Arizona has become a battleground in the Department of Justice's intensified war against health care fraud. Yesterday, U.S. Attorney Gary M. Restaino showed the DOJ's hand by charging seven Arizonans as part of a sweeping 2024 National Health Care Fraud Enforcement Action. According to a press release by the U.S. Attorney's Office, these individuals allegedly took part in schemes that amassed hundreds of millions in fraudulent billings to Medicare and Medicaid.
Among those charged is Rita Anagho, who through her company Tusa Integrated Clinic LLC, is accused of fraudulently billing the Arizona Health Care Cost Containment System (AHCCCS) approximately $69.7 million. Prosecutors claim that Anagho exploited the program, primarily targeting the American Indian Health Program and billing for nonexistent services. The fraud not only siphoned off taxpayer funds, but it also diverted resources that were earmarked for American Indian communities.
In a similar case, Daud Koleosho and Adam Mutwol, via their company Community Hope Wellness Center LLC, allegedly defrauded AHCCCS out of approximately $57.7 million. They too are accused of billing the AIHP for services that were never provided. Moved to rigorous action amid these revelations, Attorney General Merrick B. Garland stated, "The Justice Department will bring to justice criminals who defraud Americans, steal from taxpayer-funded programs, and put people in danger for the sake of profits."
The DOJ's crackdown extends beyond targeting schemes against AHCCCS. Alexandra Gehrke and Jeffrey King face charges related to exploiting terminally ill Medicare patients for unnecessary wound grafts, to the tune of over $600 million. Seemingly in the eleventh hour, they were apprehended at Sky Harbor International Airport on June 17, just as they were attempting to flee the country.
This palpable enforcement punch didn't land just in the southwest. The national operation, over a coordinated two-week law enforcement action, resulted in charges against 193 defendants implicated with over $2.75 billion in alleged false billings. The DOJ's net has brought in not just small fishes but big players too, with seizures totaling more than $231 million in cash, luxury vehicles, gold, and other high-value items.
Christi A. Grimm, the Inspector General of the Department of Health and Human Services, reinforced this sentiment, saying, "We will not tolerate fraud that preys on patients who need and deserve high quality health care." Acting Special Agent in Charge Brian Driscoll of the FBI's Phoenix Field Office echoed these convictions, highlighting the egregious effects such fraud has on vulnerable populations and taxpayers alike.
