SALT LAKE CITY — A Utah woman has been sentenced to one year in jail and ordered to pay nearly $2.7 million in restitution after pleading guilty to her role in a large-scale Medicaid and public assistance fraud scheme, state prosecutors announced.
Lillian Kaye Simiskey pleaded guilty to Pattern of Unlawful Activity, Tax Evasion, and Public Assistance Fraud. According to court documents, she must pay a total of $2,698,488.95 in fines and restitution.
The case began in February 2021, when the Utah Department of Health and Human Services referred a complaint to the Medicaid Fraud and Patient Abuse Division at the Utah Attorney General’s Office. Investigators alleged that a behavioral health provider, Measures of Affect Theoretically Relative (MATR), had submitted fraudulent claims for substance use disorder treatment services that were not performed by qualified professionals.
Prosecutors said Simiskey, a board member and administrator at MATR, was directly involved in submitting more than 7,700 false Medicaid claims between March 2019 and June 2022, resulting in over $12.9 million in Medicaid payments to the company.
Officials stated that none of these claims would have been reimbursed if Medicaid administrators had known the services were falsified or performed by unqualified individuals.
The investigation also revealed that Simiskey failed to file accurate tax returns and fraudulently received public assistance benefits while earning over $1.7 million in compensation from MATR. She was ordered to repay $59,044 for tax evasion and $39,444.95 for improperly obtained public assistance benefits.
“When fraud like this occurs, Medicaid recipients do not receive the services they need,” said Kaye Lynn Wootton, Director of the Medicaid Fraud Division. “Medicaid fraud wastes taxpayer money and limits resources for the most vulnerable individuals in our state.”
A restitution hearing for Simiskey is set for January 13, when officials will review her financial disclosures and establish a formal payment schedule for the ordered restitution.
