Latest news with #JustinLum
Yahoo
01-05-2025
- Health
- Yahoo
Arizona woman accused of being a 'body broker,' lawsuit alleges
The Brief A woman from Goodyear accused of sober living fraud is among several individuals being sued for millions of dollars by a major health insurance company. Blue Cross Blue Shield of Oklahoma accuses the woman of acting as a "body broker" to recruit and transport thousands of Native Americans across state lines to a treatment center in California. GOODYEAR, Ariz. - A major health insurance company is suing several people, including a Goodyear woman, for their alleged involvement in sober living fraud spanning different states. Blue Cross Blue Shield of Oklahoma accuses the woman of acting as a "body broker" to hunt down and traffic thousands of Native Americans, across state lines, and into a California treatment center. FOX 10 Investigator Justin Lum breaks down the alleged scheme and its ties to Arizona. What we know Blue Cross Blue Shield Oklahoma says it's dispersed $36 million in wrongful payments. The lawsuit says an "army of fraudsters" is responsible for taking advantage of tribal members, and lays out the blueprint for the defendants' alleged fraud scheme. The plaintiff, Blue Cross Blue Shield Oklahoma, says Rad Life and Excellence in Everything Recovery (EIE) both acted as "body brokers." The owner of EIE Recovery is Cari Passmore, and she's based in Goodyear. Her Facebook profile name is "Cari CC," which matches the profile disclosed in the lawsuit. Passmore is accused of sending potential patients to an insurance agent in Oklahoma to be enrolled in Blue Cross Blue Shield insurance plans. The lawsuit says the patients would then be sent to South Coast Behavioral Health in California for free detox treatment before returning to Passmore's sober living home for free housing and outpatient care. Blue Cross Blue Shield Oklahoma says the defendants split payments being made to insurance. One exhibit shows someone in a Facebook group asking who could get her sister into a California rehab, and passmore replies, "I can help with California." The backstory "They're targeting our most vulnerable people, and they go out there, and you see these recruiters blatantly, see these recruiters on these websites going to these different, whether they go to a homeless shelter or a homeless camp, and promising them steak dinners," said Reva Stewart of Turtle Island Women Warriors. She's an advocate for indigenous people impacted and displaced by the sober living scheme due to the fallout of Arizona's Medicaid scandal. AHCCCS, the state's Medicaid system, cracked down on fraudulent billing in 2023, suspending hundreds of behavioral health providers and cutting off payments. Stewart says "bad actors" have switched from Medicaid to the health insurance marketplace for some time now. "It's just as bad, it really is," she said. Dig deeper Blue Cross Blue Shield Oklahoma says Passmore falsified information, revealing a screenshot of a message between her and an alleged co-conspirator, discussing a P.O. box address for residency requirements to enroll patients. According to the lawsuit, recruits were told by insurance agent Randall Eisworth to lie about their annual income, employment and residency. It's important to note that the plaintiff recently dismissed claims against Eisworth without prejudice. Blue Cross Blue Shield Oklahoma says 23 members used a Buckeye address for a home operated by EIE. Big picture view Stewart says people she has helped on the streets tell similar stories. "I've had a few people that I've spoke with that we've helped get home that said that they were told that once they got into the house, they had to get on Blue Cross Blue Shield and all they had to do was hand over their information and that it would be done for them, so then when they decided that they needed to go to the Phoenix Indian Medical Center and utilize the services there, they were told they couldn't because they were under Blue Cross Blue Shield," Stewart said. The plaintiff says, "even worse, many of the alleged services provided at Excellence were not actually provided," and that Passmore gave patients "comfort meds" without professional administration or prescription from a stockpile of old medication she kept from prior patients." What's next Blue Cross Blue Shield Oklahoma is suing Passmore and EIE along with South Coast Behavioral Health and Rad Life Recovery under the Racketeer Influenced and Corrupt Organizations Act, known as RICO, as well as fraud, and negligent misrepresentation. It's demanding a jury trial. Passmore's attorney has no comment on pending litigation. Attorneys for the rest of the defendants have not responded to FOX 10's requests for comment. Stewart says she's not surprised that the sober living scheme is still very much alive across so many states, but she's focused on humanitarian efforts to get relatives home. "These people are all of the people that have taken advantage of anyone and everyone who is vulnerable for their greed. That's what makes me angry," she said. As for Passmore, she has some history with another insurance company. Back in 2021, Passmore agreed to pay $50,000 to Premera Blue Cross as part of a stipulated judgment in which she accepted liability in their lawsuit against her.
