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. We have successfully defended clients in parallel investigations and proceedings conducted by the Office of Inspector General (state and . The issue involves two kinds of cases. Young Adult Program; Young Adult Resources; Youth Empowerment Council; . 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 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 investigation has also uncovered duplicate payments to health-care providers which went unnoticed by AHCCCS. Form Number: CRS App. The AHCCCS OIG's contract permits it to conduct unlimited searches for a basic monthly charge. 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. 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. How Do I Report Fraud In Arizona? 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. Second Criminal Investigation. PHOENIX - The state's Medicaid program needs to do a . With so many diverse roles, you can see why our employees join state service and never want to leave. 4. In January, a sampling done by federal auditors found 25 possible instances of . CAREERS Virtually everything Arizona state employees do affects the quality of life for our residents and guests. >. o Any documentation formally requested via the IOC Request for 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." Sep 26, 2012 Updated Sep 26, 2012. 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. Veit also will pay a $15,000 investigation fee to the Attorney General's . With so many diverse roles, you can see why our employees join state service and never want to leave. 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. 5 . Sep 26, 2012. 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). 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 Inspector General (OIG) at AHCCCS handles all alleged fraud investigations. When the investigation is concluded, The Health Plan issues a decision letter to the grievant (and the . The court affirmed the lower court's decision on two grounds. The indicted defendants are listed below: 1) Dale Henson, 53. 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. (DHS) and the Arizona Health Care Cost Containment System (AHCCCS). (PFIT) at Arizona Health Care Cost Containment System (AHCCCS) In November 2020, AHCCCS upheld part of Contreras' grievance, noting that surveillance footage backed up his claim about being kept in restraints. Investigations and OCWI; Office of Licensing & Regulation (OLR) Young Adult. You need to have professionals working for you. Stat. CRSApplicationInstructions_18.pdf. "AHCCCS conducted an extensive internal investigation and determined that, due to a programming error, 3,146 IRS 1095-B Forms . Note: At this stage the redaction process is the same as the QOC . 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. 2) Kevin Maulson, 60 3) Russell Freeman, 51 4) Paul . Investigations and OCWI; Office of Licensing & Regulation (OLR) Young Adult. The Health Plan follows the investigation process described in Arizona Administrative Code Title 9, Chapter 21 (9 A.A.C. information in its investigations. 446 - Grievances and Investigations Concerning Persons with Serious Mental Illness; Attachment A - AHCCCS Appeal or Serious Mental Illness Grievance Form; 447 - Employment; 103 Fraud, Waste, and Abuse . CONTROLLED SUBSTANCES PRESCRIPTION MONITORING PROGRAM (A.R.S 362602; A.R.S. 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 . 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. Title Reference: Statewide Behavioral Health and Appeals Coordinator. AHCCCS supported the investigations of 22 successful prosecutions of either members or providers. Form Name: Application for Enrollment into AHCCCS CRS. AHCCCS 801 E Jefferson St Phoenix, AZ 85034 Find Us On Google Maps. o SMI Appeal results for Special Assistance members - Available upon occurrence. . under investigation from fraud or abuse or claims under review for medical necessity. After nearly three hours of testimony, where investigators make it clear they are going after Petersen, authorities released Jennet. 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. complaint to AHCCCS and/or DES for appropriate investigation. The Office of Special Investigations (OSI) was created by legislative action to investigate welfare fraud. Special agents with U.S. Immigration and Customs Enforcement's (ICE) Homeland Security Investigations (HSI) and officers with the Arizona . information in our 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. Stat. 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. Between November 2015 and May 2019, AHCCCS paid for at least 29 births. Healthcare Professional - Pharmacist skilled in Operations, Compliance, Health Policy, Investigations & Inspections . (DES/DDD) contracted with Hacienda to provide medical and behavioral health services to members of AHCCCS. (A person doesn't have to be Medicaid-eligible (Title XIX) to receive services. If you are being investigated by the DSS/HRA, contact an attorney immediately. Arizona Health Care Cost Containment System . Investigations 105 Modifications 105 Provisional Credentialing Process and Requirements 107 . 