After the Arizona Governor and the President of the Navajo Nation both declared COVID-19 public emergencies, the need for non-emergency medical transports dramatically decreased. 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. 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 $1.3 residence in Gilbert, Arizona. including but not limited to, provider terminations, credible allegation of fraud payment suspensions, final overpayment findings, and the imposition of civil monetary penalties. The money funds group therapy and cultural activities at the center as well as transportation to and from the center, meals and housing. An official website of the United States government. 8) Aaron Wright, 40. Subscribe to Newsletters local police and law enforcement agencies, county prosecutors, contracted health plans, and other state agencies. Did You Know Communications. The goal of The Quality Department Investigations is to identify adverse outcomes whether at the provider level or a systemic issue; develop and implement plan of correction to reduce likely hood of reoccurrence or similar outcome, improving the care our members receive. Analysis of electrical accidents and the related causes involving hbbd``b`z$A5@ep %`@O 'HMy@Hko J: Phoenix resident Curtis Nez credits outpatient treatment with helping him stay sober. King said the proposed change appears to be an attempt to crack down on AHCCS funding abuse. Grievance and Appeal System - AZ Complete Health 567 0 obj <> endobj Proposition 211 is designed to unearth the ultimate source of all campaign funding. The agency confirmed to ABC15 that most of the affected patients are Native American. rG ")_6S:NRjFjLAphzFF&yKBn~'!lVK"uL8 UUYgyWHjHTE8|+y,u^Ey^]r@p( s?z Fraudsters are using the uncertainty around COVID-19 to line their pockets, said Sean Kaul, Special Agent in Charge of the FBI Phoenix Field Office. Criminal Division | Arizona Attorney General That would drop to $157 per patient per day under the proposal. endstream endobj 568 0 obj <>/Metadata 25 0 R/Pages 565 0 R/StructTreeRoot 33 0 R/Type/Catalog>> endobj 569 0 obj <>/MediaBox[0 0 612 792]/Parent 565 0 R/Resources<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 570 0 obj <>stream Patients file grievances, experts want reforms at Arizona State Hospital x}n0. 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. United States Attorney's Office Announces Charges in Fraud Cases Lock nr Cd86C3Y-LU'~WU0O3Z2P/O 58j!iPv@8:PEz/>#WVf?OK3J5Nw7QsnG:40'F7SRiM#4=( g]*3f$2TAAix91ix}d23B )nf:kFYR{3X\^&ZHhaS+ip *SWX*v RmSiZv6n*M7UXZlVtJxghJ@N'Gn/yrf_4 R7t|> 8I4"8^T~^v30,'!d9Py d90HH6_E\}Y+M`+'tew6 4 The charges include healthcare fraud, wire fraud, money laundering, and aggravated identity theft. The Arizona Attorney Generals Office conducted this investigation along with investigators from the Office of Inspector General for the U.S. Department of Health and Human Servicesand the Officeof Inspector General for AHCCCS. The unit consists of attorneys, investigators, an auditor, a nurse investigator, paralegal and support staff. And she said AHCCCS has not reviewed the health plans, with which it contracts to provide direct services to patients, once every three years as required. The CNAP Manual contains policy for Arizona's Cash and Nutrition Assistance Programs administered by the Family Assistance Administration (FAA). AHCCCS supported the investigations of 62 successful prosecutions of either members or providers. Tucson: (520) 620-7300 Abuse or neglect allegation made about staff member(s); Physical injury that occurs as the result of personal, chemical or mechanical restraint; Unauthorized absence from a licensed behavioral health facility, group home or HCTC of children or recipients under court order for treatment; Discovery that a client, staff member, or employee has a communicable disease as listed in R9-6-202 (A) or (B); Incidents or allegations of violations of the rights as described in A.A.C. An official website of the United States government. A complaint is simply the method by which a person is charged with criminal activity and raises no inference of guilt. At least give us more time, King said. The FBI thanks the U.S. Department of Health and Human Services Office of the Inspector General (HHS-OIG), and the Arizona Health Care Cost Containment System Office of the Inspector General (AHCCCS-OIG) for their partnerships and collaboration on these cases. grTkae`jK5]+wn_} Ox [hV2k1Y! @Uc$' x!Wmz I "|U;D&NL# Ce. If the incident needs immediate attention, and it is not during regular business hours, call 911 immediately. These same provisions also exhibit an intent to provide law enforcement access to . That will just result in fewer services overall. RELEASE NUMBER: 2020-053_COVID Fraud. But heres the thing: As of this past July, Perry said the case was still under investigation. You will need Adobe Reader to open PDFs on this site. In fact, nearly 60% had been open for longer than a year. OIG investigations are often extremely complicated and detailed, requiring significant research, subpoena of third parties, forensic accounting evaluations, medical record reviews, onsite