Indian Health and Human Services
Fighting fraud in Indian Health and Human Services programs is an OIG priority. OIG also investigates retaliation complaints filed by employees of HHS contractors and grantees who report fraud. Below are some examples of investigations and enforcement actions:
2024
A North Carolina pediatrician applied for a job with the Indian Health Service while she was under investigation by the North Carolina Medicaid Board for having a sexual relationship with a male patient, among other allegations. She failed to disclose this on her credentialing application and was hired to work in an IHS hospital in August 2020. In January 2021, her medical license was indefinitely suspended. HHS OIG investigated, and she was indicted on two counts of False Statement by a federal grand jury in January of 2023. She pleaded guilty on June 10, 2024. was sentenced to time served, followed by one year of supervised release, and ordered to pay a $100 special assessment to the Federal Crime Victims Fund and $22,832.00 in restitution. “This physician sentenced in this case lied to conceal the fact that she was under investigation for sexual misconduct allegations when applying for a position in the Indian Health Service, thus jeopardizing patient safety through her dishonesty,” said Special Agent in Charge Linda T. Hanley of the Department of Health and Human Services Office of Inspector General (HHS-OIG). “HHS-OIG will continue to hold accountable those who undermine the integrity of federal health care programs to ensure that patients are provided quality care by appropriately licensed providers.”
https://www.justice.gov/usao-sd/pr/north-carolina-woman-sentenced-making-false-statements
On July 22, 2024, the former program manager and director of the Prairie Band Potawatomi Nation’s Diabetes Prevention Program made a court appearance following his indictment for thefts concerning a program receiving federal funds. According to court documents, between January 2023 and December 2023, he is accused of using his position to embezzle $5,000 or more in federal grant money. On July 22, 2024, the former program manager and director of the Prairie Band Potawatomi Nation’s Diabetes Prevention Program made a court appearance following his indictment for thefts concerning a program receiving federal funds. According to court documents, between January 2023 and December 2023, he is accused of using his position to embezzle $5,000 or more in federal grant money.
https://www.justice.gov/usao-ks/pr/topeka-man-charged-embezzlement
PHOENIX, Ariz. – Today, United States Attorney Gary M. Restaino announced criminal charges against seven defendants in connection with alleged schemes to defraud Medicare and Medicaid (specifically AHCCCS, the Arizona Health Care Cost Containment System). The charges filed in federal court are part of the Department of Justice’s 2024 National Health Care Fraud Enforcement Action.
The charges in these cases stem from schemes to obtain, in the aggregate, hundreds of millions of dollars in fraudulent billings. For example, Rita Anagho, acting primarily though her company, Tusa Integrated Clinic LLC (“TUSA”), was charged for fraudulently billing AHCCCS approximately $69.7 million for behavioral healthcare services. ANAGHO primarily targeted AHCCCS’s American Indian Health Program (“AIHP”) and billed for services that were never provided or not provided as represented. AHCCCS provides health care services to Native Americans through AIHP, and there has been widespread fraud reported in which residential and outpatient treatment centers recruited Native Americans and other individuals to exploit the AIHP under AHCCCS. Many of the patients recruited for TUSA were Native Americans or other individuals who were enrolled in AIHP, and in some cases, patients were switched from their existing AHCCCS insurance plan to AIHP, regardless of whether the patient was Native American.
https://www.justice.gov/usao-az/pr/seven-charged-arizona-part-department-justices-2024-national-health-care-fraud
On June 20, 2024, Julian Bear Runner was sentenced to 22 months in federal prison, followed by three years of supervised release, and ordered to pay a $800 special assessment to the Federal Crime Victims Fund and $82,483.71 in restitution to the Oglala Sioux Tribe.
Between January of 2019 and January of 2020, at Pine Ridge, Bear Runner, while acting in his capacity as President of the Oglala Sioux Tribe, fraudulently submitted travel vouchers for official business travel and received payment for travel that he was not entitled to as he was not actually traveling. As a result of the fraudulently submitted travel authorizations, Bear Runner received more than $80,000 in advance travel payments but did not go on the travel. Instead, Bear Runner cashed the checks at a casino, gambled, and stayed in local hotels.
