Blue Cross and Blue Shield of Oklahoma (“BCBSOK”) have filed a civil Racketeering (RICO) action against South Coast Behavioral Health LLC (“SCBH”), Excellence Recovery LLC (“Excellence Recovery”), Everything in Excellence Recovery LLC (“EIE”), Rad Life Recovery, LLC, (“Rad Life”), and individuals involved with those companies, that are California addiction treatment centers mostly located in Orange County. The lawsuit was filed in the United States District Court Central District of California (case 2:24-cv-10683-MWC-AJR).
According to the allegations of the complaint, “Since at least 2020, BCBSOK and hundreds of individuals suffering from Substance Use Disorder (“SUD”) have been victimized by California-based SUD treatment providers and their co-conspirators.”
“California and Oklahoma are separated by over 1,000 miles and multiple states. There are hundreds, if not thousands, of SUD treatment providers between them. And yet, in the last few years alone, thousands of alleged Oklahoma residents have been trafficked across the country to California under the guise of obtaining SUD treatment. The one thing they have in common is that they are members of BCBSOK health benefit plans, most of them having been enrolled right before their arrival in California.”
“This surprising migration is not a result of quality treatment. Rather, it is driven by an army of fraudsters that have overrun certain parts of California’s SUD treatment industry to prey upon alleged Oklahoma residents, many of whom are members of Native American tribes.”
Oklahoma, according to many sources has the fifth highest rate of SUD in the country, at 16.1% of its population.”The combination of a state plan offering robust out-of-state benefits and a large population in need of treatment provided a perfect target for profiteers like Defendants.”
“These SUD providers employ a range of fraudulent tactics. They hire “body brokers” to hunt down potential patients in exchange for kickbacks. Body brokers work with insurance agents to fraudulently enroll individuals in insurance plans. Once enrolled, patients are shipped across the country to receive “treatment,” the main goal of which is to enrich the providers, body brokers, insurance agents, and the others involved in the schemes. There are unlawful kickbacks at every level. In fact, many patients themselves receive cash, free “treatment,” and housing, which unlawfully influences their choice of providers and induces them to stay under the control of a particular provider so that their insurance can continue to be billed. It is becoming exceedingly difficult for good, quality, providers to operate in an industry awash in kickbacks and de facto bribes.”
“When insurance payments run out, the SUD providers kick patients to the curb, leaving these vulnerable individuals to fend for themselves thousands of miles from their homes. Often, these individuals are given no notice of their impending evictions and suddenly find themselves on the streets with no money to afford housing or the necessities of daily life, much less an expensive trip back home. Putting these already-vulnerable individuals in such desperate circumstances only heightens the chances for relapse.”
Plaintiffs go on to allege “the defendants here are among the worst perpetrators of these tactics. Collectively, they have caused BCBSOK plans alone to make over $36 million in wrongful payments.” Last month, Blue Cross and Blue Shield of Oklahoma told the Southern California News Group that it will stop paying for all addiction treatment in California on Jan. 1, with a few exceptions.
Young and associates are being sued by insurer Aetna in a fraud case that echoes this one. Young has countersued Aetna, saying the insurer is just trying to avoid paying what’s owed.
It all echoes the battle between Health Net and now-defunct Sovereign Health that began in 2016. Health Net won big, with $45 million in damages and interest against Sovereign.