Arizona Medicaid Exclusion

Arizona Medicaid Exclusion

arizona medicaid exclusions

 

Arizona Exclusion

The Arizona Health Care Cost Containment System (AHCCCS) Office of Inspector General takes on the task of safeguarding the state’s Medicaid Program which amounts to $9 billion. Its mission is “to uphold the integrity of the Medicaid program by collaborating with internal and external stakeholders and law enforcement entities to prevent, detect, investigate, and recover improper payments and impose penalties, due to fraud, waste, and abuse.”

To further optimize its functions and programs, the AHCCCS works in partnership with an array of data and analytics providers such as the following:

  • EDI Watch
  • HMS
  • Work Number
  • Lexus/Nexus
  • Medicaid Integrity Contractors (MIC)
  • Medi-Medi
  • Fraud Investigations Database (FID)
  • Government databases: Social Security, ADES Base Wage data, MVD and the Arizona Criminal Justice Information System

The AHCCCS Program Integrity initiatives are anchored on the Federal law (42 CFR 455.2), which defines fraud as “an intentional deception or misrepresentation made by a person with the knowledge that the deception could result in some unauthorized benefit to himself or some other person. It includes any act that constitutes fraud under applicable Federal or State law.”

For a comprehensive understanding of the state of Arizona’s Program Integrity Plan, visit these links:
Program Integrity Plan | Rich Text Version

Program Integrity Fact Sheet | Rich Text Version

As of 2014, the AHCCCS has made over $1 billion in both recovered and avoided expenditures. Latest Program Integrity statistics made available by the AHCCCS include the following:

Member Compliance Unit

  • Recoveries $11,654.12
  • Program Savings $79,449.84
  • Fraud Prevention Savings $249,734.60
  • DES/ O SI Savings $55,347
  • Active Cases 597

Provider Compliance Unit

  • Recoveries $95,289.32
  • Program Savings $3,498.60
  • Active Cases 562

To report fraud, please refer to the following contact information.

Provider Fraud
In Maricopa County: 602-417-4045
Outside of Maricopa County: 888-ITS-NOT-OK or 888-487-6686

Member Fraud
In Maricopa County: 602-417-4193
Outside of Maricopa County: 888-ITS-NOT-OK or 888-487-6686

For fraud-related inquiries:
Email: AHCCCSFraud@azahcccs.gov

To report suspected fraud online, please refer to these links:

  • https://www.azahcccs.gov/Fraud/ReportFraud/onlineform.aspx
  • https://www.azahcccs.gov/Fraud/Downloads/SelfDisclosure.pdf

Here are some OIG Exclusion Data for the State of Arizona from the List of Excluded Individuals/Entities otherwise known as the LEIE.

  • There have been 2,153 Arizona individuals and/or entities listed with the OIG since 1983.
  • This includes a total of 21 businesses/entities.
  • Specialties with exclusions include but are not limited too are:
  • Those in the accounting/bookkeeping/billing department in healthcare facilities.
  • Dental Hygienists
  • Chiropractor
  • Emergency medical technician
  • Personal Care Provider
  • Physical Therapy
  • Psychology
  • 607 OIG exclusions on the LEIE from the years 2010-2015 from Arizona – more than 25% of all time OIG exclusions from Arizona!

Sources

  1. https://www.azahcccs.gov/Fraud/AboutOIG/
  2. https://www.azahcccs.gov/Fraud/Downloads/ProgramIntegrityFactSheet.pdf
  3. https://www.azahcccs.gov/Fraud/AboutOIG/statistics.html
  4. https://www.azahcccs.gov/Fraud/Downloads/ProgramIntegrityPlan.pdf
  5. http://oig.hhs.gov/exclusions/exclusions_list.asp

About Anne Goodman