Now more than ever, the integrity of our healthcare system is paramount as we fight a global pandemic, said United States Attorney Michael Bailey. Phoenix, AZ 85004, Phoenix: (602) 514-7500 Because there's gonna be literally no services.. Individuals are presumed innocent until proven guilty beyond a reasonable doubt. OIG conducts thorough civil and criminal investigations while adhering to its federal, state and contractual requirements. Tucson: (520) 620-7300 AHCCCS is Arizonas Medicaid agency, offering health care programs to low-income Arizona residents. endstream endobj 572 0 obj <>stream Questionnaire is the . Pay Your Premium Out-of-State Toll Free: 1-800-523-0231, How to Apply A lock ( Miguel Denga and Alsadi own and operate Philia Homecare, LLC. All defendants are presumed innocent until proven guilty in a court of law. RQ0F`Ht1I$-YF[@hzZP+C~UY?mqWy $9o&L7I$if?eBc&ImT\C/V++F'E@%^% Two other complaints charge a total of six individuals associated with five Phoenix-area businesses that purport to provide non-emergency medical transportation services on the Navajo Nation. ;~F` i_-|tI?=WOpTa#R}w]=lNDP` @ 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. New home buyers can sue over construction defects even if they signed waivers not to do so, the Arizona Supreme Court says in a new ruling. Evidence that potential fraud occurred during the current or previous application period (initial or renewal). Yuma:(928) 314-6410. ) or https:// means youve safely connected to the .gov website. District of Arizona These statutes provide for a computerized central database tracking system to track the Google admits no wrongdoing over a claim by the state that its tracking and data collection violates the Arizona Consumer Fraud Act. Have a question about Government Services? 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. And Perry said there clearly are such cases. Fee-for-Service Fee Schedules, Contact Us Hn0:@%Y]QIS KVl ;5G9ika 8$EH=`"'iXS}0,3''GWsCf~0%9SDM ypY{Q_F\eU7\yc@q}`?Wh @H R#r+wo Tucson: (520) 620-7300 A complaint is simply the method by which a person is charged with criminal activity and raises no inference of guilt. CONTROLLED SUBSTANCES PRESCRIPTION MONITORING PROGRAM (A.R.S 362602; A.R.S. Those services could now be in jeopardy because of proposed cuts. And if it is not, Perry said, AHCCCS should work with the legislature to provide more funds. The agency confirmed to ABC15 that most of the affected patients are Native American. A .gov website belongs to an official government organization in the United States. This research ends to investigate factors affecting the teachers' job performance in Agricultural High School in Mazandaran province, Iran. Policy. Health Care-Acquired and Provider Preventable Conditions as described in the AHCCCS AMPM Chapter 900. R9-20-203 or in A.A.C. The indicted defendants are listed below: 2) Kevin Maulson, 60 10) Keyana Carter, 29 Already, the culturally based addiction treatment center with two locations has moved its 70 patients to a single location in preparation for the potential funding changes, which are scheduled to take effect May 1. PHOENIX, Ariz. Dale Henson, 53, and his wife Zoila Henson, 53, both of Chandler, Arizona, were arrested on Wednesday for fraudulently billing the Arizona Healthcare Cost Containment System and for fraud involving receipt of COVID-19 Economic Injury Disaster Loan funds. The complaint alleges that Alsadi and the Dengas falsely billed AHCCCS for more than 1,500 non-emergency medical transports in April 2020 when those transports never occurred. Investigations often take considerable time to obtain these details, sometimes years, depending on the specific case circumstances. M` Additionally, the OIG works closely with federal, state, and local law enforcement agencies to detect, The OIG is designated as a criminal justice agency and is authorized by the Federal Bureau of Investigation and the . An official website of the United States government. The report found some incidents that auditors decided to single out for special mention. AHCCCS, in a response to the audit, said part of the problem was related to the COVID outbreak. Jeremiah Faber is scheduled to make his initial appearance in court on June 30, 2020. OIG Administrative Assistant, (602) 417-4193, General AHCCCS Information A .gov website belongs to an official government organization in the United States. Office of Special Investigations (OSI)/AHCCCS Office of Inspector General (AOIG). Copyright 2023 Centene Corporation, LLC. R9-21, Article 2; Retaliation for submitting grievances to authorities; Threat of discharge/transfer for punishment; Treatment involving denial of opportunity to sleep; Treatment involving denial of opportunity to use toilet; Use of restraint or seclusion as retaliation; and/or. Its absolutely horrific, he said of the proposal. 