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CMS NEWS – Rick Scott Demands More Cuts to Medicaid, Which His Company Allegedly Scammed

CMS NEWS – Rick Scott Demands More Cuts to Medicaid, Which His Company Allegedly Scammed


Alternative Headline: Rick Scott Pushes Medicaid Cuts

[MM Curator Summary]: Sen. Rick Scott seeks $313 billion more in Medicaid cuts despite past ties to a major Medicaid fraud case. 

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Rick Scott Demands More Cuts to Medicaid, Which His Company Allegedly Scammed

Scott proposes slashing $313 billion more from Medicaid, a safety-net program his hospital company was accused of fraudulently billing

Sen. Rick Scott (R-Fla.), who’s famous for his former hospital company’s record-setting Medicare fraud settlements, is currently leading an effort to make Donald Trump’s “Big Beautiful Bill” even more painful for America’s poor. 

The legislation already cuts $930 billion from Medicaid, the nation’s government health insurance program for low-income and disabled Americans, and would eliminate coverage for millions. Scott’s amendment, expected to get a vote Monday, would take away another $313 billion in state Medicaid funds and force hundreds of thousands of additional people, at least, off the program.

Scott has framed his proposed Medicaid cuts as necessary to preserve the program “for those who truly need it” — and not “able-bodied” adults. “If you don’t want to work, you’re the one who decided you don’t want health care,” he recently said on Fox News. He’s suggested Democrats are using tax dollars to “give illegal aliens Medicaid benefits,” even though undocumented immigrants are not eligible for Medicaid, claiming that blue states want to “exploit this safety net.”

Ironically enough, some of the claims against Scott’s old hospital company revolved around exploiting Medicaid, and billing for services that patients didn’t need. 

Scott’s office did not immediately respond to Rolling Stone’s request for comment Monday.

The senator resigned as CEO of the hospital chain known as HCA Healthcare in 1997 amid an ongoing federal probe and a series of whistleblower complaints. He has long faced attacks from Democrats over the $1.7 billion that HCA paid to resolve fraud allegations in the early 2000s. Some of the allegations involved Medicaid.

In late 2000, as part of the “largest government fraud settlement ever” with the Justice Department, HCA pleaded guilty to criminal conduct and agreed to pay over $840 million in fines, penalties, and damages to resolve claims of unlawful billing practices. 

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Among the claims HCA settled over: The company was accused of billing “Medicare, Medicaid, the Defense Department’s TRICARE health care program, and the Federal Employees’ Health Benefits Program, for lab tests that were not medically necessary” and “not ordered by physicians.”

HCA was accused of “upcoding,” or pretending patients were sicker than they were in order to increase reimbursements to its hospitals. “The guilty plea includes one count relating to this upcoding practice,” the Justice Department wrote in a press release. The company was also accused of billing Medicaid “for home health visits for patients who did not qualify to receive them or were not performed,” the department said.

The civil and administrative settlement agreement between HCA and the U.S. Justice Department said the company, from 1995 to 1998, submitted claims to Medicaid, Medicare, and TRICARE, “(a) for visits to patients who did not qualify for home health services because (i) the patients were not homebound, (ii) there was no medical need for such services, or (iii) there was no medical need for skilled services; (b) for visits that were not provided; (c) for visits to deliver services that were in fact or should have been provided by an assisted living facility.”

HCA and the Justice Department entered into an additional settlement agreement in 2003, in which the company agreed to pay another $631 million to resolve false claims it submitted to federal health programs. 

In a civil settlement agreement, the Justice Department wrote that health regulators “contend that they have certain administrative claims against HCA under the provisions for permissive exclusion from the Medicare, Medicaid, and other federal health care programs.”

Under both agreements, the Justice Department announced that HCA would pay millions of dollars to state Medicaid agencies: $13.6 million in 2000, and then $17.5 million in 2003. The department said the latter figure represented “direct state losses.”

https://www.rollingstone.com/politics/politics-features/rick-scott-medicaid-scam-trump-big-beautiful-bill-1235375383/


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FRAUD – Massachusetts Autism Service Provider Charged with Over $1 Million in Fraudulent Medicaid Claims

FRAUD – Massachusetts Autism Service Provider Charged with Over $1 Million in Fraudulent Medicaid Claims


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Alternative Headline: Randolph Provider Charged in $1M Fraud

[MM Curator Summary]: A Randolph autism service provider is accused of fraudulently billing over $1 million to MassHealth for unprovided ABA therapy services.

