SALT LAKE CITY (KUTV) -- A woman was sentenced and ordered to pay more than $2.5 million in restitution after she assisted in defrauding Medicaid of nearly $13 million.
Lillian Kaye Simiskey was sentenced to nearly a year in jail.
She pleaded guilty to a pattern of unlawful activity, a second-degree felony; tax evasion, a third-degree felony; and public assistance fraud, a third-degree felony.
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A restitution hearing was scheduled for Jan. 13, 2026, to evaluate Simiskey's financial declaration and establish a payment schedule.
The investigation began in February 2021, when the Utah Attorney General's Office received a complaint from the Utah Department of Health and Human Services regarding concerns over Measures of Affect Theoretically Relative (MATR) -- a behavioral health company offering substance use disorder treatment -- submitting false claims to Medicaid.
Simiskey was a member of the board and an administrator within MATR. She, along with two others, was responsible for submitting more than 7,700 claims to Medicaid.
"In total, over 7,700 claims were submitted to Medicaid throughout the period of March 11, 2019, through June 8, 2022, resulting in Medicaid funds in the amount of over $12.9 million being paid to MATR," the Utah Attorney General's Office said. "None of these services would have been paid if the Utah Medicaid program had known that services had been provided by unqualified individuals and that falsified information had been entered into medical records, by Simiskey and others."
Medicaid's Fraud Division also identified evidence of tax and public assistance fraud.
Simiskey reportedly failed to file some personal tax returns and mistated her income on others. She also reportedly received public assistance benefits for herself by failing to properly report her employment and income from MATR.
"In reality, Simiskey was the second highest paid worker at MATR, receiving compensation of over $1.7 million from January 2019, through July 2022, all while she was receiving public assistance benefits and failing to pay required taxes," the Utah Attorney General's Office said. "Simiskey will pay $2.6 million in restitution to Medicaid, $59,044 to the Utah Tax Commission, and $39,444.95 to the Utah Department of Workforce Services."
Kaye Lynn Wootton, Director of the Medicaid Fraud Division, said that when fraud like this happens, 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," she said. "Additionally, Medicaid fraud wastes taxpayer money and limits the resources available for some of the most needy individuals in our State."