This case was brought pursuant to the Guardians Project, a federal law enforcement initiative to coordinate efforts between participating agencies, to promote citizen disclosure of public corruption, fraud, and embezzlement involving federal program funds, contracts, and grants, and to hold accountable those who are responsible for adversely affecting those living in South Dakota's Indian country communities. The Guardians Project is another step of federal law enforcement's on-going efforts to increase engagement, coordination, and positive action on behalf of tribal communities. Led by the U.S. Attorney's Office, the participating agencies include: the FBI; the Offices of Inspector General for the Departments of Interior, Health and Human Services, and other Federal OIGs.
https://www.justice.gov/usao-sd/pr/former-oglala-sioux-tribe-president-sentenced-federal-prison
A former Oglala Sioux Tribal President was convicted of stealing thousands of dollars in official travel funds for trips he did not take. Instead, he spent the funds to gamble at a local casino and stayed at local hotels. As the US Attorney for South Dakota stated, the former President, "[s]tole more than $80,000 from the Oglala Sioux Tribe, embezzling money that could have been used to improve life for those living throughout the Pine Ridge Reservation."
https://www.justice.gov/usao-sd/pr/former-oglala-sioux-tribe-president-convicted-wire-fraud-larceny-and-embezzlement
The complainant was employed by Tohono O'odham Nation Health Care (TONHC), a Tribal facility that has a Funding Agreement with IHS. He alleged that he raised concerns with TONHC management officials that staff received improper compensation for hours they did not work and that patients were transported to the radiology department in an unsafe matter. OIG investigators found that management officials denied complainant's retention bonus, issued a clarification of expectations letter, and subsequently constructively discharged him in retaliation for making protected disclosures. OIG's investigatory report, provided to the Secretary of HHS, included recommendations for appropriate action to compensate the complainant.
https://oig.hhs.gov/fraud/whistleblower/whistleblower-retaliation-investigation/findings-of-whistleblower-retaliation-by-indian-health-service-contractor-management/
On January 24 the United States Attorney for Wyoming announced the sentencing of the former Finance Director of Wind River Family and Community Health care to 36 months in prison for assault resulting in serious bodily injury. Separately, the defendant was sentenced to 24 months in prison for theft of an Indian organization. The sentences will be served concurrently. The defendant was also ordered to pay over $81,000 in restitution. According to court documents, from about October 1, 2022 through March 31, 2023, the defendant used a company credit card for personal expenses including firearms, furniture and groceries.
https://www.justice.gov/usao-wy/pr/arapahoe-man-sentenced-assault-resulting-serious-bodily-injury-and-theft-indian
On 1/31/2024 the U.S. Attorney's Office, District of Montana announced that the former operations manager of the Blackfeet Tribe admitted to stealing more than $78,000 of COVID-19 relief funds. The former staffer allegedly claimed repayment for buying COVID-19 supplies from Amazon for the Tribe. However, he never purchased the supplies and was paid from American Rescue Plan Act funds that had been allocated to the Tribe. https://www.justice.gov/usao-mt/pr/former-blackfeet-tribal-operations-manager-admits-stealing-tribal-covid-19-relief
2023
On 2/27/23, the United States Attorney for South Dakota announced the indictment of a former President to the Oglala Sioux Tribe for wire fraud, larceny, embezzlement. and theft from an Indian Tribal Organization. According to the 7/21/22 indictment, "[b]eginning in January 2019 and continuing through January 2020," the former President "began scheduling official travel and receiving checks for related costs when in fact he was not traveling or incurring the costs of airline flights, hotels, or food. Despite knowing he had not traveled and that he was not entitled to the travel funds," he "fraudulently submitted vouchers claiming he was going to travel and was entitled to travel funds." He "would then take the travel checks and would use the embezzled funds for his own personal use, including cashing the checks and spending the funds at the Prairie Wind Casino on the Pine Ridge Reservation."
https://www.justice.gov/usao-sd/pr/former-oglala-sioux-tribe-president-indicted-wire-fraud-and-embezzlement
2022
The Director of the Ponca Tribe's Domestic Violence Department was convicted of embezzlement and theft from an Indian tribal organization and ordered to serve 4 years' probation and pay $19,431.57 in restitution. The employee created false reimbursement requests indicating they were intended to pay for medical bills, grocery bills, and home furnishing and décor-related expenses for certain tribal domestic violence victims. She then signed the final authorization for the reimbursement of these bills from tribal grant funds provided by the federal government pursuant to the Victims of Crimes Act. In truth, the bills being reimbursed were not expenses incurred by tribal domestic violence victims. Instead, they were for her own personal bills.
https://www.justice.gov/usao-ne/pr/norfolk-woman-convicted-two-counts-embezzlement-and-theft-indian-tribal-organization
A Tribal member who worked for the Tribe was indicted for theft of funds from a Federal program and embezzling at least $5,000 from the Oglala Sioux Tribal Health Administration.
