Latest news with #AHCCCS
Khaleej Times
01-07-2025
- Business
- Khaleej Times
Dubai: Businessman allegedly bought villa with funds from $650 million US healthcare scam
A Pakistani businessman who allegedly bought a Dh10.6-million villa on a golf estate in Dubai is at the centre of what US authorities have described as the largest healthcare fraud scheme in the history of the US Justice Department. According to a press release issued recently from the US Attorney's Office in Arizona, the 41-year-old has been indicted for conspiracy t o commit healthcare fraud, three counts of wire fraud, and money laundering. The charges stem from a $650-million scheme involving at least 41 substance abuse clinics in the US state of Arizona. Khaleej Times is withholding the man's name for legal reasons. US prosecutors allege the man owned ProMD Solutions, a Pakistan-based company that provided credentialing, enrollment, medical coding, and billing services for outpatient treatment centres. The clinics were registered as addiction treatment centres for people with drug and alcohol dependency. But prosecutors say many of the services were either never provided, falsely billed, or so poor in quality that they served no medical purpose. Investigators say many of the patients were recruited from homeless shelters or Native American reservations solely to inflate claim volumes. The clinics were registered with Arizona's Medicaid programme, the Arizona Health Care Cost Containment System (AHCCCS), and submitted around $650 million in fraudulent claims. AHCCCS reportedly paid out $564 million based on those claims. To back up the false billing, fake therapy notes and fabricated medical records were created. These documents were also used to mislead auditors during official reviews. The man is believed to have personally pocketed $24.5 million from the scam. US authorities allege he used $2.9 million (Dh10.6 million) of that money to purchase a high-end property in Dubai. 'These criminals didn't just steal someone else's money. They stole from you (American taxpayers),' said Matthew Galeotti, who leads the Justice Department's criminal division. 'Every fraudulent claim, every fake billing, every kickback scheme represents money taken directly from the pockets of American taxpayers who fund these essential programmes through their hard work and sacrifice.' The charges are part of a sweeping federal crackdown that has exposed nearly $15 billion in fraudulent claims. On Monday, the Justice Department announced that more than 320 people had been charged across the United States in the largest-ever coordinated takedown of healthcare fraud. In Arizona alone, seven individuals have been charged across five separate cases, including this one involving the clinics linked to the Pakistani suspect.
Yahoo
28-05-2025
- Business
- Yahoo
Phoenix Union brings remote health care services to students and staff
The Phoenix Union High School District is now offering telemedicine services to give students and staff quick health care access. The health services are intended to reduce absenteeism and improve well-being. With the new program, school community members can forgo taking time away from campus to see their primary care provider and instead see a remote nurse practitioner from the school nurse's office. 'We're really hoping to see with this level of immediate care that it'll positively impact school attendance and staff attendance,' said Phoenix Union Chief Achievement Officer Laura Telles. After Golden Health Initiative approached Phoenix Union about a partnership, the district wanted to choose pilot sites carefully before expanding the program districtwide. Golden Health Initiative is a company that aims to increase access to health care with its clinical services. The district surveyed student and staff families and found the two schools' communities showed significant interest in greater health care accessibility: the Academies at South Mountain in south Phoenix and Alhambra High School in west Phoenix. Phoenix Union found the community surrounding the Academies at South Mountain had insufficient access to nearby medical facilities, meaning many families had to drive to neighboring areas for care. Significant immigrant and refugee populations surround Alhambra, and Phoenix Union leaders thought telemedicine would make health care accessible in multiple languages. Students visiting their school nurse's office at South Mountain and Alhambra high schools can now receive telemedicine services, including behavioral and mental health services, if their parents have signed Phoenix Union consent forms. Golden Health Initiative accepts all insurances, including Medicaid, said Christine Carvalho, the company's acting CEO. Medicaid in Arizona is offered through the Arizona Health Care Cost Containment System, commonly called AHCCCS. Nurses at the schools will work with a remote nurse practitioner using kits provided by 19Labs that are 'basically an emergency room in a box,' Carvalho said. The kits are equipped with diagnostic tools such as a thermometer, an oximeter and a blood pressure monitor. Another component is an exam camera that allows the nurse practitioner to look into the throat, nose and ears. The equipment is Bluetooth compatible, so the nurse practitioner can read vitals while the nurse examines the student. From there, the nurse practitioner can prescribe the student medicine or refer them to a specialist. 