Does anything that the United States government issue for the betterment of the downtrodden get past a fraudster? Useful for Native Americans and fraudster alike, there is a United States Federal billing program that allows Native Americans to receive healthcare before a pre- payment review. “Pre-payment review” meaning that Medicare wants to review all the claims from a particular office or facility before they pay them. Not unreasonable. But sometimes, unfortunately because of the law, Medicare has to pay before they get to review. Bummer for the taxpayer. Win for the fraudster. On August 24, 2024, Diane Moore was sentenced to five years for stealing almost $22,000,000 in a health care scheme targeting the Medicaid program that specifically aided in the Native Americans. All because she knew that she was going to get paid for her claims before anyone could confirm the services.
Moore owned two behavioral health counseling services, Harmony Family Services (HFS) and Harmony Family Services II (HFS II) that were approved to provide care to Arizona Health Care Cost Containment System (AHCCCS) a Medicaid funded program. Despite her prior felony convictions! A small detail she forgot to put on the applications! Oops. Starting in January 2020, Moore began obtaining AHCCCS identification numbers for AHCCCS enrollees by paying other providers to transport AHCCCS enrollees for a one day visit to her facilities. Thus, obtaining their identification numbers upon arrival. After these AHCCCS enrollees left, Moore would submit bills to AHCCCS, claiming she provided services to those same enrollees for up to ninety days. Ironically, the maximize that Medicaid would pay! Unfortunately, Moore processed claims for those who were deceased! And then her claims got flagged.
In addition to her stay in prison, the Court ordered the forfeiture of four single-family homes owned by Moore as well as seven luxury vehicles, designer apparel, luxury jewelry, and artwork.
Shout out to the Internal Revenue Service!
Today’s Fraud of The Day is based on article “Mesa business owner sentenced to 5 years for health care fraud” published by KTAR News on August 24, 2024.
A Mesa woman was sentenced this week to 66 months in prison for defrauding Arizona’s Medicaid program. Diana Moore was also ordered to pay more than $21 million in restitution to the Arizona Health Care Cost Containment System (AHCCCS) after pleading guilty to wire fraud and money laundering on July 10, 2023.
The 44-year-old fraudulently billed AHCCCS, per the U.S. Attorney’s Office of Arizona. She took advantage of a billing program that allows Native Americans to receive healthcare before a pre-payment review. Almost all of the AHCCCS enrollees Moore billed were part of the American Indian Health Plan.