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The Massachusetts Attorney General’s Office has opened a new chapter in its ongoing mission to clamp down on health care fraud, indicting a Randolph autism service provider for falsely billing over $1 million. As detailed by the Attorney General’s announcement, Patrice Lamour and her two companies, Lamour by Design (LBD) and Lamour Community Health Institute (LCHI), face charges for their alleged misconduct. Specifically, the grand jury indicted the parties for one count of Medicaid False Claims and one count of Larceny over $1,200, according to Mass.gov.

The AG’s investigation stems from a referral by MassHealth after inconsistencies surfaced in billing practices. Services in question include Applied Behavioral Analysis (ABA), a key therapy for children with autism spectrum disorder, demanding oversight by licensed professionals. The problem, it seems, was that LBD claimed and was paid for certain supervision and family training services that could not have taken place due to staffing deficiencies — the only full-time Licensed Applied Behavioral Analyst (LABA) insisted he did not perform those services.

Allegations don’t stop there; both LBD and LCHI are accused of invoicing MassHealth for services on days when no services could have been provided, such as holidays or after patient cancellations. Moreover, staff were allegedly directed by Patrice Lamour to bill based on historical data and to falsify documentation to cover up the fraudulent activity.

It’s important to reiterate that these charges are just that — allegations. Patrice Lamour and her companies are presumed innocent until proven otherwise in court. Nevertheless, if the charges hold, this would not be the first instance of ABA providers facing justice. Earlier, the AGO secured a conviction against an Essex County man for stealing over $33,000 in MassHealth funds, and announced multi-million dollar settlements with other ABA providers for submitting fraudulent claims.

The encounter with such fraud is a sobering reminder of the cascading effects such actions can have on vulnerable populations like children with autism, who depend on these vital services. The Massachusetts Medicaid Fraud Division, bolstered by federal and state funding, is dedicated to unearth and prosecute such cases, safeguarding both the recipients of healthcare and the integrity of the healthcare system. They urge the public to report any suspected Medicaid fraud or instances of mistreatment in healthcare settings.

https://hoodline.com/2025/06/massachusetts-autism-service-provider-charged-with-over-1-million-in-fraudulent-medicaid-claims/




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FRAUD – Omaha woman sentenced for billing Medicaid for services she didn’t provide

FRAUD – Omaha woman sentenced for billing Medicaid for services she didn’t provide


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Alternative Headline: Omaha Woman Fined for Fraud

[MM Curator Summary]: An Omaha woman was sentenced for billing Medicaid for services she didn’t provide and must repay over $12,000.

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An Omaha woman was ordered to pay more than $12,000 after she pleaded no contest to Medicaid fraud.

Lisa Mitchell, 57, was found guilty of theft by unlawful taking.

According to the Nebraska attorney general, she billed Medicaid for services she never actually rendered

Mitchell was also sentenced to five years of probation.


She will be excluded from providing or billing for services paid for by any federally funded health program.



 https://www.msn.com/en-us/news/crime/omaha-woman-sentenced-for-billing-medicaid-for-services-she-didnt-provide/ar-AA1Feqkt?apiversion=v2&noservercache=1&domshim=1&renderwebcomponents=1&wcseo=1&batchservertelemetry=1&noservertelemetry=1





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FRAUD – Trump Grants Clemency to Executive Who Orchestrated $205M Medicare Fraud Scheme

FRAUD – Trump Grants Clemency to Executive Who Orchestrated $205M Medicare Fraud Scheme 


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Alternative Headline: Trump Commutes Medicare Fraudster

[MM Curator Summary]:  Trump commuted the sentence of a man who orchestrated a $205 million Medicare fraud, contradicting GOP fraud-cutting claims.

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Republicans have claimed they’re “saving” Medicaid from “waste, fraud and abuse” with massive cuts.

President Donald Trump has quietly commuted the sentence of a Florida health care executive convicted of leading a Medicare fraud scheme to pilfer $205 million from the program through false means — even as the GOP claims that their massive cuts to Medicare, Medicaid, and other programs are aimed at weeding out “waste, fraud and abuse.”

