Arizona's Overdose Deaths Are Climbing While the Rest of the Country's Are Falling. The Crackdown That Was Supposed to Help Is Part of Why.

Raquel Moody was 17 the first time alcohol took something from her. By the time she was cycling through what Arizona called “sober living,” she had already served prison time and buried the version of herself that thought getting clean would be simple. What she found instead, over and over, in one Phoenix-area house after another, was a system built to look like help. “They were all connected,” she told KJZZ’s Indigenous Affairs Desk in 2025. “If you were told to leave one, they had someone already waiting to take us.” She moved through thirteen of these houses. None of them treated her. All of them billed Arizona’s Medicaid program as if they had.

Arizona is a worse place to overdose today than it was two years ago, and that is not a metaphor.

The state that built its Medicaid crackdown on stories like Raquel Moody’s now has an overdose rate moving in the opposite direction from the rest of the country, and the two facts are not a coincidence — they’re the same failure, wearing two different faces.

Nationally, overdose deaths fell almost 14% last year, from roughly 81,300 to just under 70,000 — the lowest count since 2018, according to provisional CDC data. Arizona went the other way. Deaths rose from 2,531 to 2,988, an 18% increase, according to a special report from the Arizona Public Health Association written by epidemiologist Allan Williams. Synthetic-opioid deaths — fentanyl, mostly — rose nearly 33% in the state. Cocaine deaths rose almost 70%. Whatever is working in the other 49 states is not working here.

The fraud was real. So was what it took down with it.

Here is the part of the story Arizona would rather you heard on its own: in May 2023, reporters at NPR and the Washington Post exposed a scheme in which brokers drove vans onto tribal land — Navajo, White Mountain Apache, and other reservations across the Southwest — and recruited people struggling with addiction, homelessness, and grief with a simple pitch: free housing, free treatment, a fresh start in Phoenix. What they delivered instead were unlicensed houses that billed the American Indian Health Program for services that never happened, sometimes for people who had already left the state, sometimes for people who were dead. The total take, before state and federal investigators moved in, reached an estimated $2.8 billion.

Arizona’s response was aggressive, and on its own terms it worked. Attorney General Kris Mayes has now announced 140 people and entities indicted, 41 convictions, and more than $139 million recovered or seized. Rita Anagho, a nurse practitioner who ran a Phoenix clinic called TUSA Integrated, was sentenced in May to three and a half years and lost her license. “Billing to the programs targeted in this scheme has dropped by an astonishing 92% since we launched our crackdown,” Mayes said — from $3.11 billion billed to tribal health plans between 2021 and 2023, down to $229.9 million in the two years since.

Read that number again slowly, because it is doing more work than a press release wants it to. A 92% collapse in billing is not a scalpel. It is the kind of number you get when you shut off the tap entirely and sort out later what was clean water and what was sewage. Nobody — not the Attorney General’s office, not AHCCCS, not the state health department — has published a number for how much of that missing $2.9 billion in annual billing was fraud, and how much was a Navajo grandmother’s real outpatient counseling session, a real detox bed in Tucson, a real telehealth buprenorphine appointment that a legitimate clinic can no longer afford to run because the entire reimbursement category became radioactive.

We have watched this exact trade before, and we know how it ends

We have watched a government decide that shutting something down was the whole job before, and we have watched the bill for that decision arrive years late and paid in bodies. In the early 2010s, federal and state regulators cracked down hard on the “pill mills” flooding Florida and Appalachia with OxyContin — and they were right to. But the crackdown arrived with no matching investment in treatment for the hundreds of thousands of people already physically dependent on prescription opioids. Cut off from pills, many of them didn’t get better. They went looking for something else, and heroin — cheaper, more available, entirely unregulated — was waiting. Within a few years, heroin deaths tripled, and fentanyl arrived to make the math so much worse. The lesson from that decade was never “don’t stop the fraud” or “don’t stop the pill mills.” It was: if you shut off a supply of something people are using to survive without opening a door to something that actually helps them, they don’t disappear. They just go somewhere more dangerous. Arizona’s behavioral-health billing collapse is the same shape of decision, aimed at a different target, arriving with the same missing second half.

In the early 2010s, federal and state regulators cracked down hard on the “pill mills” flooding Florida and Appalachia with OxyContin — and they were right to.

