SLC woman ordered to pay $2.6 million in Medicaid fraud case

SALT LAKE COUNTY, Utah (ABC4) — A Salt Lake City woman has been convicted for violations of the Medicaid False Claims Act, Tax Fraud, and Public Assistance Fraud.

Lillian Kaye Simiskey, 41, was found guilty earlier this month of one count of Pattern of Unlawful Activity (a second-degree felony), tax evasion (a third-degree felony), and public assistance fraud (a second-degree felony).

Simiskey was first charged in March 2024 after an investigation revealed her involvement in Medicaid fraud.

According to court documents, Simiskey was a board member and administrator at a Medicaid provider that offered substance use disorder treatment. Alongside two other employees, Simiskey submitted claims to Medicaid for services that were documented in a fraudulent manner and were not provided by qualified professionals.

The investigation was conducted by the Medicaid Fraud Division at the Office of the Utah Attorney General.

They found that Simiskey and the other individuals submitted over 7,700 fraudulent claims to Medicaid between March 11, 2019, and June 8, 2022. Each of those claims would reportedly not have been paid for by the Utah Medicaid program, but they resulted in $12.9 million being paid to the provider that Simiskey worked for.

Reportedly, Simiskey also failed to properly report her employment and income and failed to pay the appropriate taxes for her income.

This week, Simiskey was ordered to pay a total of $2,698,488.95 in restitution. $2.6 million will be paid to Medicaid, $59,044 will be paid to the Utah Tax Commission and $39,444.95 will be paid to the Utah Department of Workforce Services.

In regard to this case, the Director of the Medicaid Fraud Division Kaye Lynn Wootton said “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.”

Wooton added, “Medicaid fraud wastes taxpayer money and limits the resources available for some of the most needy individuals in our State.”