Pine Ridge Woman Pleads Not Guilty to Embezzlement and Theft from Indian Tribal Organization
A Tribal member was sentenced to 9 year in prison for obtaining and distributing fentanyl and hydrocodone pills on the Pine Ridge Indian Reservation.
https://www.justice.gov/usao-sd/pr/kyle-woman-sentenced-nine-years-federal-prison
A Tribal member was convicted of possession with intent to distribute a controlled substance after distributing hydrocodone on an Indian Reservation.
https://www.justice.gov/usao-sd/pr/rapid-city-man-sentenced-drug-distribution
2021
A former IHS physician was sentenced to 10 years in prison followed by 5 years of supervised release, a $35,000 fine and a $500 special assessment for sexually abusing five female patients--- often after locking the door of the examination room. He also threatened to withhold medications or care from some of them unless they complied with his sexual demands. These incidents occurred between 2007 and 2018.
https://www.justice.gov/usao-sd/pr/former-indian-health-service-doctor-sentenced-120-months-imprisonment-abusive-sexual
A South Dakota tribal member was addicted to prescription controlled substances and was no longer able to obtain controlled substances as a result of her behavior. She assaulted other IHS beneficiaries, including her minor children, in order to obtain prescriptions from medical providers for the injuries she intentionally inflicted. As a result of her actions, three victims lost four fingers to amputation. She fabricated stories as to how the individuals received their injuries, and also provided false statements to health care providers in order to obtain controlled substances and health care benefits. Once the individuals received controlled substances, she took the controlled substances, despite the individuals having significant bodily injuries. On October 22, 2021, she was sentenced to 12 years in prison.
https://www.justice.gov/usao-sd/pr/mission-woman-sentenced-12-years-federal-prison
The former Executive Director of Ain Dah Ing, a Wisconsin halfway house serving Native Americans suffering from addiction and substance abuse disorders was sentenced to two years for theft of federal funds. The center's former bookkeeper received a one year sentence. Both defendants were ordered to pay $777,283 in restitution. The center was funded by an IHS contract and the defendants embezzled 67% of the programming funding over a ten-year period and gambled away most of the money.
https://www.justice.gov/usao-wdwi/pr/two-sentenced-embezzling-over-777000-native-american-addiction-counseling-center
A former paramedic pled guilty to stealing hundreds of vials of fentanyl, morphine and hydromorphone from the Rosebud Ambulance Service and Crow Creek Ambulance Service He consumed all the stolen substances. He was sentenced to one month in Federal prison, one year of supervised release, a special assessment to the Federal Crime Victims Fund in the amount of $100, and restitution in the amount of $4,428.98.
https://www.justice.gov/usao-sd/pr/rosebud-man-sentenced-obtaining-controlled-substances-deception
A former IHS doctor who managed the hospital's diabetes program, used his ability to prescribe an expensive diabetes drug that was unavailable in the IHS pharmacy, to obtain $45,540 in kickback from private pharmacies that filled the prescriptions. The doctor pled guilty to a federal conflict of interest violation and was sentenced to three months in prison, two years of supervised release, and a $10,000 fine.
https://www.justice.gov/usao-mt/pr/ex-indian-health-services-doctor-sentenced-prison-fined-drug-kickback-scheme-while
2020
A tribal member was charged with assaulting five individuals with rocks on the reservation for the purpose of committing health care fraud. These assaults resulted in serious bodily injury and required three of the victims to suffer finger amputations. It is further alleged that she also committed health care fraud by giving fraudulent information concerning the intentional assaults in order to obtain services and controlled substances, namely Hydrocodone.
https://www.justice.gov/usao-sd/pr/pine-ridge-woman-charged-twenty-felonies
A former IHS physician pled guilty to conflict of interest charges. He had been in charge of the diabetes program at an IHS hospital in Montana and prescribed an expensive diabetes drug that was not on the IHS formulary and not available at the hospital's pharmacy. Court documents reflect that Dr. Devous solicited multiple pharmacies in Montana to fill expensive prescriptions in exchange for Dr. Devous receiving a "cut" of the profits and kickbacks. The pharmacy paid the doctor $45.540 during a six-month period.
