Fort Defiance family sentenced to prison for medical transport fraud

Late last month, U.S. District Judge Steven Logan sentenced Vestah Tikium to 33 months in federal prison, followed by three years of supervised release. Tikium’s son, Terdell Dawes, was sentenced to 24 months in federal prison, while her other son, Terrell Dawes, was sentenced to 18 months in federal prison. Tikium and her sons also were ordered to pay more than $3 million in restitution.  All three had previously pleaded guilty to conspiracy to commit health care fraud. All are residence of Fort Defiance and members of the Navajo Nation.

Tikium and her sons falsely billed Arizona’s Health Care Cost Containment System (AHCCCS) for tens of thousands of medical transports that never occurred, generating more than $3 million in fraudulent payments from AHCCCS. AHCCCS is Arizona’s Medicaid agency that offers health care programs to low-income Arizona residents.

Tikium and her sons owned and operated Diné Transport, which purported to provide non-emergency medical transportation for AHCCCS recipients on the Navajo Reservation. Approximately 95 percent of the claims submitted by Diné Transport between March 2013 and July 2013 were false.

“Health care fraud is a prevalent problem that causes higher health care costs and increased taxes for everyone,” stated Acting U.S. Attorney Elizabeth A. Strange.  “Our office will continue to work with our law enforcement partners to target those who perpetuate health care fraud, and we will prosecute them to the full extent of the law.”

“The FBI views health care fraud as a serious crime problem,” said FBI Special Agent in Charge Michael DeLeon. “It degrades the integrity of our health care system and legitimate patient care. The sentences handed down on these individuals sends a clear message to those persons who are defrauding our health insurance programs. The FBI remains committed to investigating health care fraud and bringing these individuals to justice. The FBI will continue to work aggressively with our law enforcement partners to investigate those who violate the public trust by cheating the medical insurance system.”

In the last year, five other individuals have been convicted and sentenced for perpetrating similar frauds to falsely bill AHCCCS for non-emergency medical transports that purportedly occurred on the Navajo Reservation:

* In November 2016, Sylvia Begay was sentenced to 28 months in federal prison and ordered to pay more than $2.1 million in restitution.

* Also in November 2016, Virgil Begay was sentenced to 21 months in federal prison and ordered to pay more than $1.3 million in restitution.

* In March 2017, Natasha Begaye was sentenced to probation and ordered to pay approximately $380,000 in restitution.

* Also in March 2017, Cortasha Upshaw was sentenced to probation and ordered to pay approximately $245,000 in restitution.

* In April 2017, Elseddig Musa was sentenced to 57 months in federal prison and ordered to pay more than $1.2 million in restitution.

The investigation in this case was conducted by the FBI and the AHCCCS Office of Inspector General, with assistance from the Navajo Nation Police Department.

The prosecution was handled by Bridget Minder and Peter Sexton, Assistant U.S. Attorneys, District of Arizona, Phoenix.