Yahoo
29-04-2025
- Health
- Yahoo
Phoenix motel used as unlicensed health care center tied to clinic convicted of AHCCCS fraud
The Brief In this FOX 10 Investigates report, we're learning more about Thomas Suites, an unlicensed treatment facility that had connections with a multi-million-dollar fraud case. At the now closed-down Thomas Suites, there were reports of drug use, no running water and other sorts of crime. PHOENIX - FOX 10 Investigator Justin Lum is uncovering how an unlicensed treatment facility operated out of a Phoenix motel with ties to a multi-million-dollar fraud case. The Medicaid fraud scandal has cost the state $2.5 billion and displaced thousands of vulnerable people fighting drug addictions. A majority of the victims are Native Americans, and some are recruited from reservations to get treatment that's rarely provided. What we know Thomas Suites has been on the radar of investigators for a while now. FOX 10 obtained records from Arizona's Department of Health Services (AZDHS), which include a cease-and-desist order served to Thomas Suites. Thomas Suites was fined more than $150,000 in civil penalties. Now, we're learning more about living conditions from just months ago. Thomas Suites was operated in the heart of Phoenix near SR 51 and Thomas Road. This facility is now shut down, AZDHS says, and it appears a Motel 6 is taking its place. Back in November 2024, FOX 10 cameras documented residents living at what state investigators deemed an unlicensed health care institution and a "public nuisance inimical to the public health and safety." What's left of Thomas Suites' social media describes it as a "transitional living facility for men and women reentering society from incarceration," but that's not what the program started out as, AZDHS says. Click to open this PDF in a new window. Timeline AZDHS began investigating Thomas Suites back in 2023 after receiving a complaint that said Native American families and individuals were being housed in an unlicensed motel. In August 2024, AZDHS issued a cease-and-desist after learning nearly 150 people lived at Thomas Suites, received counseling, and drug testing at the unlicensed facility. Investigators also observed an office with a locked safe for medications designated for several residents. Documents say clients were transported from Thomas Suites to a clinic called New Life Wellness multiple times a week. Both Phoenix and Flagstaff locations for New Life Wellness had been suspended by AHCCCS, the state's Medicaid agency, the year before in May 2023 over credible allegations of fraud. Suspension letters accused New Life Wellness of "ghost billing," which means billing for services never provided, also double billing claims for a member who was receiving care at another facility, and even billing for people who were dead. Well, in March 2024, a judge told the owner of New Life Wellness, James Demasi, "On behalf of New Life Wellness center, they are charged with count one, fraudulent schemes and artifices, a class two felony. A non-repetitive offense committed between November 8th, 2020 and May 31, 2023. Do you understand the charge?" He replies, "I understand, your honor." The judge asks, "How do you plead to count one?" Demasi says, "That is correct." The judge clarifies, "Do you plead guilty or not guilty?" Demasi says, "I plead guilty, yes." On behalf of both New Life Wellness locations, Demasi took a plea deal from the Arizona Attorney General's Office, pleading guilty to fraudulent schemes and illegal control of an enterprise. The judge ordered that he must pay $25 million in restitution to the state. Click to open this PDF in a new window. What they're saying With AHCCCS officially terminating New Life Wellness locations, his business at Thomas Suites pivoted, bringing in parolees under the supervision of the Arizona Department of Corrections, Rehabilitation and Reentry. Benjamin Jeffrey is a community advocate who stepped up to help residents of Thomas Suites last November. "At the end of the day, they were living in deplorable conditions. They were living in a health and safety hazard environment, but it was better than being on the streets," Jeffrey said. "I've got 150 to 175 people in this hotel. There is no running water. They are drawing buckets of water out of the swimming pool to flush the toilets, and they cannot take a shower. So, it quickly became a health and safety situation." Demasi wasn't paying his bills. This was the third time water was shut off to Thomas Suites, the city of Phoenix says. Jeffrey says he galvanized other local organizations to help get residents temporary housing, but the city turned the water back on, so despite the issues, many residents chose to stay. "The residents were being told, 'You don't have to come out, you don't have to accept help,'" Jeffrey said. Remember that cease-and-desist order? FOX 10 learned the facility is no longer operating as Thomas Suites since earlier this year. The investigation is complete, but we're told court proceedings in this case are ongoing as entities like Thomas Suites has the right to appeal any enforcement action taken against them for due process. We've reached out to Demasi and his attorneys for comment, and have not heard back. FOX 10 Investigator Justin Lum asked Jeffrey if he would call this a large-scale halfway house. He answered, "It was essentially a large-scale halfway house that promised a lot of services but was allowing people to do drugs. There was crime, drug dealing, no running water, no fire sprinklers." By the numbers According to AHCCCS, both New Life Wellness locations owned by Demasi made a total of $80 million in payments from 2015 to the end of 2024. What you can do Click here to learn more about the sober living crisis in Arizona. Click here to learn more about AHCCCS fraud and how to report it.
