MESA, Ariz. — An East Valley woman has been sentenced to 66 months in prison for exploiting Arizona's Medicaid program.
Diana Moore, 44, of Mesa was ordered this week by a judge to pay over $21 million in restitution to the Arizona Health Care Cost Containment System for fraudulently billing the public service, according to the U.S. Attorney's Office of Arizona.
Moore owned multiple behavioral health counseling services that would submit for reimbursements from AHCCCS for services Moore claimed to have provided to AHCCCS members.
Starting in 2020, the defendant began obtaining the identification numbers of AHCCCS members by paying other providers to transport members to her counseling facilities. After the members left, Moore would continuously bill AHCCCS by falsely claiming her entities were providing these members daily care for up to 90 days.
Moore additionally submitted claims for AHCCCS members who were deceased or imprisoned at the time Moore claimed to have provided them care.
Nearly all of the AHCCCS members billed for by Moore were enrolled in the American Indian Health Plan, which services Arizona's Native American populations. The defendant pleaded guilty earlier this year to money laundering and wire fraud.
The scheme was reflective of a bigger, widespread problem that's been exploiting AHCCCS and Native American patients for the last few years. Indigenous residents are recruited to undergo treatment at illegitimate facilities in Phoenix and then end up stranded without a way to get home.
The issue became so prevalent that the Navajo Nation issued a public health emergency last summer due to the number of individuals affected by the crisis.
In 2023, Arizona's elected officials announced they were suspending AHCCCS payments to over 100 providers due to the rampant fraud that was being committed.
This type of fraud is estimated to have cost Arizona over $2 billion, according to state senators.
During Moore's sentencing hearing, court officials noted the particular harm done to the Native American populations in Arizona as a result of defrauding the American Indian Health Plan.
“Defendant misused this program, and the unique identification numbers generated by it, to benefit herself -- in some cases by billing for patients she never treated, and in other cases by falsely inflating the duration of treatment," U.S. Attorney Gary Restaino said in a statement.
Moore's attorney claims the defendant fell under the influence and manipulation of two primary actors who were preying upon Native American communities. These individuals allegedly convinced people like Moore that they could earn a massive amount of money by following their instructions.
"The actors taught them how to open and create companies, how to conduct the billing schemes, and received money from all of the people they recruited to create companies in an almost pyramid scheme-like fashion," Moore's attorney wrote in a court filing.
Moore now "deeply regrets" her actions and is doing everything to "remedy her misdeeds," the defendant's attorney wrote.
In addition to the restitution she owes AHCCCS, Moore was ordered to forfeit four homes, seven luxury cars and 100 other items purchased with funds from the fraud scheme.
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