Arizona Fights Major Health Care Fraud

Arizona Fights Major Health Care Fraud

In a large-scale crackdown, the Justice Department has charged nearly 200 people in a nationwide crackdown on health care fraud involving $2.7 billion in false claims. The defendants include doctors, nurse practitioners, and others involved in a variety of scams, including a $900 million fraud in Arizona that targeted dying patients. Focusing on Arizona, the Department of Justice (DOJ) announced criminal charges against seven people in Arizona under the National Health Care Fraud Enforcement Action 2024. This operation highlights the ongoing challenges in combating health care fraud and aims to protect vulnerable populations from exploitation. While the fraudsters profiled in this blog are all facing criminal charges for their alleged misconduct, the False Claims Act is the government’s best tool for prosecuting civil fraud.

Plans Unveiled: Arizona

Fraudulent Billing in Behavioral Health Services

One of the cases involves Rita Anagho and her addiction treatment center, Tusa Integrated Clinic LLC (TUSA). Anagho is accused of fraudulently billing Arizona Medicaid, the Arizona Health Care Cost Containment System (AHCCCS), approximately $69.7 million for behavioral health services that were never provided or were misrepresented. After receiving a subpoena for her treatment center’s records, Anagho even asked staff to take notes as if they had had sessions with patients the previous year. Anagho allegedly targeted the American Indian Health Program (AHIP), recruiting Native Americans so she could file false claims under the program.

Exploitation of vulnerable populations

In another case, Daud Koleosho and Adam Mutwol, through their company Community Hope Wellness Center LLC (CHWC), fraudulently billed AHCCCS for approximately $57.7 million. Like Anagho, they targeted AIHP and billed for services that were never provided, were substandard, or were medically inappropriate, causing substantial financial harm to the program and patients. They were charged with conspiracy to commit health care fraud. These two fraudsters operated a scheme in collaboration with owners of addiction treatment homes, paying kickbacks to the homes for referrals of Arizona Medicaid patients.

Health Insurance Fraud Targeting Elderly Patients

The scope of these fraudulent activities is even more egregious: Alexandra Gehrke and Jeffrey King were charged with targeting elderly Medicare patients, many of whom were terminally ill and receiving hospice care. They submitted false claims for medically unnecessary wound grafts, often performed hours or days after the patients’ deaths, resulting in fraudulent billings of more than $600 million. Gehrke and King were apprehended at Sky Harbor International Airport as they attempted to flee the country. Another Arizona defendant in the National Enforcement Action ran a similar scheme, targeting vulnerable elderly patients and paying bribes to transplant companies for Medicare business.

The broader impact of healthcare fraud

The takedown is part of a larger, two-week nationwide crackdown coordinated by the Justice Department. A total of 193 defendants were charged for their alleged involvement in health care fraud and opioid abuse, submitting more than $2.75 billion in false invoices. The government seized more than $231 million in cash, luxury vehicles, gold, and other property as part of the operation.

Protecting vulnerable populations

Fraud against publicly funded health care systems, such as Medicare and Medicaid, not only results in significant financial losses, but also deprives the most vulnerable and marginalized populations of essential care and benefits. The Acting Special Agent in Charge of the FBI Phoenix Field Office emphasized the continued commitment to identifying and prosecuting individuals involved in health care fraud: “Fraud against publicly funded health care systems not only costs taxpayers billions each year, but as we have seen in Arizona, it deprives our most vulnerable populations of essential care and benefits.”

Conclusion

The Healthcare Fraud Whistleblower Operation in Arizona and across the country underscores the importance of vigilance and coordinated efforts in combating healthcare fraud. With billions of dollars at stake, it is critical to protect government-funded healthcare programs and ensure resources are directed to those who need them most. Whistleblowers—whether they are nurses, medical providers, billers, therapists, or other employees of healthcare companies—have the power to speak out, be protected from retaliation, and be rewarded for their efforts in combating healthcare fraud.