A U.S. Court has sentenced Rita Anagho, 54, to 14 years in prison for using her company, Tusa Integrated Clinic, to defraud Arizona’s Medicaid agency of more than $69 million in less than a year.
The court on Thursday ordered Ms Anagho to pay $55 million in restitution and seized $9.5 million from seven bank accounts linked to her. She also forfeited nearly $7 million in real estate to the U.S. government.
Mrs Anagho, 54, of San Tan Valley, Arizona, owned and operated the clinic, an addiction treatment centre that fraudulently billed the Arizona Health Care Cost Containment System (AHCCCS) over $69 million from approximately May 2022 through March 2023, the U.S. government alleged. AHCCCS paid Tusa approximately $54.9 million based on these false and fraudulent claims.
Anagho, a licensed nurse practitioner, coordinated and carried out the health care fraud scheme by exploiting vulnerable substance abuse treatment patients. Ms Anagho enrolled patients whose health care coverage was provided by the AHCCCS in her fraudulent clinic.
Mrs Anagho ran a fraudulent addiction treatment therapy scheme targeting native Americans covered by Arizona Medicaid to seek reimbursement from the government between May 2022 and March 2023, a statement by the Department of Justice said Thursday. Her target consisted largely of substance abusers who had higher insurance, billing the government for services that weren’t provided and sometimes exaggerating the services provided to obtain higher pay.
She specifically targeted patients enrolled in the American Indian Health Care Programme (AIHP) fee-for-service plan because it paid higher reimbursement rates for services like addiction therapy. The fraudster connived with sober homes to refer substance abusers to her clinic and then shared the fraud proceeds with them.
“In addition, Anagho and her co-conspirators paid illegal kickbacks to owners of numerous area sober homes for patients who were referred to her clinic,” the statement added.
She also created paperwork for the medical records to add a semblance of legitimacy to the fraud scheme and cover her tracks after her clinic got subpoenaed.
She “instructed her former employees to create fake medical records when Tusa received a subpoena for documents”.
“Mrs Anagho’s scheme manipulated a program that was intended to help Native Americans in Arizona,” U.S. attorney Timothy Courchaine for the District of Arizona said. “The 14-year sentence that she received is a sign of how serious and damaging health care fraud is to our society, and how important it is that we stop individuals who undermine the value of these programmes.”