Arizona Attorney General Kris Mayes on Thursday announced that Medicaid fraud plunged by sweeping margins in the state following a three-year crackdown on crime.
In May 2023, Mayes and Gov. Katie Hobbs (D-AZ) began aggressively targeting fraud in the American Indian Health Plan, which is funded and administered by Arizona’s Medicaid program, AHCCCS. Mayes said the inquiry targeted fraudulent sober living homes and treatment providers, described as one of the largest fraud schemes in Arizona history. Since the crackdown sparked, behavioral health code billing for the American Indian Health Plan has dropped by 92%, from $3.1 billion to roughly $230 million, according to the attorney general’s office.
“For the past three years, my office has made it a top priority to hunt down and prosecute the criminals who stole from Arizona’s Medicaid program while exploiting some of our most vulnerable residents,” Mayes said in a statement. “We are not done. We will continue to pursue individuals and entities that participated in this fraud.”
Though officials say Arizona has made strides, the Trump administration has continued to target the state as prime territory for health fraud. In April, the Justice Department named Arizona as one of several states being probed by the agency’s “West Coast Strike Force,” saying that fraud schemes uncovered thus far are worth over a billion dollars of taxpayer money. Earlier this month, the Centers for Medicare & Medicaid Services said Arizona is one of the states it has heightened oversight over, due to “newly enrolled Medicare hospice providers … with elevated fraud risk.”
Mayes’s announcement this week came as she announced the sentencing of nurse practitioner Rita Anagho, who prosecutors say was involved in fraudulent schemes that included billing for behavioral health services never rendered, and billing for services provided to minors who received no care. Officials said she was part of a system that often targeted Native Americans seeking rehabilitative care, who were housed in unlicensed and unregulated sober living homes across Arizona.
Arizona officials on Thursday announced 140 indictments related to the schemes. Anagho operated TUSA Integrated Clinic and served as the behavioral health professional for as many as 10 to 15 other behavioral health facilities, many of which have since been suspended or terminated, according to the state.
Anagho was sentenced to 3.5 years in prison after pleading guilty. The nurse’s case is one of around 140 cases tied to the scheme, with roughly 100 still moving through the legal system, according to Mayes’s office, which condemned Anagho for being part of a ploy to “exploit vulnerable Native Americans struggling with addiction who sought help and were instead trafficked for financial gain.
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“This was a systematic pattern of fraudulent billing,” Mayes said. “This fraud was allowed to metastasize largely because the people in charge prior to 2023 were asleep at the wheel, and we have the stats to prove it. … I know that no number of indictments or convictions or amount paid back in restitution can undo the pain and heartbreak and suffering caused by this scandal. But please know that we have heard your stories, and we have seen the damage that has been done.”
The Washington Examiner reached out to the Centers for Medicare & Medicaid Services for comment.