SALT LAKE CITY — A Utah woman has been sentenced to a year in jail and ordered to pay millions in restitution for her role in a Medicaid fraud and public assistance scam.
Lillian Kaye Simiskey pleaded guilty to one count of Pattern of Unlawful Activity, one count of Tax Evasion, and one count of Public Assistance Fraud. In all, the fines Simiskey is ordered to pay total $2,698,488.95.
In February 2021, the Utah Department of Health and Human Services referred a case to the Medicaid Fraud and Patient Abuse Division at the Utah Attorney General's office, alleging a provider, Measures of Affect Theoretically Relative (MATR), had submitted claims for services that were not provided by qualified professionals and were documented fraudulently.
MATR was a behavioral health company offering substance use disorder treatment with a center in Mt. Pleasant and multiple offices across the state.
Prosecutors explained that Simiskey was a board member and administrator within MATR, and that she and two others were responsible for submitting claims to Medicaid for services allegedly provided by MATR. During the period between March 11, 2019 and June 8, 2022, more than 7,700 claims were submitted, resulting in over $12.9 million being paid to MATR in Medicaid funds.
None of the services would have been paid in the Utah Medicaid program had officials known the services were being provided by unqualified individuals and that falsified information had been entered into medical records.
The Medicaid Fraud Division's investigation allegedly uncovered evidence of tax fraud and public assistance fraud. Investigators claim Simiskey evaded state tax liabilities by failing to file personal tax returns and misstating her income on others. For those offenses, Simiskey was ordered to pay restitution of $59,044.
Additionally, Simiskey received public assistance benefits for herself by failing to properly report her employment and income from MATR, with fraud resulting in the loss of $39,444.95.
At the time of the filings, prosecutors said Simiskey was the second-highest-paid worker at MATR and received compensation of over $1.7 million from January 2019 through July 2022, all while receiving public assistance benefits and failing to pay required taxes.
“When fraud like this occurs, Medicaid recipients do not receive the services they need. Many of the patients in this case were court-ordered to receive substance abuse treatment, but unbeknownst to judges and probation officers, they did not receive services from qualified providers,” Kaye Lynn Wootton, Director of the Medicaid Fraud Division, said. “Additionally, Medicaid fraud wastes taxpayer money and limits the resources available for some of the most needy individuals in our State.”
A restitution hearing for Simiskey is scheduled for January 13, where officials will evaluate Simiskey's financial declaration and establish a payment schedule for restitution payments.
