Estimated read time: 4-5 minutes
MT. PLEASANT, Sanpete County — The three top administrators involved with a substance abuse treatment center in Utah are accused of defrauding Medicaid out of nearly $13 million.
Lillian Kaye Simiskey, 40, was charged Friday in 3rd District Court with two counts of violating the Utah False Claims Act, three counts of tax evasion and public assistance fraud, all second-degree felonies; and three counts of failing to render a proper tax return, a third-degree felony.
On Tuesday, Margaret Krisandra Christie, 41, of St. George, was charged in 3rd District Court with two counts of violating the Utah False Claims Act, and public assistance fraud, second-degree felonies; and Deaun Larson Holdaway, 66, of Mount Pleasant, was charged with three counts of making false claims for medical benefits, and public assistance fraud, second-degree felonies.
The investigation began in 2021 when the Utah Attorney General's Office received a complaint from the Utah Department of Health and Human Services that the business, Measures of Affect Theoretically Relative, commonly referred to as MATR, "had submitted claims to Medicaid for services which were not provided by qualified professionals and were documented in a fraudulent manner," according to charging documents.
Prosecutors say the business was a "behavioral health company offering substance use disorder treatment" with its primary place of business in Mt. Pleasant. Outpatient services were also offered at offices in Salt Lake, Utah and Washington counties. The business became a Medicaid provider in 2018.
"Shortly after (Measures of Affect Theoretically Relative) was approved as a Medicaid provider, Medicaid revenue became the primary source of income for the company and eventually became (Measures of Affect Theoretically Relative's) sole source of income," the charges state.
From March 2019 through June 2022, Measures of Affect Theoretically Relative submitted over 500 Medicaid claims for alleged treatment, according to Medicaid claims data, charging documents state.
"Through interviews with multiple recipients and staff members, a review of medical records, and an analysis of Medicaid claims, however, investigators identified that services billed for Therapeutic Behavioral Services and Group Psychotherapy were not provided by qualified professionals, did not comply with Medicaid regulations, and were based on falsified documentation," according to the charges. "In total, over 7,700 claims were submitted for billing … from March 11, 2019, through June 8, 2022, resulting in Medicaid funds in the amount of $12,994,704.31 being paid to MATR. Medicaid representatives indicated that these services would not have been funded if the Medicaid program had known that services had been provided by unqualified individuals and that falsified information had been entered into medical records."
Simiskey, Christie and Foldaway were the three primary administrators at Measures of Affect Theoretically Relative.
"These administrators were the top three highest paid (Measures of Affect Theoretically Relative) employees," the charges state.
Simikey was the program director and oversaw the office operations of all its locations, the charges state. Between 2019 and 2022 she received $1.7 million in compensation. Christie was in charge of the St. George office, according to the charges. Holdaway "served as office manager and handled day-to-day operations in the Mt. Pleasant location."
"Prior to working at (Measures of Affect Theoretically Relative), Simiskey had worked at a turkey processing plant earning a wage of approximately $10 per hour. Simiskey had no formal education, degrees, certifications, or training related to the provision of behavioral health or substance use disorder treatment, but quickly took on a management role at (Measures of Affect Theoretically Relative)," according to the charges.
Charging documents also state that Christie "did not possess the appropriate qualifications to provide either service (therapeutic behavioral services or group psychotherapy)"; however, she "was involved in performing patient assessments, creating care plans, conducting group therapy, documenting services in the medical record, instructing workers to document false information in client medical records, and sending these records out ... to sign as if they conducted the sessions. Christie was involved in billing these fraudulent claims to Utah Medicaid for reimbursement. Christie also trained other employees in this manner and signed employee checks."
Holdaway "was the third highest paid, receiving compensation of over $1.36 million from Jan. 3, 2019, through Aug. 5, 2022. Holdaway had no formal education, degrees, or licenses which would qualify her to provide behavioral health or substance use disorder therapy," the charges state.
Prosecutors also learned Simiskey "applied for medical assistance benefits through the Division of Workforce Services, indicating on the application form neither she nor anyone in her household had earned income," the charges state.
On the date of that application, however, the charges state Simiskey received over $158,000 in checks from Measures of Affect Theoretically Relative between 2019 and 2020.
Court records state Measures of Affect Theoretically Relative ceased operations Aug. 1, 2022. But investigators believe it "ceased operations when it began being investigated and then reopened under a new name, Limitless Recovery, to continue billing Medicaid."
The charges also contend that Simiskey did not file a tax return in 2019 and reported a gross income of $48,000 in 2020 and 2021 on her tax returns.
