At least 150 cases being investigated, $8 million in insurance fraud last year
Cathyann Santos wanted to get clean. An offer came along that she couldn’t refuse.
A free flight to Southern California where she could get a new start at a sober home far away from her circle of users. Addicted to fentanyl, and unable to get detox in her community of Spirit Lake, she took the chance. “For us addicts, when we hear there’s help and we want it, we’re gonna go,” Santos said.
Two months later her boyfriend Benjamin Barragan, father of five of their children, took the same offer. Also wanting to get clean, he followed her to a separate treatment center in California.
On June 13, staff at that facility found him dead from an overdose. His family wasn’t notified until a week later and struggled to get enough money together for his body to be sent home to Spirit Lake. The center eventually paid $20,000 to help cover some of the transfer costs, though family and friends are still searching for answers.
Why was it so easy to overdose at what was supposed to be a treatment center?
Also searching for answers is Jolene Thomas, mother of Kalisha Thomas, who died of an overdose at a Southern California facility Dec. 16, 2022 in similar circumstances.
Ever since her daughter’s death Jolene has been trying to raise awareness about people being scammed into traveling to out-of-state treatment centers, being used to collect large amounts of insurance money, not getting the help they need, and potentially putting their lives at risk far from home.
Jolene marched in the Turtle Mountain Days Parade in July with a banner for Kalisha, hoping members of her tribe would be more cautious about body brokers, or people who place addicts in out-of-state treatment centers as part of an insurance scam.
Cases under investigation
According to the office of the North Dakota Insurance Commissioner, the Federal Bureau of Investigation is looking into around 150 possible insurance scams where people from North Dakota went out-of-state for treatment. Requests to the FBI’s regional office in Minneapolis for more information went unanswered as of press time.
State insurance investigator Dale Pittman said his office estimated around $8 million in insurance losses in the state last year, compared to around $1.5 million five years ago, showing the problem is growing.
“It’s widespread,” Pittman said.
While there are some legitimate treatment centers, many are not legit and people should be cautious before accepting a ticket to a facility in California, Pittman said.
Some are so bad they allow addicts to continue to use or even get them hooked back on drugs, or use clients in prostitution rings, he said.
“Most of them look like illegitimate treatment,” Pittman said. “Yes, they’re all licensed, they have the proper credentials, it’s just that there are so many of them.”
Red flags
Offers of free flights to California for treatment should immediately raise red flags, Pittman said.
“How many treatment centers do you know where they’re going to pay for that? They’re not going to pay an airline ticket for you to come to them,” he said. “These body brokers are making some big bucks through this scheme.”
Joshua Schauer, a recovering addict in Bismarck also fell for the scheme, he said. He went twice, but began feeling uncomfortable about the practices at the facility. After leaving the second time, his family had to help him pay for a bus ride back to North Dakota.
“They would pay for your plane ticket right on the spot, no questions asked,” Schauer said.
“Then they would talk with you and get you set up on the phone with an insurance person in Alabama, and they’d set up with North Dakota Blue Cross Blue Shield, they’d do all the paperwork for you and all you’d have to do is sign, and you’d be on a plane within a couple of hours.”
Pittman said this is part of a “billing triangle” that makes investigations complicated since some facilities are legitimate and some are not.
Santos also recalled having her insurance set up quickly by the brokers before she got on the flight to California, and described how the center later double-dipped by having her on both North Dakota and California insurance.
Schauer said, after detoxing on his visits, he’d go to sober living treatment houses in residential neighborhoods, where several people would be housed in one place. Rules weren’t followed, treatment was haphazard, and in some cases involved tarot card readings, he said. Residents were openly allowed to smoke marijuana at some of the locations where he was housed since it is legal in the state.
“It’s a big headache out there,” Schauer said. “I was put out on the streets and just walking for nine days fretting about how to call my family to let them know what happened.”
Former addict Mike Rosario, who now runs a youth boxing clinic at New Song Church in Bismarck, said he’s been out to California to see some of these operations and some are doing good treatment work while others are not.
However, Rosario said, people might just need to visit to see if a place is really legit or not.
“They might sound good on the phone, they might look good on the documents or the computer or whatever, but the reality is there are just people out there taking people, they’re body brokering,” he said.
“If they’re offering any types of promises that sound too good to be true, other than the recovery part, if they’re offering gifts,” then people should be cautious, he said.
Treatment vacuum
Body brokers continue to target addicts in the state. Tribal areas and rural communities where treatment is lacking are prime targets.
At Spirit Lake, as many as a dozen or more people are being offered free flights to treatment centers in California every month, according to some accounts.
Bigger picture, the ease of enticing people to far-off locations to get treatment shows just how much more treatment capacity is needed locally in some communities in North Dakota.
Spirit Lake, for example, only has a 16-bed treatment center and no detox facility. That means anyone hoping to go into treatment there needs to stop using days before entering.
Spirit Lake tribal health director Kevin Dauphinais said he let the FBI and other authorities know the tribe was being targeted by brokers about a year ago. Brokers coming to the reservation were promising free flights, $300 in walking around cash, free phones and food stamps.
“First thing I said, it’s fraudulent,” he said. “First of all, there ain’t nothing free in this world. They’re preying on a minority group of people who is uneducated and not aware … the majority of our people haven’t been out of the state, some people haven’t gone to Bismarck, Grand Forks, because that’s how poverty stricken it is.”
Dauphinais and other members of the tribe, including a licensed addiction counselor, also went to inspect facilities in California where tribal members were flown. From his understanding, some take in around $35,000 per patient per month in these scams.
“There were a lot of red flags,” he said, but added that it’s the choice of people to go to these treatment centers and they can’t force them to return to North Dakota.
Dauphinais said the tribe has plans for increasing treatment capacity locally and creating sober living and transitional living services, but funding is difficult to access and workforce constraints are a hurdle.
Licensed treatment personnel who live on or near the reservation are hard to come by, as is a licensed MD and accompanying nurses that would be needed for a higher level detox facility.
He joked they should follow the lead of these fraudulent operations in California with the amount of money they’re bringing in and the apparent ease at which they’re getting insurance reimbursements.
“One of the problems is we’ve had a lack of services,” he said. “We’ve got the state licenses, we’ve been following all the criteria they want us to, but the reimbursability ain’t there.”
With opiate and methamphetamine addiction becoming so prominent and the type of care required for that increasing, a local detox facility is needed more than ever, Dauphinais said.
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