Seven people have been charged in connection with alleged schemes to defraud AHCCCS (Arizona Health Care Cost Containment System) as part of schemes to obtain, in the aggregate, hundreds of millions of dollars in fraudulent billings.
According to the Department of Justice, Rita Anagho, acting primarily though her company, Tusa Integrated Clinic LLC (“TUSA”), was charged for fraudulently billing AHCCCS approximately $69.7 million for behavioral healthcare services. ANAGHO primarily targeted AHCCCS’s American Indian Health Program (“AIHP”) and billed for services that were never provided or not provided as represented. AHCCCS provides health care services to Native Americans through AIHP, and there has been widespread fraud reported in which residential and outpatient treatment centers recruited Native Americans and other individuals to exploit the AIHP under AHCCCS. Many of the patients recruited for TUSA were Native Americans or other individuals who were enrolled in AIHP, and in some cases, patients were switched from their existing AHCCCS insurance plan to AIHP, regardless of whether the patient was Native American.
In another matter, Daud Koleosho and Adam Mutwol, acting primarily though their company, Community Hope Wellness Center LLC (“CHWC”), fraudulently billed AHCCCS approximately $57.7 million for behavioral health care services. They too primarily targeted the AIHP, billed AHCCCS for services that were never provided, and overbilled for services that were provided, all to the detriment of the AIHP.
In another case, Alexandra Gehrke and Jeffrey King were charged for targeting elderly Medicare patients, many of whom were terminally ill in hospice care, for medically unnecessary wound grafts. Medicare and other health care benefit programs paid over $600 million based on the false and fraudulent claims they submitted for these vulnerable beneficiaries. Gehrke and King were arrested on June 17, 2024, at Sky Harbor International Airport as they were attempting to board a flight out of the country.