Former nurse practitioner sentenced in Arizona prosecution of Indigenous health care fraud

By Jeff Wendt
Mail

A former nurse practitioner was sentenced May 6 for being involved in a fraudulent scheme involving the state's Medicaid Indian Health Plan, state Attorney General Kris Mayes announced Thursday at a press conference.

Rita Anagho was sentenced to 3.5 years in prison after entering a guilty plea in the case. In a separate federal case against Anagho, she was ordered to pay $55 million in restitution and is awaiting sentencing. Anagho also had her nursing license revoked last year.

“For the past three years, my office has made it a top priority to hunt down and prosecute the criminals who stole from Arizona’s Medicaid program while exploiting some of our most vulnerable residents,” Mayes said in the press conference Thursday. “And billing to the programs targeted in this scheme has dropped by an astonishing 92% since we launched our fraud crackdown." 

Anagho operated the TUSA Integrated Clinic, serving as the behavioral health professional for as many as 10-15 other behavioral facilities.

Anagho engaged in fraudulent billing schemes targeting the Arizona Health Care Cost Containment System, the state's Medicaid program. It inlcuded billing for behavioral health services never rendered, billing for services provided to minors who received no care, billing for incarcerated and deceased members, and coercing Arizona Health Care Cost Containment System members to change health plans under threat of removal from unlicensed sober living homes.

Those individuals and entities are responsible for over $3.1 billion in fraudulent code billing of the American Indian Health Plan. Since Mayes started taking action three years ago, that number has dropped 92% to $292 million in fraudulent code billing.

More than 140 individuals and entities have been indicted related to the fraud schemes, 89 have either pleaded guilty, been sentenced or reached a court-approved settlement favorable to the state, and 41 of those have been convicted.

Mayes has been able to recover or seize more than $139 million in cash and property, and has worked with AHCCCS to put guardrails and measures in place to prevent future fraudulent billing.

“Arizona is a national leader in combating fraud,” Mayes said. “Our office earned the Inspector General’s Award for fighting fraud and abuse.”

More than $462 million was coded under the H0015 code, which is alcohol or drug services; intensive outpatient (treatment program that operates at least three hours/day and at least three days/week and is based on an individualized treatment plan), This includes: assessment, counseling; crisis intervention, and activity therapies or education. Since the crackdown, only $590,000 has been assigned this coding.

More than $331 million was coded under the H004 code, behavioral health counseling and therapy, per 15 minutes (group). Since the crackdown, just over $35 million has been assigned this coding.

Other codes have seen similar declines since the crackdown in 2023.

"We are not done," Mayes said. "We will continue to pursue individuals and entity that participated in this fraud.”

Jeff Wendt
Reporter | Phoenix/Cave Creek

jwendt@iniusa.org

Meet Jeff
Jeff Wendt started at Independent Newsmedia in January 2023, after 25 years working for Gannett and The Arizona Republic. Started as a high school sports scoretaker, worked up to reporting high school sports and then became an associate high school sports editor in 2002. Also worked in the Design Studio as a copy editor.

Community: Jeff serves on the Board of Elders at his local church.

Education: Arizona State University with a Bachelor’s Degree in Journalism and Mass Communication

Random fact: Attended Game 2 of the 2001 World Series.

Hobbies: Playing video games (yes still the kid in me), watching reality TV, playing poker.