AZ: They Wanted to Get Sober. They Got a Nightmare Instead.

The white vans were the first thing people noticed.

They began popping up around tribal reservations in the Southwest a few years ago, trolling through alleys and parking lots on a hunt for new business. They approached anyone who looked homeless or intoxicated with an alluring pitch: Get in, and we’ll give you shelter, sobriety and a better life.

Monica Antonio, 21, was one of thousands of people who leaped at the chance. She had been desperate to stop drinking for her three young children, her family said. But the San Carlos Apache Reservation in rural eastern Arizona, where she lived, had limited resources for drug or alcohol treatment. So last January, a van whisked her 130 miles to one of hundreds of sober-living houses that have proliferated around Phoenix in recent years, with little oversight or control.

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She did well at first, earning a 30-day sobriety certificate, but friends and family said they started to worry when Ms. Antonio posted online photos showing drinking and drug use inside her sober-living home. They said she started to slip.

She had tumbled into what prosecutors and tribal leaders call one of the largest, most exploitative frauds in Arizona’s history — a scheme in which hundreds of rehab centers provided shoddy or nonexistent addiction treatment to thousands of vulnerable Native Americans that cost the state as much as $1 billion. Scores of people ended up homeless, still struggling with untreated addiction, officials say.

In the grimmest cases, tribal members died of overdoses inside the sober homes where they had sought help.

Navajo activists in Phoenix, who first alerted authorities more than a year ago to problems inside the sober-living homes, say they have tracked the deaths of at least 40 Native Americans who had been at these homes. Some died while they were still patients; some overdosed on buses or the streets after fleeing or getting kicked out. Others ended up homeless in Phoenix and died of heat exposure or were hit by cars.

Operators set up companies with names like Healing Fountain, Happy Valley or Angelic Behavioral Health, registered with the state as counseling centers and behavioral health residential facilities, and placed them in subdivisions where small-scale investors have snapped up homes as rental properties.

They began running up huge bills, Arizona authorities say. One business billed the state thousands, purportedly to treat a 4-year-old for alcohol addiction. Another charged $1.2 million to treat a parent and two young children for a year.

Similar frauds have occurred in Nevada, Georgia and Texas, Ms. Mayes said, though on a smaller scale.

“It’s scary that this is happening in the middle of America,” said President Buu Nygren of the Navajo Nation, which declared a public health emergency over the fraud.

State officials said the Medicaid fund for Native American treatment amounted to a virtually unguarded pool of money that was poorly regulated and easily exploited. They have since tightened their rules and shut off the unlimited supply of money.

Reva Stewart, a Navajo activist working with families to find their relatives, said some fraudulent homes are still operating and people are still being recruited. “It’s really frustrating,” she said.

State officials say they are continuing to investigate.

Arizona has suspended more than 300 treatment businesses — including the company that ran the home where Ms. Antonio stayed. It has charged more than 40 people with defrauding taxpayers by running up huge bills through Arizona’s American Indian Health Program, which is part of its Medicaid system.

Tribal leaders and more than a dozen former patients said that the human toll of the scheme was far worse and larger than any financial loss.

People who traveled from as far as Montana and the Dakotas described Arizona’s sober-living providers as slapdash operations where drugs and alcohol were plentiful, but actual help was scarce. Some homes were well kept while others were furnished only with mattresses and a few boxes of macaroni and cheese.

“It was so empty and depressing,” said Cydney Smith, a San Carlos Apache member who lived in a residential facility last year. “The door was broken. No bed. People were coming in and doing drugs.”

Some homes conducted regular drug tests and had zero tolerance. Others looked the other way while people smoked meth and drank in their bedrooms, former residents said.

“There were fights, there were drugs, there was alcohol in these homes,” said State Senator Theresa Hatathlie, a Navajo citizen who says she tried for years to get regulators to shut down the unlicensed sober-living houses. “There was no enforcement. The idea seems like: Let’s keep them drunk, keep them using. The longer they stay, the more money.”

It was a volume business, and the operators paid residents to recruit friends and family as new patients.

Several tribal members said they never spoke with any counselors or addiction experts. Instead, they were shuttled to group rehab sessions, where the only requirement was that they sign in and provide their tribal identification numbers so providers could start billing.

Joryan Polk, 22, a member of the San Carlos Apache Tribe, had grown so despondent during his drug treatment program that he called his mother to say that no one was listening or helping, his mother said. He was found dead and face down in his bedroom last January after overdosing on meth and fentanyl. Residents at the home told a police officer that nobody had checked on Mr. Polk for about two days, according to a police report.

The facility where he had been receiving care, Empire Wellness, was suspended in July for billing issues, according to state officials. State officials have declined to provide details about the investigation into the business; the facility’s owner did not answer questions about the investigation.

Daniel Fallah, the owner, said that he had tried to help Mr. Polk get off drugs and that his company regularly did drug screenings and did not allow its patients to use. He said there were staff members inside the home to monitor residents.

“Everybody’s a grown-up,” he said, in an interview before the business was suspended. “People make choices.”

Friends and relatives of Ms. Antonio, the patient from the San Carlos Apache Reservation, said they were still trying to unravel what happened to her.

She was found dead on her mattress the next morning. An autopsy found she had died of alcohol poisoning. Tessie Dillon, one of Ms. Antonio’s aunts, said the family rushed from the San Carlos reservation to Phoenix. She said the sober-living home reeked of alcohol, and that Ms. Antonio’s bedroom had little else than a thin mattress and her clothes piled in the closet.

An administrator from the treatment business did promise to pay Ms. Antonio’s $5,000 funeral bill, Ms. Dillon said.

“We sent them the invoice,” she said. “Nothing.”