'It can all be done and integrated into the school day or immediately afterwards, and education doesn't suffer,' said Lisette Polletta, a spokesperson for 19Labs. The telemedicine services were only offered in the spring 2025 semester to students and staff during school hours, but Phoenix Union is looking to expand hours and coverage so family members can also take advantage of the services after school or on weekends beginning in June. Golden Health Initiative and Phoenix Union are considering bringing telemedicine services to all of the district's schools before January 2026 and are looking to introduce a physical clinic where people can receive hands-on care and advanced testing. Coverage of education solutions on and in The Arizona Republic is partially supported by a grant from the Arizona Local News Foundation's Arizona Community Collaborative Fund. This article originally appeared on Arizona Republic: Phoenix Union offers telemedicine to students and staff
Yahoo
23-05-2025
- Yahoo
Sober Living Scheme: Arizona Attorney General addresses Medicaid fraud
The Brief Arizona Attorney General Kris Mayes sat down with FOX 10 Investigator Justin Lum to talk about the state's Sober Living Crisis. The crisis, along with the scandal involving the Arizona Health Care Cost Containment System (AHCCCS), could ultimately cost the state $2 billion. "This is going to take years to fix," AG Mayes said. PHOENIX - As fallout from the Sober Living Crisis and the scandal involving Arizona's Medicaid agency that ultimately cost the state $2 billion continues, Attorney General Kris Mayes sat down with us to talk about the situation. The backstory Attorney General Mayes sat down for the interview after nearly 20 people, a behavioral health provider and a church are accused of defrauding the Arizona Health Care Cost Containment System (AHCCCS) for $60 million. While AG Mayes could not get into specifics of the case, we know that, according to investigators, Happy House Behavioral Health and other defendants allegedly conspired by patient brokering and using sober living homes to take advantage of Medicaid members. The suspects are also accused of wiring millions of dollars to Hope of Life International Church and an entity in Rwanda, which is a country located in Africa. The defendants have pleaded not guilty. What they're saying Attorney Joshua Kolsrud, who represents Pastor Theodore Macuranyana, released a statement in connection with Macuranyana's indictment. Kolsrud's statement reads: "Kolsrud Law Offices condemns the Arizona Attorney General's Office for its unjust indictment of Pastor Theodore Macuranyana, a respected community leader with no criminal history, and his religious organization in a healthcare fraud investigation. This action exemplifies egregious prosecutorial overreach. The Attorney General's Office seeks to escape accountability for failing to detect an alleged fraud that triggered over $60 million in payouts within a year. Instead of addressing this regulatory failure, the prosecution pursues baseless charges against uninvolved parties to deflect blame. Criminal charges must be rooted in evidence, not politics. Targeting a church and its leadership without proof sets a dangerous precedent and erodes public trust in the justice system. The AG's Office unfortunately has a history of politically motivated prosecutions. Just yesterday, May 19, 2025, the Maricopa County Superior Court ruled that the AG's Office unfairly presented its so-called "Fake Electors" case to the grand jury and violated the defendants' constitutional rights. The judge ordered the case remanded back to the grand jury. Kolsrud Law Offices demands a transparent review of the facts, free from political motives." We've reached out to the attorneys for the rest of the defendants in this latest indictment, but have not heard back. Dig deeper As we have reported on since 2023, thousands of victims, mainly Native Americans, were not provided legitimate treatment services for substance abuse and mental health. Per AG Mayes, more than 120 individuals and entities have been charged in connection to the Sober Living Scheme, but only a small percentage of the estimated $2 billion has been recovered, as she says funds have been spent on assets like cars and homes, or wired offshore. Cases we are seeing prosecuted stem back to before 2023, when AHCCCS and the state's Attorney General's Office were led by another administration. "How much does this fall on checks and balances handled by our state agencies?" we asked AG Mayes. "This is about a government failure. That is something that we're working on right now, that AHCCCS is now working on," AG Mayes replied. "We continue to provide advice and some guidance to them about what we think they need to do to stop this fraud. This is going to take years to fix. It could take up to a decade to fix this. This is something that was allowed to fester for way too long, and far too many people were hurt by it." AG Mayes also confirmed that there are clear international ties to this scheme, as alleged in the money laundering charge involving Rwanda.