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. of business. AHCCCS realized over $1 billion in avoided and recovered costs as a result of coordination of benefits, third party recoveries, and OIG activities. 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 5. Another man, Michael Cameron, was arrested in connection with the investigation, but Garcia said he was not a state employee. calendar days to the AHCCCS-OIG by completing and submitting the "Provider Self Disclosure" form, found on the AHCCCS-OIG webpage. Such investigation shall be completed within 60 days from Effective Date: Monday, October 1, 2018. We will help you with the process for initiating a grievance or requesting an investigation. 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. 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. "As promised, you're . Type: N/A. AHCCCS has a contract for unlimited searches for a basic monthly charge. Pursuant to 42 CFR 455.12-23 and an Intergovernmental Agreement with the Arizona Attorney General's EXPLOITATION For purposed of this Policy, the illegal or improper use of an AHCCCS AHCCCS, Arizona's Medicaid agency, helping provide rides to COVID-19 vaccine appointments. 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. 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. OSI administration is located in Phoenix with field offices in Flagstaff 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 . If a claim for payment under Medicare as primary coverage has been initially 13-4062(4), in cases of suspected AHCCCS fraud. Please see the provider manual section on IAD reporting for . 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. ACOM POLICY 442 - OPT OUT REQUEST FOR A MEMBER WITH A SERIOUS MENTAL ILLNESS DESIGNATION. 21), Article 4, and in AHCCCS ACOM 446 (Grievance and Investigations Concerning Persons with Serious Mental Illness). Email Address: [email protected] 1-800-867-5808. 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 . Hacienda ran an Intermediate Care Facility and was contracted to . 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. A fraud investigation determines whether a scam has taken place and gathers evidence to protect the victims involved. 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. 5. 12-06 www.azauditor.gov Contact person: Dot Reinhard (602 . of Completion of the form: Employee reporting the incident/accident completes ELECTRONIC document (faxed copies are no longer 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. 2 FTP Server - IOC Reports/Documents o Special Assistance Report - Available the 25th day of the month. PHOENIX State officials have announced a first-in-the-nation approach to helping vulnerable . . The Investigation Revenue and Enforcement Administration Bureau of Fraud Investigation has professionals working for them. 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. 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 . AHCCCS says they became aware of the breach on January 15, 2019. . The Supreme Court affirmed Defendant's convictions and sentences, holding that the Arizona Health Care Cost Containment System (AHCCCS) statutory scheme, Ariz. Rev. The OIG is designated as a criminal justice agency and is authorized by the Federal Bureau of Investigation and the . Maricopa County Sheriff's Office deputies assisted with the execution of the search warrants at one location. Their work was vital to these investigations." Phone: 602-417-4000 In-State Toll Free: 1-800-654-8713 (Outside Maricopa County) AHCCCS system for the date(s) of service but at a later date eligibility was posted retroactively to cover the date(s) of service. . Due Jun 20, 2022 05:00 PM (US/Arizona) AHCCCS Director helps lead the National Association of Medicaid Directors (NAMD) Executive Young Adult Program; Young Adult Resources; Youth Empowerment Council; . 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. How to Apply Covered Services Pay Your Premium Health Insurance for Children . The couple was counted earlier this month by the . This project was funded in part by support from the Fund for Investigative . The strategies here apply to Family Health Plus and Child Health Plus investigations as well. . 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). Status: Open for Comment. 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. One of the primary functions of the AHCCCS-OIG is to analyze and 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. Arizona Health Care Cost Containment System (AHCCCS) and the Office of Quality of Care (QOC) . To apply for the AHCCCS," Jennet said. The AHCCCS Office of Data Analytics has a management team as well as five units to perform these functions: . CAREERS Virtually everything Arizona state employees do affects the quality of life for our residents and guests. The AHCCCS' contract