Last Wednesday, Trump granted clemency to two dozen people, including Lawrence Duran, who was convicted in 2011 for defrauding Medicare and money laundering, among other charges. Duran, who owned a mental health care company with seven locations across Florida, and his girlfriend received $87 million from the scheme.

As the Miami Herald points out, this was, at the time, the largest therapy-related Medicare fraud scheme in history, with hundreds of thousands of false claims. Duran was sentenced to 50 years in prison, and he and other collaborators were ordered to pay $87 million in restitution.

Trump commuted Duran’s sentence, and wrote in his clemency order that Duran would be subject to “no further fines [or] restitution” related to his case.

The commutation is striking as Trump administration officials and top Republican leaders have spent weeks claiming that the reconciliation bill — which could kick tens of millions of people off of Medicaid, Medicare, and other benefits — is actually aimed at saving American taxpayers from paying into fraud within the program.

The GOP’s claim that they are targeting fraud in their proposed cuts has always been questionable at best, and an outright lie in most contexts. Some have even falsely insisted that their changes to Medicaid aren’t cuts at all.

But experts have said that their policies have little to nothing to do with eliminating fraud or waste, and rather are aimed at kicking people off of life-saving benefits. (Though the GOP has coalesced around Medicaid talking points, the Congressional Budget Office has estimated that Medicare will also see $500 billion in cuts under the reconciliation bill.)

In that vein, Trump’s commutation is perhaps another show that the GOP has little interest in saving Americans from those aiming to defraud taxpayer-funded programs.

The commutation falls in line with Trump’s pattern of pardoning people convicted of white collar crimes, including numerous people convicted of major fraud schemes. The goal, analysts have said, is seemingly to worsen the two-tiered criminal legal system that disproportionately targets non-white people, the poor and the left.

The Trump administration is cracking down on political dissent. Under pressure from an array of McCarthy-style tactics, academics, activists and nonprofits face significant threats for speaking out or organizing in resistance.

https://truthout.org/articles/trump-grants-clemency-to-executive-who-orchestrated-205m-medicare-fraud-scheme/




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FRAUD – Avon Woman Convicted in Medicaid Fraud Scheme

FRAUD – Avon Woman Convicted in Medicaid Fraud Scheme


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Alternative Headline: Avon Therapist Sentenced for Fraud

[MM Curator Summary]: A Connecticut therapist was sentenced for defrauding Medicaid of over $27,000 by submitting false claims.

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(Rocky Hill, CT)  – Chief State’s Attorney Patrick J. Griffin today announced that an Avon woman has been sentenced in Hartford Superior Court for defrauding Medicaid by submitting fraudulent claims for services she did not perform. 

The Honorable Paul R. Doyle on June 3, 2025 sentenced Soraya Sawicki, age 64, of Avon, to 18 months in prison, execution of that time suspended, with five years of conditional discharge, with the condition being that she cannot serve as a provider in the Medicaid program. Upon sentencing, the defendant paid full restitution of $27,068.81. Sawicki pleaded guilty to Health Insurance Fraud, in violation of Connecticut General Statutes § 53-442, a class B felony.

By being found guilty of a program-related felony, the defendant is also subject to mandatory exclusion as a health care provider to certain federally funded health programs pursuant to federal and state laws and regulators. Medicaid is a government program that provides health coverage to low-income, disabled, and elderly individuals, and is financed by both the federal and state governments and administered by the Connecticut Department of Social Services.

An investigation by the Inspectors of the Medicaid Fraud Control Unit in the Office of the Chief State’s Attorney determined that between September of 2019 and June of 2021, Sawicki, a licensed clinical social worker and the owner of Infinity Integrated Counseling and Spa Services, LLC, located in Avon, billed for services that were never provided. The amount totaled $27,068.81.

The case was investigated and prosecuted by the Medicaid Fraud Control Unit. The Unit is grateful for the assistance it received in the investigation from the State of Connecticut Department of Social Services Office of Quality Assurance and the Avon Police Department.

The Connecticut Medicaid Fraud Control Unit receives 75 percent of its funding from the U.S. Department of Health and Human Services under a grant award totaling $2,362,872.00 for fiscal year of October 1, 2024 through September 30, 2025. The remaining 25 percent, totaling $787,620.00 for the same fiscal year is funded by the State of Connecticut.


