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Prosecutions Don’t Stop Fraudsters

Prosecutions Don’t Stop Fraudsters

Senior Director of Strategic Alliances
LexisNexis Risk Solutions - Government

On May 18, 2023, Arizona state officials announced that they had discovered that dozens of behavioral health and sober living homes had carried out a years-long Medicaid fraud scheme. According to Governor Katie Hobbs, “For years, these providers have allegedly defrauded the state of millions of dollars while creating a large-scale humanitarian crisis.” Is there any kind of fraud? No, there isn’t. And unfortunately, this one disproportionately affects Arizona’s tribal communities.

The alleged fraud took place largely on tribal land to deceive state officials. Navajo authorities said tribal members seeking help for addiction have been recruited to these homes with false hopes of recovery from as far away as the northern community of Tuba City, Arizona, and even New Mexico. Patients were enticed with food and shelter only to be encouraged to continue their addictions while the facilities billed Medicaid for care that never happened. Reports were made of forced stays with claims that people had to escape out of windows and jump over fences in the middle of the night just to access a phone to reach the outside world.

This is a scheme that the authorities have been trying to stop for many years. Arizona Health Care Cost Containment System (AHCCCS) which oversees the state’s Medicaid programs has gone after individual offenders as they were found. So far, $75 million has been seized from these fraudsters and 45 indictments have been issued in the investigation. In spite of all that these people simply formed new corporate entities to go back in business. Because even prosecutions don’t stop a fraudster.

Crackdowns in government benefit schemes lead to displaced victims. The AHCCCS so far has cut off funding to more than 100 homes targeted by the investigation and is prepared to stop the flow of cash to many more fraudsters in the coming months. This has affected as many as 7,000 Native Americans who have been victimized in this scheme who need help for a sober life.

Great job by Health and Human Services Department in pushing back on this case.

Today’s Fraud Of The Day is based on article “Navajo leaders seek tribal members caught up in sober-living Medicare scam in Arizona” published by AZ PM News on May 20, 2023

Navajo leaders on Friday unveiled an operation to find and get needed services to hundreds of tribal members they predict will soon be on the streets of metro Phoenix amid a state crackdown on Medicaid fraud that affected as many as 7,000 Native Americans recruited to illegitimate sober living homes in recent years.

Called Rainbow Bridge, the operation is in response to actions announced this week by the state of Arizona against more than 100 unlicensed and fraudulent sober living homes in the Phoenix metropolitan area.

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