They continued, “Oregon has strong protections in place to prevent fraud, waste, and abuse, ensuring taxpayer dollars are used responsibly—to meet the health care needs of children, seniors, and low-income families across the state. OHA works closely with federal and state partners to conduct rigorous investigations, identify wrongdoing and hold people accountable. Protecting the integrity of this program is central to our mission and the sustainability of our health care system.”

An OHA spokesperson said, “OHA also shares the goal of reducing healthcare costs. Families in Oregon and across the nation are experiencing real cost pressure across the healthcare system. Providers, especially in rural communities, are under strain, while patients face rising premiums and coverage loss. OHA supports serious oversight and accountability and remains focused on solutions that protect access, strengthen affordability, and help people get the care they need.”

“What I learned when I spoke to the CCOs is that once there was a period of time, I think, when they were trying to enroll behavioral health organizations rapidly, and I think they let the guardrails down,” said Diehl. “And so, what they were doing is, if the Behavioral Health Organization was enrolled in the Health Authority, they could bill Medicaid. So, they weren’t doing any credentialing. They weren’t doing certificates of authority for these organizations.”

Among other reports, the letter cited a request from Diehl to the Oregon Department of Justice and ODHS last year for an investigation into Uplifting Journey LLC, a sober living facility in Lake Oswego that opened in 2023. Diehl said the facility was reported to have received more than $2.3 million in Medicaid funds in under one year, while allegedly housing Tren de Aragua (TdA) gang members involved in serious crimes.

The committee is asking Kotek and Wendt to respond to a list of questions by March 17, including actions being taken to assess and address fraud risk, what program integrity measures are currently in place, steps to disenroll fraudulent Medicaid providers, how providers are screened for compliance with federal law, and information about improper payments and recovery efforts in Oregon’s Medicaid program.

“Despite multiple red flags — including repeated police calls to the property, violent criminal charges, and reports of fraud — the Oregon Health Authority (OHA) appears to have taken no effective action. Its offices certified the company, processed daily reimbursement claims, and then offered contradictory statements about whether any enrollment agreement even existed,” he wrote.

“This kind of fraud is, to me, the worst kind of fraud,” Diehl said. “This is defrauding the most vulnerable people in our community. I mean, seniors and children and people with disabilities; that’s who they’re taking the money from. So, I’m very glad that the feds are looking into this, and I hope that the Health Authority takes it seriously.”

A spokesperson for OHA confirmed that to KATU in a statement saying, “Oregon Health Authority (OHA) has been in direct contact with the representative and will share additional information as it becomes available. More than 1.4 million people in Oregon rely on Medicaid, and OHA takes responsibility to safeguard the program very seriously.”

The U.S. House Committee on Energy and Commerce emphasized that “ensuring Medicaid program integrity is critical to preserving access to vital health care services for those that need it most. Every dollar stolen from the Medicaid program by fraudsters is taken from children, pregnant women, the elderly, and people with disabilities.”

His requisition comes three days after the U.S. House Committee on Energy and Commerce sent a letter to Gov. Tina Kotek, D-Oregon, and ODHS Director Lisel Wendt, demanding information “related to program integrity and fraud, waste, and abuse (FWA)” in Oregon’s Medicaid program, also known as the Oregon Health Plan.

After the alleged crimes committed by supposed TdA gang members, Uplifting Journey shut down the halfway house and Portland office, while one of the founders, Julius Maximo, registered another company, Restorative Journey in Southwest Portland, that was quickly approved for Medicaid reimbursement by OHA.

“I reached out to the Health Authority to understand how they qualified these suppliers,” Diehl said. “And basically, what I learned is Uplifting Journey was enrolled by the Health Authority, but they didn’t appear to ever receive any credentialing from the CCO (coordinated care organization).”

“The people of Oregon — particularly our most vulnerable citizens who depend on Medicaid for care — deserve better stewardship of their tax dollars and stronger protection from fraud,” Diehl said. “This case has shaken public confidence and highlights the urgent need for independent oversight.”

“Defrauding Medicaid is theft from children, the elderly, disabled individuals, and those battling addiction,” he said. “I reiterate my call for a thorough state and federal investigation, full audits of provider enrollment and credentialing, and recovery of misspent funds.”

The letter was sent in response to recent investigations into Medicaid fraud in other states, including Minnesota. The committee informed Kotek and Wendt that they are examining Oregon’s Medicaid program, among other states, to rule out FWA.

LAKE OSWEGO, Ore. (KATU) — Oregon Rep. Ed Diehl, R-Stayton, is once again urging the Oregon Department of Justice and the U.S. Department of Health & Human Services to investigate reports of Medicaid fraud and mismanagement across the state.

“The company received its first Medicaid payment the day after the attempted murder tied to Uplifting Journey,” Diehl said. “Other ‘managing employees’ listed in its filings appear to have little or no verifiable connection to Oregon.”

KATU was able to contact at least two neighbors who confirmed calls had been made to Lake Oswego police in regard to the facility and the property. Neighbors also said they frequently saw women entering through the back of the house.

In September, Diehl stressed concerns over the Oregon Health Authority’s decision to continue payments to the company despite concerns and what systems are in place to ensure behavioral health providers are legitimate and qualified.

They continued, “It is the duty of states to design Medicaid programs with adequate fraud control measures and work with [the Centers for Medicare and Medicaid] to swiftly identify and address vulnerabilities in programs.”

One of those alleged members is reported to have been arrested for kidnapping and attempted murder of a woman in Washington. Court documents connected them to the facility in Lake Oswego.

The committee informed the governor and Wendt that they found “recent fraud investigations and convictions related to Oregon Health Plan [that] are concerning.”

KATU has reached out to Kotek and ODHS, as well as to the owner of the facility facing the allegations. We are awaiting responses.

According to Diehl, OHA has not told him whether an investigation is ongoing, but said they are in contact.

CCOs are “a mandatory delivery model for the Oregon Health Plan," according to OHA.

Diehl wrote to the Oregon Department of Justice and ODHS in September.

Diehl said this “congressional scrutiny” is long overdue.