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FRAUD – Indian-origin pharma tycoon Tonmoy Sharma arrested in Los Angeles over $149 million healthcare fraud

FRAUD – Indian-origin pharma tycoon Tonmoy Sharma arrested in Los Angeles over $149 million healthcare fraud


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Alternative Headline: $149M Fraud by Rehab CEO

[MM Curator Summary]: Tonmoy Sharma was arrested for running a $149 million fraud scheme that lured in patients promising coverage, and then secretly using patient information to make false claims to Medicaid, and then the Affordable Care Act coverage.  


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Indian-origin doctor and businessman, the founder and former CEO of the now-defunct Sovereign Health Group, was recently arrested over $149 million medical fraud. The 61-year-old psychiatrist has been charged with four counts of wire fraud, one count of conspiracy and three counts of illegal remunerations for referrals to clinical treatment facilities.

    

What was the medical fraud? What was Sharma’s modus operandi?

Tonmoy Sharma’s Sovereign Health Group was a prominent addiction treatment provider throughout Southern California and several other states. According to court documents, the company billed private insurance companies for drug addicted and mentally ill patients at extremely high rates between 2014 and 2020.

Sovereign used to pursue patients aggressively through various forms of marketing forcing them to get admitted to the company’s treatment facilities. The patients were told that their treatment would be paid by a foundation funded by the donations from former SDpvereign patients. There was no such actual foundation and it was a ruse for Sovereign employees. They obtained patients’ names, date of birth and Social Security numbers and then obtained health insurance coverage on their behalf while the patients remained in the dark. Sovereign employees sometimes pretended to be the patients when calling into these insurance companies.


At Sharma’s direction, the court documents said, the employees claimed qualifying life events that had not happened in order to obtain new insurance outside the enrollment period and inflating or underreporting their income so the patients would qualify for Affordable Care Act government-subsidized private insurance instead of Medicaid, whose reimbursement rates were significantly lower than private insurers.

Sovereign also paid more than $21 million in illegal kickbacks for patient referrals to patient brokers.

Originally from Assam’s Dibrugarh, Sharma studied MBBS from Dibrugarh University. Sharma’s medical license was once revoked while he was practicing in the UK before he established his career in California.

https://www.msn.com/en-in/news/other/indian-origin-pharma-tycoon-tonmoy-sharma-arrested-in-los-angeles-over-149-million-healthcare-fraud/ar-AA1G9cyu





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FRAUD – Director of Arizona Medicaid agency resigns following fraud scheme response

FRAUD – Director of Arizona Medicaid agency resigns following fraud scheme response


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Alternative Headline: AZ Medicaid Chief Resigns

[MM Curator Summary]: Carmen Heredia, director of Arizona’s Medicaid agency, has resigned amid fallout from a $2 billion Medicaid fraud scheme targeting Native Americans and resulting in several deaths. 

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The director of Arizona’s embattled Medicaid agency resigned this week, just as she was expected to face questions from lawmakers about her handling of a massive fraud scheme that largely targeted Native Americans.

Gov. Katie Hobbs, a Democrat, announced Wednesday that she had accepted the resignation of Carmen Heredia, director of the Arizona Health Care Cost Containment System. The governor lauded Heredia’s leadership of the agency while blaming Republican lawmakers for politicizing the confirmation process, saying it had become clear they would not confirm Heredia’s nomination.

Sen. Jake Hoffman, a Republican and chair of the Senate’s Committee on Director Nominations, said in a statement that in responding to the fraud scheme, Heredia had “poorly executed” the suspensions of hundreds of behavioral health providers. Heredia had served as the head of AHCCCS without Senate confirmation since early 2023, several years after officials say the fraud likely began during the Republican administration of former Gov. Doug Ducey. In the year before Heredia became director, records show that officials were warned that the fraud was harming patients, but they struggled to respond and failed to alert the public, which Heredia did along with other state leaders in May 2023.

(Earlier this year, a spokesperson for Ducey did not comment on missed opportunities to stop the fraud but said that the former governor went to great lengths to assist in Hobbs’ transition.)

