When the investigation is concluded, The Health Plan issues a decision letter to the grievant (and the . AHCCCS also noted that "It does not appear that ASH conducted an additional investigation as required" given that the hospital's second decision letter was "identical" to the first. The Office of Inspector General (OIG) at AHCCCS handles all alleged fraud investigations. Petersen, through his adoption agency, is accused of utilizing this adoption fraud scheme in at least 29 births in Arizona between November 2015 and May 2019. Armed only with compassion, mobile crisis teams respond to emergencies all over Maricopa County when people need immediate . Veit worked at AHCCCS for 27 years before his arrest, according to Monica Coury, the agency's assistant director. o Any documentation formally requested via the IOC Request for PHOENIX - The Office of the Arizona Attorney General's Medicaid Fraud Control Unit (MCFU) is the top-performing unit in the nation in bringing criminal indictments according to data provided to the U.S. Department of Health and Human Services (HHS). ACOM POLICY 442. A fraud investigation determines whether a scam has taken place and gathers evidence to protect the victims involved. . concerning persons with a Serious Mental CRSApplicationInstructions_18.pdf. 5. "As promised, you're . Due Jun 20, 2022 05:00 PM (US/Arizona) Stat. Please see the provider manual section on IAD reporting for . 13-4062(4), in cases of suspected AHCCCS fraud. Ducey issued a statement Wednesday morning saying AHCCCS is launching . CAREERS Virtually everything Arizona state employees do affects the quality of life for our residents and guests. (DES/DDD) contracted with Hacienda to provide medical and behavioral health services to members of AHCCCS. o AHCCCS Quality Management and Medical Management review these reports and follow up as needed, track and trend reports to identify any type of systemic or individual . Application for Enrollment into AHCCCS CRS. (A person doesn't have to be Medicaid-eligible (Title XIX) to receive services. AHCCCS Allegation expected Death TERROS, General He*th (GMH) 2345 Download PDF Document Document Date: View Member IAD 7128/2020 PM Inquiry Form AHCCCS Arizona Health Care Cost Containment System INCIDENT, ACCIDENT OR DEATH REPORT MEMBER INFORMATION Member Name City Date Of Birth AHcccs ID CIS ID Eligibility Status C at ego ry Title For example, if a company makes a specific claim about a product and knows that the product won't work as promised, they are guilty of fraud. We will help you with the process for initiating a grievance or requesting an investigation. 21), Article 4, and in AHCCCS ACOM 446 (Grievance and Investigations Concerning Persons with Serious Mental Illness). Young Adult Program; Young Adult Resources; Youth Empowerment Council; . This timeframe may be extended for good cause as determined by AHCCCS or the Contractor, as applicable, b. The AHCCCS OIG's contract permits it to conduct unlimited searches for a basic monthly charge. The couple was counted earlier this month by the . Phone: 602-417-4000 In-State Toll Free: 1-800-654-8713 (Outside Maricopa County) Out-of-State Toll Free: 1-800-523-0231 For Members. For health plan fraud, you can reach aHCCCS via: -888-ITS-NOT-OK (888-487-6686) AZ Complete health via: - 1-888-788-4408 to report your claims.In order to contact AHCCCS, call or email AHCCCSFraud@azahcccs.com. REFERENCES: AHCCCS Contractor Operations Manual (ACOM), Policy 446 This Policy applies to the Division of Developmental Disabilities and their subcontractors and outlines procedures related to grievances and investigations conducted by AHCCCS and the subcontractors under A.A.C. AHCCCS told to improve fight against fraud, abuse. 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 . That said, non-Title XIX recipients do not qualify for as much. We will help you with the process for initiating a grievance or requesting an investigation. 446 - Grievances and Investigations Concerning Persons with Serious Mental Illness; Attachment A - AHCCCS Appeal or Serious Mental Illness Grievance Form; 447 - Employment; Second Criminal Investigation. under investigation from fraud or abuse or claims under review for medical necessity. 5 . 