USA Today
22-05-2025
- Health
- USA Today
20 people, including an Arizona pastor, indicted in massive sober living home fraud case
20 people, including an Arizona pastor, indicted in massive sober living home fraud case Show Caption Hide Caption Medicaid cuts: Parents, Sens. Mark Kelly, Ruben Gallego share worries Sens. Mark Kelly and Ruben Gallego speak during a town hall about Medicaid cuts at the NOAH Cholla Health Center in Scottsdale on March 17, 2025. PHOENIX — The Arizona Attorney General's Office announced the indictment of 20 people, including a church pastor, accused of submitting false medical claims to the state's Medicaid program for more than $60 million in a little less than one year. The indictments were the latest in a string of cases alleging rampant fraud against the Arizona Health Care Cost Containment System, most of which involved alcohol and drug rehabilitation services that were never rendered. Arizona Attorney General Kris Mayes held a news conference in May 2023, a few months after taking office, to announce the widespread fraud, which she called a "stunning failure of government." The cost to taxpayers is as much as $2.5 billion. Since then, more than 100 individuals and companies have faced charges in 14 cases, the office told The Arizona Republic, part of the USA TODAY Network, in April. The scheme largely involved patients enrolled in the American Indian Health Plan, designed to serve Native Americans who may live in remote areas miles from doctors and clinics. It was intentionally crafted to have little oversight and scrutiny that might delay care. Authorities said fraudsters exploited those loopholes, flooding the system with fraudulent claims for hundreds of hours of rehabilitation services that were never provided. Patients, if they existed at all, were sometimes plied with alcohol and drugs to keep them living in care homes to keep the scheme going, authorities said. This latest case named 17 individuals and two entities, one of which is a church. The grand jury charged three others, but their identities were not released in the indictment. Most of the people named in the indictment had arraignments on May 20. Additional arraignments were scheduled for May 21 and May 27. Indictment: Fraudulent claims submitted were for dead, jailed people The indictment named two men as the ringleaders of the overarching conspiracy: Desire Rusingizwa and Fabrice Mvuyekure, along with a business the two started called Happy House Behavioral Health. The scheme began in August 2022 and lasted through January 2024, the indictment said. As part of that scheme, Rusingizwa and Mvuyekure submitted more than $60 million in fraudulent claims to AHCCCS through Happy House from August 2022 to July 2023, according to the indictment. AHCCCS suspended the business in July 2023, the agency's records show. Some of the fraudulent claims submitted by Happy House were for people who are dead, jailed, or in hospitals, according to the indictment. An attorney for Rusingizwa, Shaheen P. Torgoley, said in an email that Happy House provided legitimate rehabilitation services. "Mr. Rusingizwa is a pious family man with no criminal history," his attorney wrote. "He looks forward to defending against these allegations in court. The indictment also listed Theodore Mucuranyana, pastor of Hope of Life International Church. According to court records, Happy House started on land leased from the church. The indictment accused Mucuranyana, along with the church, of money laundering. According to the indictment, Happy House Behavioral Health transferred more than $5 million to the church after it received a letter from Arizona officials saying it was under investigation for fraud. Mucuranyana did not return a phone message seeking comment. His attorney, Joshua Kolsrud, emailed a statement that blamed the Attorney General's Office for failing to detect $60 million in payouts within a year. "Instead of addressing this regulatory failure, the prosecution pursues baseless charges against uninvolved parties to deflect blame," the statement said. Kolsrud said Macuranyana was a "respected community leader with no criminal history." Julia Kolsrud, an attorney for the church, said that the church merely served as a landlord and had no insight into the inner workings of its tenant. The Republic left phone messages and sent emails to attorneys listed for the defendants in the case. They did not immediately respond. The money fraudulently obtained from AHCCCS was used to pay the operators of so-called 'sober living homes' to house the patients, the indictment said. The other individuals named in the indictment were accused of conspiring with Happy House to get paid for providing the housing. By law, sober living homes were not designed to get paid from AHCCCS funds. The person living there was supposed to work and pay for the housing with that paycheck. $5 million check. Luxury jewelry. Handbags. The indictment listed 11 businesses that prosecutors said took part in the racketeering scheme, along with specific transactions that authorities said constituted money laundering. One was a July 2023 check for $2.8 million issued to Mvueykure, the indictment said. Another woman, who was listed in corporate records as one of the principals of Happy House, received a check for the same amount on that same day, the indictment said. That person was not listed in the indictment. Happy House wrote two checks to Hope of Life Church in summer 2023, one in June for $500,000 and another in July for $5 million, according to the indictment. In August 2023, more than $900,000 was transferred from the church to pay for a property. Hope of Life Church was listed as the buyer, according to documents filed in the Maricopa County Recorder's Office. Online real estate sites show the address listed in the indictment as matching a 5-acre vacant parcel described by a listing agent as the "perfect place to build your dream home." In December 2023, Hope of Life International Church wired $2 million to an unnamed entity in Rwanda, according to the indictment. A filing in a related case seeking to seize assets said investigators searched the homes of Mvuyekure and Rusingizwa, both located in Peoria, in June 2024. Among the items seized, court records show, were luxury jewelry, watches, and handbags. The grand jury charged the individuals and businesses on April 21, according to the indictment.
