Using stolen identities, fake patient records and forged signatures, a Maryland woman already on probation scammed the state out of nearly $3.7 million for mental health services she never actually provided.

Tasha Saunders, 44, of Parkville, pleaded guilty Feb. 25 to defrauding Medicaid, the federal-state health program that covers about 1 in 4 low-income Marylanders. She’s due to be sentenced in July. Her lawyer declined to comment on the case.

It’s the first conviction since the state health officials began a crackdown about eight months ago on suspected Medicaid fraud among certain addiction and mental health treatment services.

Additional criminal and civil cases could follow, according to testimony last week from state health officials. More than 100 referrals have been sent to investigators inside the Maryland Department of Health and to a Medicaid fraud unit in the office of Maryland Attorney General Anthony Brown.

“These crimes harm our state’s neediest residents and the health providers who care for them. We will defend the funding of this critical program that allows people to live full, healthy lives,” Brown said in a statement last week announcing Saunders’ plea.

About 1.7 million Marylanders are enrolled in Medicaid, which has a large roster of people who use behavioral health services.

Saunders had been caught defrauding Medicaid once before. Court records show Saunders had pleaded guilty in 2021 to similar crimes when she used fake patient files, stolen counselor identities and almost 4,000 fraudulent claims for mental health and addiction treatment services to steal more than $470,000.

In that case, Saunders was sentenced to nine months behind bars, nine months under home detention and five years of supervised probation. She was ordered to repay the money.

She was also placed on the federal government’s public list of people and companies banned from receiving health care funds after committing fraud. However, she was able to avoid detection, officials said, by lying about her criminal background with her previous companies on her Medicaid provider application.

The companies provided psychiatric rehabilitation services, which are meant to help people with serious mental health conditions live independently. Those services have been an area of massive growth in recent years with the number of Medicaid providers tripling between 2016 and 2023, state data shows.

State health officials have expressed concern that the growth of license providers was outpacing the demand by patients and last June said they would pause enrollment of some types of providers, including those that provide psychiatric rehabilitation services. Officials also launched an investigation into existing behavioral health providers, citing concerns about low-quality care and Medicaid fraud, waste and abuse.

Most of the 127 potential fraud cases so far have been referred internally to the department’s inspector general. Cases can then be referred for criminal prosecution.

Even without a criminal case, the state has power to fix some of the problems. If investigators find a provider made a billing mistake, they can order the money refunded. If they find a credible allegation of fraud, they can refer the case to the attorney general’s office for criminal or civil review.

For years, the health department appeared to stop referring cases to prosecutors as a dysfunctional Medicaid claims processing system disrupted regulators’ abilities to audit providers and track payments, an investigation by The Baltimore Banner and The New York Times revealed last year.

The investigation also spotlighted problems at PHA Healthcare, a drug addiction treatment program that included some patients who had been placed in what were effectively government-funded drug houses. But health department spokesman Chase Cook declined last week to say whether the agency was including the program as part of its active investigation.