5. information in its investigations. ACOM POLICY 442 - OPT OUT REQUEST FOR A MEMBER WITH A SERIOUS MENTAL ILLNESS DESIGNATION. Supervisor investigation and follow-up with signature. The Office of Inspector General (OIG) is authorized to conduct audits and perform civil and criminal investigations for the purpose of recovering improper state and federal tax dollar payments due to fraud, waste, or abuse. AHCCCS has a contract for unlimited searches for a basic monthly charge. With so many diverse roles, you can see why our employees join state service and never want to leave. Veit also will pay a $15,000 investigation fee to the Attorney General's . (DHS) and the Arizona Health Care Cost Containment System (AHCCCS). The birth mothers should not have qualified for AHCCCS benefits because they were not Arizona residents. . Transmitted herewith is a report of the Auditor General, A Performance Audit of the Arizona Health Care Cost Containment System (AHCCCS)Medicaid Fraud and Abuse Prevention, Detection, Investigation, and Recovery Processes. Phone: 602-417-4000 In-State Toll Free: 1-800-654-8713 (Outside Maricopa County) Out-of-State Toll Free: 1-800-523-0231 For Members. Healthcare Fraud & Regulation. Investigations and OCWI; Office of Licensing & Regulation (OLR) Young Adult. The AHCCCS Contract and Policy Dictionary provides a centralized location for definitions that are found in the various ACOM and AMPM Policies. Attached with the form, shall be all pertinent information to assist AHCCCS in its investigation process. If you are being investigated by the DSS/HRA, contact an attorney immediately. Note: At this stage the redaction process is the same as the QOC . A unit within the AHCCCS Division of Fee-For-Service Management (DFSM) that oversees FFS quality management activities, including but not limited to, Quality of Care investigations and Health and Safety inspections. The Investigation Revenue and Enforcement Administration Bureau of Fraud Investigation has professionals working for them. How Do I Report Someone To Ahcccs? OIG has the authority to exclude individuals and entities from Federally funded health care programs pursuant to section 1128 of the Social Security Act (Act) (and from Medicare and State health care programs under section 1156 of the Act) and maintains a list of all currently excluded individuals and entities called the List of Excluded Individuals/Entities (LEIE). Arizona Health Care Cost Containment System (AHCCCS) and the Office of Quality of Care (QOC) . AHCCCS 801 E Jefferson St Phoenix, AZ 85034 Find Us On Google Maps. AHCCCS in its investigation shall be attached to the form, c. Once the Division has referred a case of alleged fraud, waste, or abuse to AHCCCS-OIG, the Division must take no action to recoup or ---DEPARTM EN T OF ---CON OM l C SEC URITY Your Partner For A Stron9er Arizona . One of the primary functions of the AHCCCS-OIG is to analyze and The Health Plan follows the investigation process described in Arizona Administrative Code Title 9, Chapter 21 (9 A.A.C. Please call the Arizona Department of Economic Security Fraud Hotline at (800)251-2436 (or (602)542-9449 (to report fraud or malpractice ) to fill out the following field. Between November 2015 and May 2019, AHCCCS paid for at least 29 births. These statutes provide for a computerized central database tracking system to track the o SMI Grievance Investigation and decision letters for Special Assistance members -Available upon occurrence. a. The review of DHS' responsibilities found that DHS needs to improve its licensure and complaint investigation processes for home health agencies. 4. PHOENIX - The state's Medicaid program needs to do a . Phone: 602-417-4000 In-State Toll Free: 1-800-654-8713 (Outside Maricopa County) The MCFU, housed in the Criminal Division of the Attorney General's Office (AGO), is also commonly referred to as the Health Care Fraud and . "AHCCCS conducted an extensive internal investigation and determined that, due to a programming error, 3,146 IRS 1095-B Forms . Such investigation shall be completed within 60 days from To apply for the AHCCCS," Jennet said. AHCCCS 801 E Jefferson St Phoenix, AZ 85034 Find Us On Google Maps. o SMI Appeal results for Special Assistance members - Available upon occurrence. The court affirmed the lower court's decision on two grounds. Please call the Arizona Department of Economic Security Fraud Hotline at (800)251-2436 (or (602)542-9449 (to report fraud or malpractice ) to fill out the following field. of The contractor maintains more than 17 billion records on individuals and businesses which AHCCCS uses as background information in its investigations. As a State of Arizona employee, you can choose from more than 1,700 types of career opportunities, all with the same employer, making job mobility and career advancement easy. Some of the sickest people in Arizona live in some of the worst places, like unlicensed boarding homes considered by many to be a thing of the past. PHOENIX, Ariz. - Dale Henson, aged 53, alongside his wife Zoila Henson, aged 53, both from Arizona's Chandler, were detained on Wednesday for falsely charging the Arizona Healthcare Cost Containment System and for conspiracy involving COVID-19 Economic Injury Disaster Loan funds receipt. 