(September 10, 2020; U.S. Attorney's Office, District of Montana)
https://go.usa.gov/xGk3D
A former Blackfeet Tribal Chairman was sentenced to 10 months in prison and ordered to pay $174,000 in restitution for taking part in an overtime scheme to steal Tribal Head Start funds. His wife, the former Head Start personnel manager, was previously sentenced to 9 months in prison. The theft resulted in a loss of funds to pay for books, learning materials and nutritional programs. According to Court records, the former Chairman approved overtime claims that he know were false. Outside auditors questioned the overtime claims, identifying them as, " beyond necessary and reasonable," and lacking any supporting documentation. The Tribe also conducted a review and repaid $250,620 to HHS for disallowed costs and other expenses. In the press release, the United States Attorney for the District of Montana, remarked, "The theft of $174,000 hurt the children enrolled in Head Start by prohibiting the purchase of books, barring the ability to obtain teaching materials and cutting food nutrition programs for those who need it most. We will continue to ensure that federal funds are used for the needs of those intended, especially children."
https://www.justice.gov/usao-mt/pr/ex-blackfeet-tribal-leader-sentenced-prison-head-start-program-fraud
A former IHS doctor was indicted on four Counts of Sexual abuse and four Counts of Abusive Sexual Contact involving four adult patients. The alleged abuse took place in 2017 and 2018 at the Wagner Indian Health Service Clinic in South Dakota.
https://www.justice.gov/usao-sd/pr/former-indian-health-services-doctor-indicted-multiple-counts-sexual-abuse-and-abusive
A former IHS doctor was indicted for having a conflict of interest by prescribing a diabetes drug in exchange for kickbacks. The doctor allegedly prescribed a medication that was not on the IHS formulary and entered into a business arrangement with an outside pharmacy to sell the drug. Under the arrangement, the doctor, his wife and a person with whom he had been negotiating for future employment, would receive 80% of the profits from the sale of the drug. This arrangement resulted in a receipt of about $45,590.
https://www.justice.gov/usao-mt/pr/former-indian-health-services-doctor-charged-conflict-interest
After his September 2019 conviction in South Dakota for multiple sex offenses against children while serving as a pediatrician in the Indian Health Service, Stanley Patrick Weber was sentenced on 2/10/2020 to 5 consecutive life sentences in Federal prison for the five aggravated sexual abuse charges, and 15 years on each of the three counts of sexual abuse of a minor. Weber was also ordered to pay $800,000 in criminal fines and an $800 special assessment to the Federal Crime Victims Fund. After the sentencing, U.S. Attorney Ron Parsons stated, "[n]ow, as one nation, one community, and one family, we must come together and do everything in our power to ensure that nothing like this can ever be done to any of our precious children again."
https://www.justice.gov/usao-sd/pr/convicted-former-pine-ridge-indian-health-service-pediatrician-sentenced-five-consecutive
2019
A former Northern Cheyenne Tribal President and Tribal Health Director who had pleaded guilty to wire fraud and false claims conspiracy for submitting fraudulent travel invoices to tribal, state and federal agencies, was sentenced to six months in prison and ordered to pay restitution. At the sentencing the judge stated that the defendant, "exploited his positions as the tribe's health director and then as its president to steal funds intended to benefit tribal members and programs for his own personal enrichment." The case is part of the Guardians Project, a multi-agency anti-fraud task force in Montana.
https://www.justice.gov/usao-mt/pr/ex-northern-cheyenne-tribal-president-sentenced-six-months-prison-travel-fraud-scheme
Idaho company All Around Sports, LLC, its owner, and two supervisors were sentenced on November 18, 2019 following their guilty pleas of Wire Fraud and Conspiracy to Commit Wire Fraud against the Oglala Sioux Tribe. The sales manager was sentenced to two years in prison while the other two defendants received sentences of home detention followed by probation. The company was sentenced to three years of probation and was ordered to pay a $42,000 fine. The owner, sales manager and company also were ordered to pay restitution to two Alaskan Native entities. The cases were brought pursuant to the South Dakota U.S. Attorney's Office's Guardians Project, a federal law enforcement initiative with coordinated efforts between participating agencies that investigates fraud involving federal program funds. The Oglala Sioux Tribe receives funding from the Indian Health Service.
