Latest news with #AmericanIndianHealthPlan
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
29-01-2025
- Health
- Yahoo
‘Scapegoat': Attorney Ben Crump says Arizona wrongfully punished health providers in Medicaid fraud scandal
The Brief Attorney Ben Crump filed a lawsuit against Arizona, alleging racial bias in a state-wide Medicaid fraud scandal. The claim says black and brown providers were wrongfully suspended and received slower reimbursements than their non-minority counterparts. The document says providers of color were 300-times more likely to face payment denials. PHOENIX - High-profile civil rights attorney Ben Crump filed a new lawsuit against the state of Arizona. The complaint is linked to the massive Medicaid scandal that cost Arizona an estimated $2 billion in fraud. It claims the scheme involved "bad actors" targeting vulnerable people with addictions. Click to open this PDF in a new window. What we know Behavioral health providers said they were hit with baseless accusations. Nearly 80 plaintiffs are included in this complaint against Arizona's Medicaid agency. They claim they've either been wrongfully suspended or reimbursed for services too slowly, causing some businesses to go bankrupt. "They came up with a way to scapegoat it and try to blame hard-working providers for their malfeasance," said Crump at a news conference. Big picture view Crump is calling out Arizona's Health Care Cost Containment System, saying AHCCCS unjustly targeted black and brown behavioral health providers during a large-scale crackdown in 2023. He says providers of color were 300-times more likely to be denied payments for services provided compared to non-minority providers. "Without just cause or reasoning, we were ignored, intentionally slow paid, and eventually received no payment at all for the services we provided to AHCCCS clients," said Shaji Koroma of Koroma Family Wellness Care. The backstory FOX 10 has extensively covered the sober living scheme that preyed on vulnerable Native Americans on the American Indian Health Plan, enticing them with alcohol and drugs while not providing any treatment services. These plaintiffs say AHCCCS overcorrected with a new administration and used a "ready, aim, fire" approach on hundreds of providers. "The state suspended, terminated and got rid of people with a knee-jerk reaction," said Rev. Andre Miller of Fosters House LLC. Some of the plaintiffs have been suspended due to allegations of fraudulent billing, which stops payments immediately. "The fact that their unsubstantiated claims were enough to suspend your license, to terminate your license without ever having an opportunity to defend yourself," Crump says regarding the root issue of the lawsuit. Suspended facilities have 30 days to appeal the decision, but plaintiffs say they are still waiting for state hearings. The crackdown, Crump believes, will result in AHCCCS patients without available treatment and care. At the end of the press conference, a heated moment as this woman spoke up: "You know how you help? You come to our communities to our tables and listen to our guidance instead of being outside of our communities and acting like you know what is best!" she said. Reva Stewart, who leads the advocacy group "Stolen People, Stolen Benefits" made her presence felt. She shared a reminder to focus on the thousands of Native American victims. "They feel like they're being discriminated against. Where are the seas of our people that should be here, if they are for the people?" Stewart said. What's next Crump's plaintiffs are suing the state over several allegations including negligence, racial discrimination and lack of due process. They are requesting a jury trial. AHCCCS provided FOX 10 with the following statement:
