- Office of Attorney General Maura Healey
Media Contact for Two Individuals Charged Criminally With Insurance Fraud Following AG’s Investigation Into Addiction Treatment Scams
BOSTON — Following an investigation into illegal treatment and recovery scams, two individuals have been indicted in connection with preying on people with substance use disorder, sending them to treatment facilities in Florida, and signing them up for false insurance policies in order to make a profit.
Michael Hislop, 56, of Dorchester, and Timothy Hirsch, 38, formerly of Pelham, New Hampshire were indicted Monday by a Suffolk Statewide Grand Jury on the charges of Larceny over $250 (9 counts each), Filing a False Health Care Application or Claim (9 counts each), and Conspiracy (4 counts each).
"People with substance use disorder deserve quality treatment options that are safe and effective," said AG Healey. "As the opioid epidemic continues to plague our communities, we're not going to let patients and their families be exploited and have their pain further compounded. These indictments are an important step toward holding accountable those who are taking advantage of this growing public health crisis."
“This matter illustrates the commitment of all agencies to combat medical billing fraud which affects all citizens,” said Anthony M. DiPaolo, Executive Director of the Insurance Fraud Bureau. “The Insurance Fraud Bureau of Massachusetts places a high priority on fighting this type of insurance fraud. The collaboration in this matter is unprecedented.”
The investigation found that, from March to June of 2016, Hislop – a well-known individual in the local recovery community – worked in partnership with detox and addiction treatment facilities in Florida, where patients from Massachusetts were lured and, at times, left without care. Hislop was known as a “runner” and was paid a commission by the Florida facilities to produce patients. Hislop allegedly recruited patients at substance use disorder meetings in Massachusetts and conspired with Hirsch, an insurance agent, to write up false and misleading insurance policies on their behalf. The facility in Florida would then bill insurance companies for treatments.
The insurance companies – Minuteman Health and Harvard Pilgrim Health Care – paid out a total of approximately $730,000 in insurance claims as a result of this scheme. Both companies 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 into Massachusetts meets that requirement. According to the AG’s investigation, Hislop would provide Hirsch with a prior out-of-state address for the applicant and Hirsch, in his capacity as an insurance agent, would push the policies through.
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. Those premiums were not always paid, resulting in the insurance policies lapsing and patients in Florida either being kicked out of their facilities or rushed through treatment to a sober home. While some completed treatment in Florida and returned to Massachusetts, in many cases, individuals who went ended up relapsing and stranded in Florida with no way home.
According to the AG’s Office, the victims who were enrolled in these policies stated that they had never seen the applications with their purported signature, that the address change was untrue, and were not even aware they were enrolled in these health insurance policies.
These charges are allegations, and all defendants are innocent until proven guilty.
AG Healey has made combatting the opioid epidemic a top priority, including improving access to effective recovery options. In 2017, after receiving multiple reports of Massachusetts residents seeking treatment being recruited to centers across the country, the AG’s Office issued an advisory warning people of scams that leave them without real care.
Many of these out-of-state centers in Arizona, California, or Florida provide little or no treatment to patients. The recruiters often use texts or social media to recruit patients and may offer to pay for airfare and health insurance to cover the costs of treatment. In other instances, the recruiters stopped paying insurance premiums, which has resulted in patients getting removed from treatment facilities and stranded without access to housing, health care, or the financial resources to return to Massachusetts.
This case is being prosecuted by Assistant Attorney General Mary L. Nguyen of AG Healey's White Collar and Public Integrity Division, Investigator Lashauna Craig, and Victim Witness Advocate Megan Murphy. The insurance Fraud Bureau of Massachusetts also provided invaluable assistance in the investigation.
To safely access treatment services in Massachusetts, please contact the Massachusetts Substance Abuse 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