https://www.justice.gov/usao-sd/pr/owner-and-supervisors-idaho-company-sentenced-federal-court-fraud-convictions
Former Indian Health Service pediatrician found guilty by a federal jury of five counts of Aggravated Sexual Abuse and three counts of Sexual Abuse of a Minor following a week-long jury trial in Rapid City, South Dakota. Evidence at trial established that Dr. Stanley Patrick Weber, while employed as a pediatrician with the Indian Health Service at Pine Ridge, sexually abused minors between 1999 and 2011.
https://www.justice.gov/usao-sd/pr/former-pine-ridge-indian-health-services-pediatrician-convicted-multiple-sex-offenses-0
A former Northern Cheyenne Tribal President and Tribal Health Director pleaded guilty to wire fraud and false claims conspiracy for submitting fraudulent travel invoices to tribal, state and federal agencies, including HHS. Prosecutors estimate that he received $20,000 in improper reimbursements.
https://www.justice.gov/usao-mt/pr/ex-northern-cheyenne-tribal-president-admits-travel-fraud-scheme
Boise, Idaho based sports poster company, All Around Sports, LLC, pleaded guilty to a federal wire fraud conspiracy charge involving the fraudulent transfer of funds from victim bank accounts located in South Dakota and Alaska. Additionally, the owner of All Around Sports, LLC pleaded guilty to wire fraud against the Oglala Sioux Tribe by unlawfully withdrawing $54,000 from the Tribe's bank account. The Tribe receives funding from the Indian Health Service.
https://www.justice.gov/usao-sd/pr/us-attorney-s-guardians-project-results-multiple-defendants-facing-federal-charges-and
Three former management employees of the Blackfeet Tribe's Head Start program were sentenced to prison and ordered to pay restitution for perpetrating a 15-month-long fraudulent overtime pay scheme. The theft of the Head Start funds resulted in the program not being able to purchase books and teaching materials. In addition, the program had to makes cuts in the children's nutrition program.
https://www.justice.gov/usao-mt/pr/three-ex-employees-blackfeet-tribe-s-head-start-program-sentenced-theft-fraud
2018
On 9/24/2018, five former Tribal Council members and tribal employees, who had been convicted of using health care funds from an IHS contract to pay themselves bonuses, were sentenced to 5 years' probation and ordered to pay restitution. Subsequently on 10/17/2018, a former Tribal Chairman and three former Council members. who had pled guilty to using health care funds to obtain bonuses, were also sentenced to 5 years' probation and restitution. In both instances, the funds used to pay bonuses were supposed to be used for providing health care to tribal members.
- https://www.justice.gov/usao-ne/pr/former-omaha-tribal-council-members-and-employees-sentenced
- https://www.justice.gov/usao-ne/pr/former-omaha-tribal-chairman-and-council-members-sentenced
Two employees of the Blackfeet Tribe's Head Start Program pled guilty to stealing money by fraudulently claiming overtime. The tribe conducted an internal review and paid HHS for disallowed costs and other expenses.
https://www.justice.gov/usao-mt/pr/blackfeet-tribe-s-head-start-program-employees-admit-theft-fraud-charges
Former IHS employee was convicted of making a false statement on a Confidential Financial Disclosure Report in connection with a $5,000 payment from Dr. Stanley Patrick Weber.
https://www.justice.gov/usao-sd/pr/nebraska-woman-sentenced-making-false-statement
Former CFO of Rocky Boy Health Clinic sentenced for wire fraud in connection with issuing checks to herself from the clinic's employee loan programs.
https://www.justice.gov/usao-mt/pr/former-chief-financial-officer-rocky-boy-health-clinic-sentenced-prison
Patient sentenced for a falsely alleging that an IHS physician engaged in sexual conduct against him.