Yahoo
20-05-2025
- Yahoo
'Devastated our lives': Former employees unaware they worked for businessman who plead guilty to AHCCCS fraud
The Brief Three people who used to work for an unlicensed health care facility in the Phoenix area are voicing their frustrations over what had happened. The owner of the facility, James Demasi, pleaded guilty in March 2024 to fraudulent schemes and illegal control of an enterprise on behalf of two treatment centers. "This man has effectively ruined some of our lives," one of the former workers said. PHOENIX - In a follow-up to a story we brought you in April, we are taking a deeper look into a Phoenix area businessman who ran an unlicensed health care facility out of a Phoenix motel that was used for clients trying to get sober. The clinics that they were transported to daily, however, defrauded Arizona's Medicaid agency for millions of dollars. The backstory James Demasi owned two clinics under the name 'New Life Wellness Center,' a behavioral health provider for people in need of substance abuse treatment. Records we obtained show that the Arizona Health Care Cost Containment System (AHCCCS), which is the state's Medicaid agency, paid New Life $80 million from 2015 through 2024. Amid a massive crackdown, however, red flags led to a criminal investigation and a costly plea deal. What we know While in court, Demasi pleaded guilty in March 2024 to fraudulent schemes and illegal control of an enterprise on behalf of his two treatment centers. Demasi also agreed to pay $25 million back to the state, nearly a year after AHCCCS suspended payments to New Life Wellness due to credible allegations of billing fraud. With Medicaid funding gone, nearly 150 clients living at the Thomas Suites Campus of Care would be impacted. We spoke with people who used to work at Thomas Suites. Local perspective "It's embarrassing. It's so embarrassing," said Morgan Valentine. "All I wanted to do was help the clients. I was driving my personal car with clients in it to and from these hotels to their doctor's appointments. He didn't care. He offered no support to his staff." Valentine was the Director of Housing for Thomas Suites, working under Demasi from November 2023 through January 2025. She said many of the clients were parolees out of prison, and unemployed. "Did you feel like it was a sinking ship?" we asked Valentine. "100% at a certain point," Valentine answered. "Like, you kind of saw the writing on the wall, and it was going under and it's going under fast, and that's why I chose to step away." "When I got hired at New Life Wellness, I was told it was like Disneyland," said a former worker, identified only as "Bob" as he wishes to remain anonymous. "Bob" worked for Demasi from December 2023 until October 2024. "Did you know that New Life Wellness had been convicted of fraud?" we asked Bob. "No," Bob replied. "Not until your report." Both Bob and Valentine said Demasi did not pay them consistently, but reassured them that money was on the way. "Everything after that was one big lie," said Bob. Dig deeper On multiple occasions in 2024, the City of Phoenix turned the water off due to non-payment. "Our clients were having to take buckets of water and fill their toilets up to go to the restroom," said Valentine. The direct impact was felt by clients, staff, and caterers like Victor Hernandez. "It just eventually had to stop, because it was too much accumulating," said Hernandez. Hernandez said he prepared meals daily for the residents at Thomas Suites from December 2023 to April 2024, investing his own money while never getting paid. "I put my whole effort into this business and both businesses that I run to make it successful, and when somebody takes good earnings off your life savings, it's pretty upsetting," said Hernandez. Hernandez has filed a civil suit against Demasi for breach of contract. "How much money do they owe you?" we asked Hernandez, to which he replied "$435,000." In a response filing, Demasi denies the allegations. His attorney has not replied to our request for further comment on the lawsuit. We also asked both Bob and Valentine on the amount of money they are owed. "Close to $20,000," Bob said. "I'd venture to say it's in the ballpark of like $30,000," said Valentine. Valentine said she believed in what she was doing at Thomas Suites, helping people get their lives on track – but now calls her experience a "broken dream." "We were lucky to get $1,000 a month from this man. Like, he just devastated our lives, having to beg for money, like around Christmas time," said Valentine. "We all have families, and having to be your employer to pay you for the hours that you worked is…this man has effectively ruined some of our lives."
