Fort Defiance couple sentenced to prison for health care fraud

Posted by Navajo Times | Dec 1, 2016 | News |

PHOENIX

A Fort Defiance, Arizona, couple was sentenced last week after pleading guilty to bilking the state of Arizona’s Medicaid system out of $3.5 million in fraudulent medical transport payments.

Sylvia Begay, 50, was sentenced by U.S. District Judge G. Murray Snow to 28 months in federal prison, followed by a three-year term of supervised release, and ordered to pay more than $2.1 million in restitution.

Virgil Begay, 53, got 21 months in federal prison followed by a three-year term of supervised release, and was ordered to pay more than $1.3 million in restitution.

The Begays generated millions of dollars in fraudulent payments to themselves by falsely billing Arizona’s Health Care Cost Containment System for tens of thousands of medical transports that never occurred. AHCCCS is Arizona’s Medicaid agency that offers health care programs to Arizona residents who meet certain income and other requirements.

The Begays owned and operated companies that provided non-emergency medical transportation for AHCCCS recipients on the Navajo reservation. From December 2010 through May 2013, Sylvia Begay’s company, Hozho Nahasdlii Health Care at Home, submitted more than 24,000 false claims to AHCCCS for medical transports that never occurred, generating approximately $2,174,207 in fraudulent payments. From May 2012 through May 2013, Virgil Begay’s company, Beauty Way Transport, submitted more than 16,000 false claims to AHCCCS for medical transports that never occurred, generating approximately $1,367,588 in fraudulent payments.

The investigation was conducted by the Federal Bureau of Investigation. The prosecution was handled by Bridget Minder and Peter Sexton, assistant U.S. attorneys, District of Arizona, Phoenix.