https://www.justice.gov/usao-sd/pr/kyle-man-sentenced-making-false-statement
2017
The Confederated Tribes of the Colville Reservation voluntary settled allegations of false Medicaid claims and agreed to a Voluntary Tribal Compliance Agreement with the HHS OIG.
https://www.justice.gov/usao-edwa/pr/confederated-tribes-colville-reservation-enter-false-claims-act-and-voluntary
Indictment of Stanley Patrick Weber related to charges of sexually abusing minors while employed by IHS.
https://www.justice.gov/usao-sd/pr/spearfish-man-indicted-multiple-sex-offenses
2016
A contractor working on the Rocky Boys Indian Reservation was convicted of Wire Fraud and Bribery for participating in a "pay to play" scheme whereby the contractor gave $50,000 to the tribal official after receiving a $200,000 progress payment of federal funds.
https://www.justice.gov/usao-mt/pr/billings-businessman-and-construction-company-convicted-pay-play-scheme-rocky-boy-s
A patient of the Fort Thompson Indian Health Service Hospital was convicted of False Statement Relating to Health Care Matters after altering his prescription in order to increase the number of opioids for dispensing at the hospital's pharmacy.
https://www.justice.gov/usao-mt/pr/billings-businessman-and-construction-company-convicted-pay-play-scheme-rocky-boy-s
Five tribal employees agreed to a civil False Claims Act settlement for taking federal funds from the Oglala Sioux Tribe's Low Income Home Energy Assistance Program (LIHEAP) and agreed to pay $84,000 in restitution. All five had previously been convicted of Conspiracy to Commit Theft of Federal Funds
https://www.justice.gov/usao-sd/pr/settlements-totaling-84000-reached-five-individuals-who-committed-fraud
-
Montana Man Sentenced For Health Care Fraud
(October 24, 2014; U.S. Attorney; District of South Dakota)
A Colstrip, Montana, man convicted of Health Care Fraud was sentenced on October 16, 2014. Dean L. Hodges, age 59, was sentenced to 2 years of probation, ordered to pay a $100 special assessment to the Federal Crime Victims Fund, and restitution in the amount of $686.
Read the Full News ReleaseRapid City Man Sentenced For Theft From Indian Health Services
(October 16, 2014; U.S. Attorney; District of South Dakota)
A Rapid City, South Dakota, man convicted of Theft or Embezzlement in Connection with Health Care was sentenced on October 16, 2014. Michael Gray, age 59, was sentenced to 2 years of probation, ordered to pay a $100 special assessment to the Federal Crime Victims Fund, and restitution in the amount of $6,476.42.
Read the Full News ReleaseFour Individuals Sentenced In Federal Program Fraud Case
(July 24, 2014; U.S. Attorney; District of South Dakota)
Four individuals convicted of Conspiracy to Commit Theft Concerning Programs Receiving Federal Funds or Theft Concerning Programs Receiving Federal Funds have been sentenced. Gerald T. Roy, Special Agent in Charge, Health and Human Services/Office of Inspector General, Office of Investigations, Kansas City, MO, stated, "Individuals who choose to misappropriate HHS funds intended for those in dire need will continue to be pursued by the OIG and their law enforcement partners."
Read the Full News ReleaseFormer Blackfeet Po'Ka Project Officials Sentenced For Massive Grant Fraud HHS Inspector General Claims $4.6 Million In Potential Fraud
(June 24, 2014; U.S. Attorney; District of Montana)
Former officials of the Blackfeet Tribe's Po'Ka Project, a multi-million dollar federally funded effort to address the needs of troubled youth on the reservation, were sentenced in federal court in Great Falls, MO.
Read the Full News ReleaseCalifornia Rural Indian Health Board Inc. Settles False Claims Act Lawsuit
(April 30, 2013; U.S. Attorney; Northern District of California)
The California Rural Indian Health Board Inc. (CRIHB), a nontribal entity and grantee of the U.S. Department of Health and Human Services Substance Abuse and Mental Health Services Administration (SAMSHA), agreed to pay the United States $532,000, and to be terminated from an existing SAMHSA grant, thereby relinquishing funds valued at over $4.6 million. In addition, CRIHB will be subject to certain administrative conditions imposed by SAMHSA, and will not be eligible to apply for any new SAMHSA funding opportunities for two federal fiscal years.
Read the Full News Release