudulent
insurance sign ups, allowing his office to claw back more than $23.3
million. His office has identified 207 total enrollments suspected of
fraud, which they say could represent $54.7 million in unjustified
claims.
In 2023, Native Americans in Montana were similarly targeted in a
Medicaid fraud scheme in which treatment centers billed the state of
Arizona thousands of dollars per patient for services that were never
provided. The scam targeted Indigenous people because a loophole in
Arizona’s American Indian Health Program allowed individuals to serve as
a treatment facility. Hundreds of people have been criminally charged
for their alleged participation in that scheme.
Brown, who is in touch with other insurance commissioners nationwide,
said he is warning leaders, particularly those who represent states with
sizable Indigenous populations, to look out for similar scams.
His office said that because the scheme occurred on tribal land, it will
be up to federal authorities to bring charges against perpetrators.
Brown said his office has been in contact with the FBI and U.S.
Attorney’s Office.
The scheme, Brown said, could significantly change insurance coverage
for Montanans in the future. Some companies could limit their coverage
for out-of-state services, for example.
“When scammers bill $10,000 a day in fake enrollments, premiums rise,
provider networks shrink, and families pay more for worse care,” he said
in a Jan. 21 news release. “Fighting fraud is how we protect
affordability.”
Brown’s staff encouraged Montanans to stay vigilant. If something sounds
too good to be true, they warned, it probably is.
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