Arizona Medicaid Exclusion

Posted by Frank Strafford on September 14, 2016 in Uncategorized,

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

To learn more about State Medicaid compliance, visit our STATE MEDICAID EXCLUSION LISTS page.

About Frank Strafford

About Frank Strafford

Related Articles

LEIE’s Weakest Link: State Data

August 2, 2021

Federal exclusion requirements have been in place for years. However, in the last decade there have been significant legislative efforts to strengthen and extend Medicaid program integrity controls to...

Streamline Verify Supporting the Battle Against ...

April 26, 2021

In March 2020, the World Health Organization classified COVID-19 as a pandemic. The federal government declared a Public Health Emergency shortly thereafter. For the first time in a century, our count...

Why We’ve Added Death Master ...

March 24, 2015

To save our clients from multi-million dollar settlements like this one. The Associated Press reports that a $4.5 million settlement has been reached with life insurers -- great news for the states, ...

Understanding OIG Exclusions

OIG Exclusions Screening Process

Exclusion FAQS

Quick OIG Exclusion Basics

Employing Excluded Individuals

Consequences to Employing an Excluded Individual

OIG Compliance Law

Laws and Publications on OIG Compliance

More Compliance Resources

About Us

Industry leader Streamline Verify has been forging new paths in Exclusion Screening.

Trusted for Good Reason

  • ✓ Guaranteed accurate
  • ✓ Certified Secure
  • ✓ Audit Proof
  • ✓ Feature-rich reporting
  • ✓ Round the clock real-time-data
  • ✓ Processing fully automated

Security First

  • ✓ Cloud hosted
  • ✓ Encrypted data
  • ✓ Real-time backups

Trusted for Accuracy

  • ✓ Physical security
  • ✓ Restricted access
  • ✓ Single sign-on
  • ✓ Password security
  • ✓ Certified secure
  • ✓ Cross checking

HEALTHCARE ESTABLISHMENTS NATIONWIDE COUNT ON STREAMLINE VERIFY

5

60%

Average workload reduction by implementing the Streamline Verify program

5

10K

Establishments trust Streamline Verify nationwide

5

2011

Serving the healthcare industry’s unique compliance needs since 2011

5

24X

Setting standards with hourly synchronization to primary source data

[class^="wpforms-"]
[class^="wpforms-"]