13) Kayla Sol, 34 Yuma:(928) 314-6410. A conviction for healthcare fraud or wire fraud carries a sentence of up to 20 years, a conviction for money laundering carries a sentence of up to 10 years, and a conviction for aggravated identity theft carries a mandatory, consecutive 24-month prison sentence in addition to hefty maximum fines for each offense. fraud actions related to the suspension of providers; and, when necessary, terminates providers in Official websites use .gov The complaint further alleges that their false billings in April 2020 generated a total of more than $450,000 in fraudulent payments from AHCCCS to the two businesses. Plus expansion candidates and more, Green Valley bite reminder that it's rattler season in Tucson, Yentzer booted from ballot in race for Tucson mayor, Award-winning journalist takes helm of Arizona Daily Star, state news operations, Arizona coach Tommy Lloyd says Wildcats are 'in great shape' despite current holes in roster, Tucson to study creating city-run electric utility; TEP opposed, Threats cause Catalina Foothills School District to cancel meeting, 40 fun events happening in Tucson this weekend April 27-30 , 30 places in Tucson where you can often find live music, Northern lights spotted over Tucson after powerful solar activity, Pac-12 basketball picks: Soon-to-depart USC is early league favorite; Arizona slotted 3rd, Arizona's top prosecutor wants Legislature to clarify abortion laws, Conservation groups sue over Mexican wolf restoration program, Abortion, border big topics in Arizona Senate debate, Prop. Health Insurance for Children, Provider Enrollment including but not limited to, provider terminations, credible allegation of fraud payment suspensions, final overpayment findings, and the imposition of civil monetary penalties. Phoenix, AZ 85004, Phoenix: (602) 514-7500 AHCCCS said the proposed change may . Examples include, but are not limited to: If you suspect that a vulnerable adult has been abused or neglected, report it immediately toAdult Protective Servicesat 1-877 SOS ADULT. If the incident needs immediate attention, and it is not during regular business hours, call 911 immediately. 12) Thomas Battle III, 43 concerning persons with a Serious Mental 4) Paul Flaa, 56 In fact, nearly 60% had been open for longer than a year. 11) Sharon Lawson, 48 The investigator must: a. 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. Share sensitive information only on official, secure websites. information in our investigations. Nez received outpatient services through Sunrise Native Recovery, an outpatient drug-and-alcohol treatment center. endstream endobj 573 0 obj <>stream PHOENIX Arizonas health care program for low income clients is not doing a good job of investigating potential incidents of fraud or abuse committed by providers or patients, the state Auditor Generals Office has concluded. The couple is alleged to have submitted $1.2 million in fraudulent bills to AHCCCS over a 9-month period in 2019-2020, and then to have used some of the proceeds to purchase a $1.3 residence in Gilbert, Arizona. These same provisions also exhibit an intent to provide law enforcement access to . Make no mistake, the FBI will actively pursue those seeking to fraudulently profit from the pandemic. 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. . She pointed out that in the last fiscal year, AHCCCS reported that it either recovered or saved about $48.1 million in state and federal funds. For Star subscribers: The Arizona Department of Education said it was inundated with last-minute requests to get funding. Lock The Criminal Division's mission is to protect the citizens of Arizona by successfully investigating and aggressively and fairly prosecuting criminal cases within the State of Arizona and in representing the State in capital and non-capital appeals. 