PHOENIX — An Arizona grand jury has indicted three people on 19 felony fraud-related counts each for their alleged actions over billing at a Phoenix behavioral health facility.
Shawnjerria Lucas, 30 and an unnamed 50-year-old operated A Better You Wellness Center, according to court documents, and Lavita Verser, 40, was employed as the center's biller. The three are accused of fraudulently billing Arizona’s Health Care Cost Containment System (AHCCCS) and the American Indian Health Program (AHIP) for behavioral health services between December 2021 and February 2023. Court documents show a portion of the $115,000,000 billed was fraudulent.
The trio are facing felony charges including conspiracy, illegal control of an enterprise, fraudulent schemes and artifices, and multiple counts of theft.
In May, Gov. Katie Hobbs and Attorney General Kris Mayes announced that they were immediately cutting off AHCCCS payments to over 100 fraudulent medical providers after an investigation revealed the fraudulent providers would allegedly recruit Native American people in crisis and bring them into "treatment" at outpatient clinics with promises of food, cash payments, or rental assistance, Mayes explained.
Once there, the patients were pressured to sign up for AHCCCS to pay for treatment, but that treatment was nowhere near what was promised. Often, it would never arrive.
Instead, people reportedly were placed into group homes with drugs and alcohol available and often cut off from their families. Gov. Hobbs described how people frequently had to jump fences in the night just to get access to a phone to call their loved ones for help.
All the while the provider would draw from the Medicaid system, "using [the patient] to overbill AHCCCS for treatment services they did not render or were grossly misrepresented," Mayes said.
In June, AHCCCS said it was making numerous reforms to prevent these types of deceptive billing practices from happening again.
The reforms include the following:
- Stop providers from billing on behalf of others
- Require certain providers to undergo site visits and fingerprint background checks
- Add the ability to flag concerning claims
- Set billing thresholds
- Implement a six-month moratorium on new provider enrollments for mental health outpatient clinics, community service agencies, integrated clinics, and behavioral health residential facilities.
In July, a Mesa woman pleaded guilty in federal court to fraudulently taking large sums of public benefits for health care services that were never provided.
Diana M. Moore admitted to committing wire fraud and money laundering for crimes that collected over $22 million in payments from AHCCCS between 2020 and 2021, according to the U.S. Attorney's Office of Arizona.
As part of her plea deal, the defendant has agreed to forfeit four homes, seven luxury cars, jewelry, artwork, designer clothing, and several other items bought through the fraudulent practices.
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