Recent cases highlight significant challenges and breaches of trust within programs associated with the Indian Health Service (IHS), ranging from individual misconduct to large-scale fraud schemes. These incidents, investigated and prosecuted by the Department of Justice and the Department of Health and Human Services Office of Inspector General (HHS-OIG), underscore the critical need for vigilance and accountability to safeguard patient care and the integrity of federal healthcare programs serving Native American communities.
One alarming case involves a pediatrician in North Carolina who secured a position within an IHS hospital in August 2020 without disclosing a pending investigation by the North Carolina Medicaid Board. The investigation stemmed from serious allegations, including a sexual relationship with a male patient. Despite the ongoing scrutiny and the eventual indefinite suspension of her medical license in January 2021, she was hired by IHS due to her failure to report these critical issues on her credentialing application. HHS-OIG launched an investigation, leading to a federal grand jury indictment in January 2023 on two counts of False Statement. The physician pleaded guilty and was sentenced on June 10, 2024, to time served, followed by one year of supervised release, along with financial penalties. Special Agent in Charge Linda T. Hanley of HHS-OIG emphasized the severity of the situation, stating, “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.” This case illustrates a direct threat to patient safety resulting from inadequate vetting processes within the IHS hiring system.
In another instance of financial mismanagement, the former program manager and director of the Prairie Band Potawatomi Nation’s Diabetes Prevention Program appeared in court on July 22, 2024, following an indictment for thefts related to a federally funded program. Court documents allege that between January 2023 and December 2023, the individual exploited his position to embezzle $5,000 or more in federal grant money intended for diabetes prevention within the tribal community. This case highlights the vulnerability of federal funds allocated to tribal health programs and the potential for misuse at the managerial level, diverting resources meant for vital health services.
Large-scale fraud schemes targeting programs that serve Native Americans have also been uncovered. In Arizona, United States Attorney Gary M. Restaino announced charges against seven defendants as part of the Department of Justice’s 2024 National Health Care Fraud Enforcement Action. These charges relate to schemes designed to defraud Medicare and Medicaid, specifically the Arizona Health Care Cost Containment System (AHCCCS). One significant case involves Rita Anagho and her company, Tusa Integrated Clinic LLC (TUSA), accused of fraudulently billing AHCCCS approximately $69.7 million for behavioral healthcare services. A key element of the fraud was the exploitation of AHCCCS’s American Indian Health Program (AIHP). TUSA allegedly billed for services that were either never provided or not delivered as represented, with a focus on recruiting Native Americans and other individuals to exploit the AIHP. Reports indicate widespread fraud within AIHP, involving residential and outpatient treatment centers that recruit individuals, sometimes switching patients from their existing AHCCCS plans to AIHP regardless of their Native American status. This case reveals a systemic issue of fraud within programs intended to provide healthcare to Native Americans, diverting substantial funds and potentially compromising the quality of care received by vulnerable populations.
Corruption within tribal leadership also poses a threat to the integrity of IHS-related programs. Julian Bear Runner, the former President of the Oglala Sioux Tribe, was sentenced on June 20, 2024, to 22 months in federal prison for defrauding the tribe. Between January 2019 and January 2020, Bear Runner fraudulently submitted travel vouchers for official business travel that never occurred. As a result, he received over $80,000 in advance travel payments, which he then used for personal gambling and hotel stays instead of official travel. This case was prosecuted under the Guardians Project, a federal law enforcement initiative aimed at combating corruption, fraud, and embezzlement in federal programs within Indian country. The U.S. Attorney for South Dakota emphasized the impact of Bear Runner’s actions, stating he “stole 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.” This incident underscores how corruption at the tribal leadership level can directly harm tribal communities by diverting funds intended for their welfare and development.
Efforts to ensure accountability within IHS-related healthcare are also evident in cases of whistleblower protection. A complainant employed by Tohono O’odham Nation Health Care (TONHC), a Tribal facility with a Funding Agreement with IHS, reported concerns about improper staff compensation and unsafe patient transport practices. OIG investigators found that TONHC management retaliated against the whistleblower by denying a retention bonus, issuing a letter of reprimand, and constructively discharging him. The OIG’s report to the Secretary of HHS recommended actions to compensate the complainant, highlighting the importance of protecting individuals who report potential wrongdoing within IHS-contracted facilities.
Further examples of financial misconduct include the case of the former Finance Director of Wind River Family and Community Health care, who was sentenced to prison for both assault and theft from an Indian organization. Between October 2022 and March 2023, this individual misused a company credit card for personal expenses, including firearms, furniture, and groceries, resulting in a loss exceeding $81,000. Similarly, the former operations manager of the Blackfeet Tribe admitted to stealing over $78,000 of COVID-19 relief funds. This individual falsely claimed to have purchased COVID-19 supplies for the Tribe from Amazon, receiving payment from American Rescue Plan Act funds without ever making the purchases. These cases demonstrate a pattern of financial malfeasance at various levels within tribal organizations, impacting the resources available for healthcare and community services.
These recent cases paint a concerning picture of the challenges facing the Indian Health Service and related tribal healthcare programs. From individual misconduct jeopardizing patient safety to large-scale fraud and embezzlement diverting critical funds, the need for robust oversight, stringent vetting processes, and strong accountability measures is clear. The ongoing work of HHS-OIG and the Department of Justice, through initiatives like the Guardians Project, is crucial in holding individuals accountable and safeguarding the integrity of healthcare services intended for Native American communities. These efforts are essential to ensuring that the Indian Health Service can effectively fulfill its mission of providing high-quality healthcare and improving the health status of American Indians and Alaska Natives.
