A Mesa business owner, Diana Marie Moore, was sentenced last week to 66 months in prison after pleaded guilty to Wire Fraud and Money Laundering for defrauding the Arizona Health Care Cost Containment System.
Moore’s prison sentence is to be followed by three years of supervised release. Moore was also ordered to pay restitution to the Arizona Health Care Cost Containment System (“AHCCCS”) in the amount of $21,730,674.04. In addition, the Court ordered the forfeiture of four single-family homes owned by Moore as well as 117 other items, including seven luxury vehicles, designer apparel, luxury jewelry, and artwork. All the items were purchased by Moore using the proceeds of her fraud scheme.
Moore admitted that she owned two behavioral health counseling services, Harmony Family Services (HFS) and Harmony Family Services II (HFS II) and that she had also submitted the application for a third behavioral health counseling service, Logan Family Health, LLC (“LFH”). All three then applied to be medical providers for the Arizona Health Care Cost Containment System (AHCCCS), Arizona’s Medicaid agency- HFS applied in 2019, HFS II applied in 2020, and LFH applied in 2022. AHCCCS approved all three applications. At the time HFS and HFS II applied to AHCCCS, Moore failed to disclose her ownership interest in the other entity. Moore also failed to disclose her prior felony conviction, which was required to be disclosed on the AHCCCS application form.
Moore also admitted that she engaged in a fraudulent billing practice targeting AHCCCS and exploiting a program that enables Native Americans to seek behavioral health treatment without first obtaining a pre-payment review. Specifically, starting in January 2020, Moore began obtaining AHCCCS identification numbers for AHCCCS enrollees by paying other providers to transport AHCCCS enrollees to the HFS or HFS II facility for a single day, and then obtaining enrollees’ identification numbers once they arrived. Nearly all of the AHCCCS enrollees billed for by Moore were members of the American Indian Health Plan. After these AHCCCS enrollees left the HFS or HFS II facility, Moore would submit bills to AHCCCS, which falsely claimed that HFS and HFS II continued providing services to those same enrollees for up to 90 days. Moore regularly claimed that HFS or HFS II provided counseling services to a given AHCCCS enrollee for eight or more hours each day, five days a week, for months in a row, even though Moore knew such services were not provided. In addition, Moore submitted claims to AHCCCS, which falsely claimed that HFS or HFS II provided services to certain AHCCCS Enrollees who were, in fact, deceased or imprisoned at the time Moore claimed to have provided services.