2) Kevin Maulson, 60 3) Russell Freeman, 51 4) Paul . Responsibility for providing services to people with serious mental illness in Arizona falls to the state's Medicaid agency, the Arizona Health Care Cost Containment System (AHCCCS). AHCCCS Clinical Resolution Unit. PHOENIX State officials have announced a first-in-the-nation approach to helping vulnerable . The Supreme Court affirmed Defendant's convictions and sentences, holding that the Arizona Health Care Cost Containment System (AHCCCS) statutory scheme, Ariz. Rev. If you feel your rights have been violated or a condition requiring investigation exists, please contact Arizona Complete Health-Complete Care Plan Member Service Department between 8:00 a.m. and 5:00 p.m. at 1-888-788-4408 or TTY/TDY 711. The November 15 letter by Sharon E. Ormsby, Inspector General of AHCCCS, announces a temporary, system-wide suspension of Medicaid payments to Head to Toe pending an investigation. The investigation developed allegations that accuse the defendants of overbilling or double-billing for services, billing for services that had not been rendered, and billing for AHCCCS patients . The indicted defendants are listed below: 1) Dale Henson, 53. functions for the AHCCCS Fee-for-Service population and is responsible for direct investigations and oversees contractor efforts related to credentialing and monitoring of health care acquired conditions and other provider preventable . by Amy Silverman October 22, 2021. Fraud is misrepresentation with the intent to deceive. Following investigation into the matter, AHCCCS and/or DES will advise OCR of its investigative results and make recommendation as to whether the complaint should be subsumed under the terms of this Agreement. Sep 26, 2012 Updated Sep 26, 2012. Stat. CAREERS Virtually everything Arizona state employees do affects the quality of life for our residents and guests. 36-2901 to -2999.57, abrogates and creates an exception to Arizona's statutory physician-patient privilege, Ariz. Rev. The AHCCCS-OIG has the authority to oversee all program integrity activities including conducting preliminary and full investigations relating to fraud, waste, and abuse in the Medicaid managed care program. AHCCCS MEDICAL POLICY MANUAL POLICY 960 -, ATTACHMENT D - INDIVIDUALS WITH INTELLECTUAL DISABILITIES INVESTIGATION TRAINING 960 - Attachment D - Page 2 of 2 Effective Dates: 10/01/20, 10/01/21, 10/01/22 Approval Dates: 08/20/20, 04/29/21, 04/14/22 3) Interviews avoid interference with substantiation and/or prosecution, and state's reinvestigation showed the AHCCCS plans to be in compliance with the disclosure requirements. . AHCCCS realized over $1 billion in avoided and recovered costs as a result of coordination of benefits, third party recoveries, and OIG activities. IADs must be submitted by the provider within 2 business days of the incident. In 1983, the United States entered into a Compact of Free Association with the Republic of the Marshall Islands, which prohibits RMI citizens from entering the United States under the Compact if their travel is for the purpose of adoption. Quality investigations shall not be delegated or performed by the staff of the provider agency/facility where the identified health and safety concerns, immediate jeopardy, or AHCCCS requested reviews have occurred. PHOENIX, Ariz. - Dale Henson, aged 53, alongside his wife Zoila Henson, aged 53, both from Arizona's Chandler, were detained on Wednesday for falsely charging the Arizona Healthcare Cost Containment System and for conspiracy involving COVID-19 Economic Injury Disaster Loan funds receipt. This report is in response to an October Form Number: CRS App. Completion of the form: Employee reporting the incident/accident completes ELECTRONIC document (faxed copies are no longer AHCCCS says they became aware of the breach on January 15, 2019. . Following the October 2019 indictment, the Arizona Attorney General's Office opened a second criminal investigation against Petersen. The couple was counted earlier this month by the . The AHCCCS Office of Data Analytics has a management team as well as five units to perform these functions: . With so many diverse roles, you can see why our employees join state service and never want to leave. As a State of Arizona employee, you can choose from more than 1,700 types of career opportunities, all with the same employer, making job mobility and career advancement easy. 5. How Do I Report Fraud In Arizona? AHCCCS-OIG is responsible for maintaining and safeguarding the integrity of these records, and will provide the Provider with sufficient time to copy records for the Provider's . The Office of Special Investigations (OSI) was created by legislative action to investigate welfare fraud. The Arizona Health Care Cost Containment System (AHCCCS) Quality Management System (QMS) Portal is used for the submission of Incident/Accident/Death (IAD) reports for Behavioral Health providers only. Type: N/A. Title Reference: Statewide Behavioral Health and Appeals Coordinator. Furthermore, the 1985 annual report pre- pared by the AHCCCS Fraud Investigation and Prosecution Unit of the Arizona Attorney General's office notes that the unit is pursuing allega- The AHCCCS' contract AHCCCS should improve its recovery processes Arizona Health Care Cost Containment SystemMedicaid Fraud and Abuse Prevention, Detection, Investigation, and Recovery Processes REPORTA copy of the full report is available at: HIGHLIGHTS PERFORMANCE AUDIT September 2012 Report No. The issue involves two kinds of cases. Effective Date: Monday, October 1, 2018. The FBI thanks the U.S. Department of Health and Human Services Office of the Inspector General (HHS-OIG), and the Arizona Health Care Cost Containment System Office of the Inspector General (AHCCCS-OIG) for their partnerships and collaboration on these cases. In one, the state seeks to reclaim money paid erroneously because of outright fraud or by abuse by either health care providers or those covered by AHCCCS. The AGO launched a criminal investigation into Hacienda's finances in early January 2019 after learning the institution failed to comply with its contract terms. How to Apply Covered Services Pay Your Premium Health Insurance for Children . The Contractor shall not delegate QOC investigation processes or onsite QOC visits. complaint to AHCCCS and/or DES for appropriate investigation. of business. AHCCCS supported the investigations of 22 successful prosecutions of either members or providers. If a claim for payment under Medicare as primary coverage has been initially The AHCCCS Office of Inspector General (AHCCCS-OIG) reserves the right to request and secure original records from the Provider at the Provider's expense. AHCCCS system for the date(s) of service but at a later date eligibility was posted retroactively to cover the date(s) of service. AHCCCS 801 E Jefferson St Phoenix, AZ 85034 Find Us On Google Maps. Email Address: [email protected] 1-800-867-5808. We have successfully defended clients in parallel investigations and proceedings conducted by the Office of Inspector General (state and . On September 2nd, 2015, special agents of the Arizona Attorney General's Office executed search warrants at four different locations in Maricopa County in conjunction with an ongoing investigation by their Health Care Fraud Special Investigation Section. The AHCCCS Office of Data Analytics has a management team as well as five units to perform these functions: . You need to have professionals working for you. (PFIT) at Arizona Health Care Cost Containment System (AHCCCS) Mobile crisis responders provide an alternative to police and paramedics. First, the court found that Arizona Health Care Cost Containment System's (AHCCCS) "broad authority to investigate suspected fraud necessarily implies an exception to the [doctor-patient] privilege for internal AHCCCS investigations and proceedings." (DES/DDD) contracted with Hacienda to provide medical and behavioral health services to members of AHCCCS. The strategies here apply to Family Health Plus and Child Health Plus investigations as well. 12-06 www.azauditor.gov Contact person: Dot Reinhard (602 . functions for the AHCCCS Fee-for-Service population and is responsible for direct investigations and oversees contractor efforts related to credentialing and monitoring of health care acquired conditions and other provider preventable . County: N/A. Howard Fischer Capitol Media Services. calendar days to the AHCCCS-OIG by completing and submitting the "Provider Self Disclosure" form, found on the AHCCCS-OIG webpage. Form Name: Application for Enrollment into AHCCCS CRS. Special agents with U.S. Immigration and Customs Enforcement's (ICE) Homeland Security Investigations (HSI) and officers with the Arizona . AHCCCS Director helps lead the National Association of Medicaid Directors (NAMD) Executive Unsafe housing jeopardizes success of community living for chronically mentally ill. After nearly three hours of testimony, where investigators make it clear they are going after Petersen, authorities released Jennet. 