Date: 08-23-2024

Case Style:

United States of America v. Diana Marie Moore

Case Number: 23-cr-0040

Judge: Susan M. Brnovich

Court: The United States District Court for the District of Arizona (Maricopa County)

Plaintiff's Attorney: The United States Attorney’s Office in Phoenix

Defendant's Attorney:

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Description:

Phoenix, Arizona criminal defense lawyer represented the Defendant charged with Exploiting the American Indian Health Plan
Mesa Business Owner Who Exploited the American Indian Health Plan Sentenced to Over 5 Years for AHCCCS Fraud

Diana Marie Moore, 44, of Mesa, admitted that she owned two behavioral health counseling services, Harmony Family Services (HFS) and Harmony Family Services II (HFS II) and that she had also submitted the application for a third behavioral health counseling service, Logan Family Health, LLC (“LFH”). All three then applied to be medical providers for the Arizona Health Care Cost Containment System (AHCCCS), Arizona’s Medicaid agency- HFS applied in 2019, HFS II applied in 2020, and LFH applied in 2022. AHCCCS approved all three applications. At the time HFS and HFS II applied to AHCCCS, Moore failed to disclose her ownership interest in the other entity. Moore also failed to disclose her prior felony conviction, which was required to be disclosed on the AHCCCS application form.

Moore further admitted that she engaged in a fraudulent billing practice targeting AHCCCS and exploiting a program that enables Native Americans to seek behavioral health treatment without first obtaining a pre-payment review. Specifically, starting in January 2020, Moore began obtaining AHCCCS identification numbers for AHCCCS enrollees by paying other providers to transport AHCCCS enrollees to the HFS or HFS II facility for a single day, and then obtaining enrollees’ identification numbers once they arrived. Nearly all of the AHCCCS enrollees billed for by Moore were members of the American Indian Health Plan. After these AHCCCS enrollees left the HFS or HFS II facility, Moore would submit bills to AHCCCS, which falsely claimed that HFS and HFS II continued providing services to those same enrollees for up to 90 days. Moore regularly claimed that HFS or HFS II provided counseling services to a given AHCCCS enrollee for eight or more hours each day, five days a week, for months in a row, even though Moore knew such services were not provided. In addition, Moore submitted claims to AHCCCS, which falsely claimed that HFS or HFS II provided services to certain AHCCCS Enrollees who were, in fact, deceased or imprisoned at the time Moore claimed to have provided services.

At the sentencing hearing, the Court noted the particular harm done to the Native American populations in Arizona as a result of this type of fraud.

“The American Indian Health Plan exists to help an underserved community surmount barriers to treatment,” said United States Attorney Gary Restaino. “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. Thanks to the Internal Revenue Service for its financial acumen in bringing defendant to justice, and to the AHCCCS Inspector General’s Office for its valuable assistance.”

“The sentencing of Diana Moore should be a reminder there are serious consequences to this type of criminal behavior,” said Carissa Messick, IRS CI Special Agent in Charge, Phoenix Field Office. “IRS CI methodically works to bring fraudsters to justice and restore confidence in our public programs.”

Internal Revenue Service Criminal Investigation conducted the investigation in this case. Assistant U.S. Attorney Aron Ketchel, District of Arizona, Phoenix, handled the prosecution.

Outcome:

Defendant was found guilty and sentenced to 66 months in prison, followed by three years of supervised release. Moore was also ordered to pay restitution to the Arizona Health Care Cost Containment System (“AHCCCS”) in the amount of $21,730,674.04. In addition, the Court ordered the forfeiture of four single-family homes

Plaintiff's Experts:

Defendant's Experts:

Comments: RELEASE NUMBER: 2024-116_Moo