1 on Yelp's SW best eateries, Pac-12 mailbag: Is an Arizona departure worst-case scenario for Pac-12? A lot of people are gonna fall through the cracks, said Allen King, Sunrises chief administrative officer. The OIG is designated as a criminal justice agency and is authorized by the Federal Bureau of AHCCCS supported the investigations of 62 successful prosecutions of either members or providers. R9-21-406. Phoenix, Arizona 85004 Investigators were not able to conduct-in person visits to homes and schools as part of their investigations, which impacted their ability to verify the reported number of members living in the home and contributing to the household, the report said. Im 16 months sober, he said. OIG works closely with federal and state partners, including the Medicaid Fraud Control Unit (MFCU) of the Arizona Attorney General, the Federal Bureau of Investigations (FBI), Drug Enforcement Agency (DEA), Health and Human Services (HHS) OIG, Main Office: Conduct investigations, Manage time effectively, deal . When the investigation is concluded, The Health Plan issues a decision letter to the grievant (and the . The goal of The Quality Department Investigations is to identify adverse outcomes whether at the provider level or a systemic issue; develop and implement plan of correction to reduce likely hood of reoccurrence or similar outcome, improving the care our members receive. Monica Klapper, Assistant U.S. Attorney, District of Arizona, Phoenix, is handling the prosecution. investigations, OIG also issues and collects civil monetary penalties; issues credible allegations of A locked padlock The couple was charged earlier this month by the federal grand jury in a 58-count indictment. 583 0 obj <>/Filter/FlateDecode/ID[<4704BC82282EC0439DECB24A83985C10>]/Index[567 39]/Info 566 0 R/Length 84/Prev 129300/Root 568 0 R/Size 606/Type/XRef/W[1 2 1]>>stream 8) Aaron Wright, 40. And that, said Auditor General Lindsey Perry, comes at a cost. Nai# Subscribe to stay connected to Tucson. 2) Kevin Maulson, 60 3) Russell Freeman, 51 4) Paul . Im 16 months sober, he said. Please visit the, Resources for Foster/Kinship/Adoptive Families, Accessing Behavioral Health Services in Schools, AHCCCS Whole Person Care Initiative (WPCI), Emergency Triage, Treat and Transport (ET3), Report Concerns About Quality of Care Received, ALTCS Electronic Member Change Request (EMCR), Quality Assessment and Performance Improvement Strategy, Pre-Admission Screening and Resident Review (PASRR), Demographics, Social Determinants and Outcomes, Tribal Court Procedures for Involuntary Commitment, Contracted Health Plan Audited Financial Statements, Monkeypox Virus and Vaccination Information, Federal Funding Accountability and Transparency Act. The statistical population includes 127 teachers. The unit is located in the Attorney General's Office, 2005 N Central Avenue in Phoenix. Before treatment, the 36-year-old didnt have a home or a job. The following incident types are required to be reported by the provider: Providers must submit incident, accident, or death reports involving sentinel events within 6 hours of the occurrence. 5) Ariel Dix, 34 Audit: AHCCCS lagging in investigating abuse, fraud, Tucson's west-side resort, Starr Pass, sold for $110 million, Cocktails on a train car and boutique bowling coming to Tucson, Tucson restaurant lands No. The investigation developed allegations of multiple forms of fraudulent billing, including overbilling/double billing for services, billing for services that had not been rendered, and billing for AHCCCS members/patients who were deceased. Richie.Taylor@azag.govMediaRequests@azag.gov, Attorney General Mark Brnovich Announces 13 Individuals and 14 Related Business Entities Indicted in Alleged Massive Health Care Fraud Billing Scheme, 49th Annual Peace Officers Memorial Service, Elder Abuse Information and Training Guide, Data Breach Notification Form Individuals, Lutheran Association of Missionaries and Pilots U.S., Inc. (d/b/a Lutheran Indian Ministries), Mary Group Home,a.k.a. On September 14, 2022, Ahmadi was designated by the U.S. OIG provides appeal rights on its notices that fall under the state statutory definition of appealable agency actions, Finally, AHCCCS risks compromising its ability to gather evidence and follow leads that might become stale as cases age.. For non-Behavioral Health providers, potential quality of care incident reports should be submitted to the Quality of Care mailbox within the timeframes indicated above. PHOENIX Attorney General Mark Brnovich announced that a State Grand Jury has indicted 13 individuals and 14 related business entities on criminal charges of Illegal Control of an Enterprise, Theft, Conspiracy, and Fraudulent Schemes and Artifices. Secure .gov websites use HTTPS The office has statutory authority to issue subpoenas and place nr Cd86C3Y-LU'~WU0O3Z2P/O 58j!iPv@8:PEz/>#WVf?OK3J5Nw7QsnG:40'F7SRiM#4=( g]*3f$2TAAix91ix}d23B )nf:kFYR{3X\^&ZHhaS+ip *SWX*v RmSiZv6n*M7UXZlVtJxghJ@N'Gn/yrf_4 R7t|> 8I4"8^T~^v30,'!d9Py d90HH6_E\}Y+M`+'tew6 4 A U.S. %PDF-1.6 % Official websites use .gov zWW\[e@*e1i6@_VE>UO4)]-1e;nis$_aY>*Z#%Y :$DYG.E'_iM7.g ~hRB8~/= Policy Manuals A possible quality of care incident can involve a facility, the staff, a physician, or another entity providing a health care services to the member. Obtain a copy of the Medicaid Fraud Control Unit Complaint Form. The Office of Inspector General (OIG) is responsible for the integrity of the AHCCCS budget, nearly $18 billion in State Fiscal Year 2023. Thanks to the diligent work of Arizonas COVID-19 Fraud Task Force, the FBI identified and dismantled fraud rings in Arizona which were trying to exploit the COVID-19 pandemic. He wasnt even sure what day it was. While Auditor General Lindsey Perry says . x}n0. The agency confirmed to ABC15 that most of the affected patients are Native American. Copyright 2023 Scripps Media, Inc. All rights reserved. 