362903). The indicted defendants are listed below: 1) Dale Henson, 53. In November 2020, AHCCCS upheld part of Contreras' grievance, noting that surveillance footage backed up his claim about being kept in restraints. information in our investigations. AHCCCS, Arizona's Medicaid agency, helping provide rides to COVID-19 vaccine appointments. Hacienda ran an Intermediate Care Facility and was contracted to . During the 2012 review, the State reported that it had collected the cost of doing investigations or case-associated Civil Monetary Penalties (CMPs) for 48 cases identified . The Arizona Health Care Cost Containment System (AHCCCS) is the single state Medicaid Agency that provides funding to administer health care benefits for persons who are Title XIX/XXI This project was funded in part by support from the Fund for Investigative . OSI administration is located in Phoenix with field offices in Flagstaff Hacienda ran an Intermediate Care Facility and was contracted to . In addition, when DHS identifies licensing violations during home health agency inspections and complaint investigations, it does not Sep 26, 2012. . 2 FTP Server - IOC Reports/Documents o Special Assistance Report - Available the 25th day of the month. Investigations 105 Modifications 105 Provisional Credentialing Process and Requirements 107 . The AHCCCS Office of Inspector General (AHCCCS-OIG) is the division of AHCCCS that has the authority to conduct preliminary and full investigations, relating to fraud, waste, and abuse, involving the programs administered by AHCCCS. Arizona Health Care Cost Containment System QuickStart Guide Incident, Accident and Death and Incident Referral Reporting IAD-IRF Document Redaction - 17 The IOC Document Redaction Release page will be displayed similar to previously accessed steps with the QOC case process. >. . Status: Open for Comment. Pursuant to 42 CFR 455.12-23 and an Intergovernmental Agreement with the Arizona Attorney General's Two suspects are in custody . How to Apply Covered Services Pay Your Premium Health Insurance for Children . The AGO launched a criminal investigation into Hacienda's finances in early January 2019 after learning the institution failed to comply with its contract terms. The AHCCCS is able to use a large contractor database, which combines personal data from multiple public and private databases, in developing fraud and abuse cases. In January, a sampling done by federal auditors found 25 possible instances of . A grievance or a request for investigation ll be subsha mitted to AHCCCS or the Contractor, orallyor in writing, no later than 12 months from the date the alleged violation or Condition Requiring Investigation occurred. R9-21-402 et seq. The investigation has also uncovered duplicate payments to health-care providers which went unnoticed by AHCCCS. Arizona Health Care Cost Containment System . Young Adult Program; Young Adult Resources; Youth Empowerment Council; . 2) Kevin Maulson, 60 3) Russell Freeman, 51 4) Paul . Investigations and OCWI; Office of Licensing & Regulation (OLR) Young Adult. The Arizona Attorney General's Office conducted this investigation along with investigators from the Office of Inspector General for the U.S. Department of Health and Human Services and the Office of Inspector General for AHCCCS. 103 Fraud, Waste, and Abuse . How Do I Report Fraud In Arizona? Healthcare Professional - Pharmacist skilled in Operations, Compliance, Health Policy, Investigations & Inspections . We assist individuals, entities, and other law firms with criminal and parallel issues related to healthcare fraud and abuse allegations in state and federal enforcement actions. The OIG is designated as a criminal justice agency and is authorized by the Federal Bureau of Investigation and the . Their work was vital to these investigations." The Arizona Attorney General's Office conducted this investigation along with investigators from the Office of Inspector General for the U.S. Department of Health and Human Services and the Office of Inspector General for AHCCCS. Another man, Michael Cameron, was arrested in connection with the investigation, but Garcia said he was not a state employee. . PHOENIX - The second defendant of an adoption and financial scheme was sentenced Tuesday to two years in state prison for helping her co-defendant in the operation at the expense of Arizona taxpayers. Division: AHCCCS. CONTROLLED SUBSTANCES PRESCRIPTION MONITORING PROGRAM (A.R.S 362602; A.R.S. If you feel your rights have been violated or a condition requiring investigation exists, please contact Arizona Complete Health-Complete Care Plan Member Service Department between 8:00 a.m. and 5:00 p.m. at 1-888-788-4408 or TTY/TDY 711. Maricopa County Sheriff's Office deputies assisted with the execution of the search warrants at one location. EXPLOITATION For purposed of this Policy, the illegal or improper use of an AHCCCS Quality of Care investigations- SMI/GMH/Child Seclusion and Restraint reports - SMI/GMH/Child SpecialAssistance active list maintained by OHR - SMI ONLY .