Arizona officials acknowledged that a fraud scheme targeting Indigenous people with addictions cost taxpayers $2.5 billion. But they haven’t accounted publicly for the number of deaths tied to the scheme.

At least 40 Native American residents of sober living homes and treatment facilities in the Phoenix area died as state Medicaid officials struggled to respond to a massive fraud scheme that targeted Indigenous people with addictions.

The deaths, almost all from drug and alcohol use, span from the spring of 2022 to the summer of 2024, according to a review of records from the Maricopa County Office of the Medical Examiner. Over half died as officials ignored calls to address lax oversight later shown to have contributed to thousands of patients being recruited into sham treatment programs.

Patients continued to die even after Arizona officials in May 2023 announced a sweeping investigation of hundreds of facilities. By then, the fraud was so widespread that officials spent the next year seeking to halt Medicaid reimbursements to behavioral health businesses accused of wrongdoing.