602.542.3881 So we can figure things out and talk with the AHCCCS program, let them really understand.. The new report finds that the Arizona Health Care Cost Containment System has taken more than a year to initiate or complete preliminary investigation of more than half of potential fraud and abuse cases that were open in May when auditors looked at the agencys records. An indictment is simply a method by which a person is charged with criminal activity and raises no inference of guilt. CycIA4[QMciX 9; AHCCCSOnline Website Today, he is studying to be an electrician technician. prevent, investigate and prosecute any provider, subcontractor, member, entity, or employee involved in A concern about the quality of health care provided, or the appropriateness of the medical treatment received. Submit all potential quality issues using the Arizona Complete Health Quality of Care Notification Form (PDF)to the following: AzCHQOC@AZCompleteHealth.com. 0 The indictment also alleges the couple lied in their applications for COVID-19 pandemic-related loans and used the proceeds of the loan funds for personal expenses, such as the purchase of a residence in Mexico, where Zoila Henson is a citizen. And while the agency said it is bringing new people on board, it said it can take a year to properly train them. She said the agency needs to conduct a workload and cost analysis to evaluate whether its funding and staffing levels are sufficient for timely investigating fraud and abuse incidents. Flagstaff: (928)556-0833 Perry said that goes to the question of whether the agency is making incentive payments to providers for their performance without first determining that the providers actually are eligible. U.S. Attorney's Office, District of Arizona, Chandler Couple Arrested for AHCCCS Fraud and Pandemic Loan Fraud, Phoenix Man Sentenced for Importing Counterfeit N95 Masks from Asia, Phoenix Woman Sentenced to Prison for Paycheck Protection Loan Fraud, Gilbert Man Sentenced to Prison for PPP Fraud. The complaint further alleges that their false billings in April 2020 generated a total of more than $2.75 million in fraudulent payments from AHCCCS to the three businesses. 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 . That, however, still left the issue of staff turnover and an insufficient number of investigators. Email ABC15 Investigator Anne Ryman atanne.ryman@abc15.com, call her at 602-685-6345, or connect onTwitterand Facebook. 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. Abuse or neglect allegation made about staff member(s); Physical injury that occurs as the result of personal, chemical or mechanical restraint; Unauthorized absence from a licensed behavioral health facility, group home or HCTC of children or recipients under court order for treatment; Discovery that a client, staff member, or employee has a communicable disease as listed in R9-6-202 (A) or (B); Incidents or allegations of violations of the rights as described in A.A.C. AHCCCS is primarily federally funded, and it provides healthcare programs for Arizonas low-income residents. How to Create Positive New Habits in our New World, Provider Accessibility Initiative COVID-19 Web Series, Overview of the Arizona Public Health System, Covered Services and Related Program Requirements, Medical Management/Utilization Management Requirements, Credentialing and Re-Credentialing Requirements, Specific Physical Health Provider Requirements, Behavioral Health Network Provider Service Delivery Requirements, Health Plan Coordination of Care Requirements, Specific Behavioral Health Program Requirements, Training and Peer Support Supervision Requirements, Provider Engagement Specialist Feedback Survey, AzAHP Child and Family Team (CFT) Initiatives Notification, Incorrect Member Cost Share Application- Provider Overpayment, Cultural Competency and Health Equity Reminders, Potential Quality Issue (PQI) Referral Form (PDF), Nondiscrimination and Accessibility (PDF).
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