Under Heredia’s leadership, AHCCCS withheld payment to more than 300 businesses as the agency investigated allegations that they were fraudulently billing Medicaid for treatment services. Often, the services had not been provided, and business owners were accused of allowing patients to continue the substance use they had hoped to overcome through treatment.

In a statement, Heredia said she submitted her resignation with a heavy heart and expressed concern that a partisan agenda had resulted in professionals being dragged “through career damaging hearings.” Two years ago, Senate Republicans derailed the nomination of one of Hobbs’ previous picks to lead the health department.

Last September, more than a year after the crackdown began, the Arizona Center for Investigative Reporting and ProPublica reported that the suspensions had rendered patients homeless. Victims of the scheme, some from other states, were also left without access to the drug and alcohol treatment they were seeking.

Over several years, businesses across much of Arizona, but mostly in Phoenix, reaped huge Medicaid reimbursements by enrolling Native Americans in their programs and billing the state’s American Indian Health Program at exorbitant rates for services, like counseling sessions. (The AIHP is a Medicaid insurance option that, until the fraud was discovered, had no set limit on the amount of money providers could bill for services.)

At a news conference Thursday, Attorney General Kris Mayes, a Democrat, said there had been more than 100 indictments and 25 convictions so far related to the scheme. She also said she expected more indictments to come.

AHCCCS said over the past two years that officials’ top priority was patient safety, and in May 2023, the agency set up a hotline for victims. It provided brief hotel stays for people displaced from shuttered facilities. However, AHCCCS said last year that it had no record of what happened to a majority of the hotline’s then 11,400 callers, largely because after six months it had stopped tracking outcomes for people who did not stay in a hotel. According to available data, more than 575 people ended up without housing as of last September. AZCIR and ProPublica also found that at least 40 Indigenous residents of sober living homes and treatment facilities in the Phoenix area died as the state fumbled its response.

A handful of the suspended providers, out of hundreds investigated, were allowed to resume billing Medicaid after clearing allegations with the state. But they said the suspensions still pushed them to the brink financially and upended their patients’ care, AZCIR and ProPublica found. As a result, Heredia’s swift and aggressive response to the crisis — which authorities said was needed to root out fraud and save lives — caused concerns that behavioral health care, especially for Native Americans, was increasingly difficult to access.

“Under Katie Hobbs’ leadership, Heredia’s response has been incredibly disturbing, to say the least,” Hoffman said. “We are left with a broken system due to Heredia’s mismanagement, and our vulnerable populations are caught up in this collapse.”

A spokesperson for Senate Republicans declined a request for an interview with Hoffman.

While Hoffman’s statement mostly focused on the fraud scheme that authorities say cost the state $2 billion, he said he also took issue with other matters within AHCCCS involving long-term care.

In addition to Heredia’s resignation, Jennifer Cunico, the director of the Arizona Department of Health Services, also stepped down this week. Like Heredia, Cunico was set to appear before lawmakers for a confirmation hearing. Cunico said she was proud of her work at the department but made the difficult decision to withdraw her nomination after it became clear she wouldn’t be confirmed either. Her resignation comes two years after Hobbs’ previous pick to lead the health department withdrew her nomination following a heated confirmation hearing.

Hoffman said Cunico had defended public health officials’ pandemic response during meetings with lawmakers but did not provide details. Hoffman previously sponsored legislation that prohibited state and local agencies from enacting vaccine mandates.

The governor defended Heredia’s response to the fraud crisis and said both Heredia and Cunico had worked on a range of initiatives, including improving access to maternal health care.

“Carmen Heredia helped root out a multi-billion dollar wave of Medicaid fraud and the related humanitarian fallout which the previous administration ignored,” Hobbs said in a statement. “Her work to eliminate waste, fraud, and abuse in our healthcare system is a model for the nation, and she always ensured people who needed help continued to get it.”

She added, “The Senate’s unprecedented politicization of the director confirmation process has ended the directorship of two healthcare professionals who have made our state government run more efficiently and more effectively.”

Christopher Lomahquahu, an investigative reporter and Roy W. Howard fellow for AZCIR, contributed reporting.

This story was co-published with Arizona Center for Investigative Reporting.

https://www.tucsonsentinel.com/local/report/050525_heredia_resignation/director-arizona-medicaid-agency-resigns-following-fraud-scheme-response/