Naloxone reversals in Arizona nearly tripled over the same period the state’s overdose deaths climbed — which tells you people are overdosing more often, not simply that fewer of them are being saved. More people are hitting the moment where they need rescuing. Fewer of them, evidently, are finding their way to anything durable once they’re rescued.

If you are the person standing in that gap right now — sober forty-eight hours, discharged from an ER with a naloxone kit and a pamphlet, trying to figure out where the nearest real program is because the last three phone numbers you called were disconnected clinics swept up in the fraud purge — you already know the thing this article is spending 1,800 words explaining. You know it because you’re the one who has to solve it by Thursday.

What actually happened to Raquel Moody, and the twelve houses that didn’t

Moody’s story matters here not as color but as data. She is White Mountain Apache. She started drinking at 17, later used methamphetamine, and served time before she started looking for treatment. What she got, according to her account to KJZZ, was a revolving door: thirteen different Phoenix-area facilities, coordinated closely enough that when one house told her to leave, another was “already waiting to take us.” Ricky Gonzales, another survivor interviewed in the same reporting, put words to why people like Moody kept walking back into houses that were failing them: “It’s not that people are fools. It’s just that they’re vulnerable, and they’ve got nobody.”

Moody is sober now — two years, by her count — and works as a behavioral health technician at Scottsdale Recovery Center, on the other side of the desk from where she used to sit. Reva Stewart, a Navajo Nation member who founded the advocacy group Turtle Island Women Warriors after her own cousin was swept into the scheme, has spent years since 2020 tracking down people who went missing into fake sober-living networks. She found one man who had collapsed and been missing for weeks; he now works two jobs and cares for his parents. “If we can help one person get home instead of in a casket,” Stewart said, “we’re going to keep doing this.”

Those are the wins. They are real, and they are not the same thing as a functioning treatment system. For every Raquel Moody who found her way to Scottsdale Recovery Center, the AzPHA and Attorney General’s own numbers imply there are people who needed a bed in the eighteen months after the crackdown and found the number disconnected, the clinic closed, the whole category of care treated by frightened administrators as too risky to touch. Overdose deaths don’t distinguish between “died because the fraud clinic was fake” and “died because the real clinic next door got caught in the same net and shut its doors.”

The fix isn’t softer enforcement. It’s the settlement money AZ hasn’t spent yet.

Nobody credible is arguing Arizona should have gone easier on a $2.8 billion scheme that trafficked vulnerable people onto reservations and back. The prosecutions were overdue and the sentences are proportionate. The argument here is narrower and, we think, harder to dodge: enforcement without reconstruction is half a policy. Arizona has the money sitting right there to build the other half. The state and its counties are due $1.215 billion over 18 years from the national opioid settlements — funds explicitly meant for exactly this kind of capacity-rebuilding, tracked, audited, and released whenever the state chooses to draw on them faster. If a 92% collapse in tribal behavioral-health billing has left real gaps in Maricopa, Navajo, Apache, and Pinal counties, that money can plug them within a fiscal year, not a decade. The state does not need a new plan. It needs to spend a plan it already has, on the population its own enforcement action left most exposed.

Arizona has the money sitting right there to build the other half.

This is still yours regardless of what the state does next: naloxone remains free and federally funded in Arizona, test strips are legal to carry, and 988 is answered around the clock, staffed by people who are not measuring your call against a Medicaid billing code. None of that fixes the hole where thirteen fake houses used to be. It is, still, a door that stays open.

If you’re a case manager or discharge planner making a referral this week, the fraud purge means you cannot assume a facility’s continued existence equals continued licensure — cross-check the AHCCCS provider directory or the Arizona Department of Health Services licensing search before you send someone to an address you haven’t verified since 2023. It takes five minutes and it is the difference between a referral and a repeat of Raquel Moody’s thirteen houses.

Arizona spent two years proving it could find the fraud. The overdose numbers are the answer to a question nobody in Phoenix wanted to ask out loud: did it find anything to put in its place? Ask Raquel Moody. She’ll tell you it took thirteen tries before somebody did.

Rize’s treatment finder verifies facility licensing status before it ever shows you a name — built, in part, because of exactly this history. For the policy and funding decisions shaping what replaces it, our Arizona Watch coverage and opioid-crisis reporting track the settlement-fund spending as it happens, including our most recent look at where the state’s own numbers are pointing.