assessment, skip tracing, billing and claims examination, 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. AHCCCS had not completed a preliminary investigation of 87% of potential provider fraud or abuse to the Attorney Generals Office within three months, the time frame established in an agreement between the two agencies, Perry said. Follow the U.S. Attorneys Office, District of Arizona, on Twitter @USAO_AZ for the latest news. law enforcement agency. Investigation and the Arizona Department of Public Safety to access criminal justice information PHOENIX, Ariz. The United States Attorneys Office unsealed three criminal complaints filed in Federal District Court charging multiple individuals with health care fraud associated with the COVID-19 pandemic. Monica Klapper, Assistant U.S. Attorney, District of Arizona, Phoenix, is handling the prosecution. Have a question about Government Services? Im 16 months sober, he said. AHCCCS in all but a few instances is the "payor of last resort," meaning that if an AHCCCS member has other insurance coverage, that insurer must pay for the medical expenses incurred. Today, he is studying to be an electrician technician. ), include requirements for the types of agency actions that must provide hearing rights, the format of the notice of the agency Doug Ducey to call a special legislative session to let lawmakers provide "additional clarity'' , For Star subscribers: A federal judge has blocked the state from enforcing a new law that he said could inadvertently make felons out of volun. AHCCCS said it was having difficulty in subpoenaing needed information from the member and the members employer because the member had moved and changed jobs multiple times since 2014. Make no mistake, the FBI will actively pursue those seeking to fraudulently profit from the pandemic. For example, at Sunrise Native Recovery their reimbursement has been $1,300 per patient per day. Copyright 2023 Scripps Media, Inc. All rights reserved. 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. Policy. Have a question about Government Services? Policy Manuals Because there's gonna be literally no services.. A lot of people are gonna fall through the cracks, said Allen King, Sunrises chief administrative officer. Perry, however, said AHCCCS needs to do more. FAA workers may submit their requests to investigate potential fraud using the investigation referral process. R9-20-203 or in A.A.C. 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. 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. In addition to criminal General Questions and Fraud Reporting A concern about the quality of health care provided, or the appropriateness of the medical treatment received. A U.S. 602.364.0411 (fax). AHCCCS receives data from Motor Vehicle Division (MVD) and Industrial Commission to assist with third party liability identification. An indictment is simply a method by which a person is charged with criminal activity and raises no inference of guilt. Uber offering horse drawn carriage rides in honor of royal coronation. News & Press Releases, Can't find what you're looking for? Conduct investigations, Manage time effectively, deal . The accused persons and businesseslisted beloware alleged to have fraudulently billed the states Medicaid agency, Arizona Health Care Cost Containment System (AHCCCS), for millions of dollars of services they claim to have provided to AHCCCS patients. Healthcare Fraud & Regulation - Mitchell | Stein | Carey | Chapman Please see the provider manual section on IAD reporting for further information. We remain committed to rooting out and prosecuting any individual who would use this crisis as an opportunity to defraud individuals or the government.. Mansour Ahmadi is a U.S.-designated Iranian cyber hacker who, along with Ahmad Khatibi Aghda and Amir Hossein Nickaein Ravari, carried out a wide-ranging hacking campaign to compromise hundreds of computers across the United States and abroad. 41-1092 et seq. AHCCCS, in a response to the audit, said part of the problem was related to the COVID outbreak. investigations, OIG also issues and collects civil monetary penalties; issues credible allegations of If, at any point in an investigation, elements of criminal conduct and/or a reliable indication of fraud is determined, OIG partners with the appropriate Investigations must be conducted pursuant to A.A.C. Jeremiah Faber is scheduled to make his initial appearance in court on June 30, 2020. A .gov website belongs to an official government organization in the United States. OIG Administrative Assistant, (602) 417-4193, General AHCCCS Information U.S. Attorney's Office, District of Arizona, United States Attorney's Office Announces Charges in Fraud Cases Related to COVID-19, 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. 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. Phoenix, AZ 85004, Phoenix: (602) 514-7500 On September 14, 2022, Ahmadi was designated by the U.S. The state Auditor General's Office has found Arizona's Medicaid program is not sufficiently investigating potential cases of fraud. Office of Special Investigations (OSI)/AHCCCS Office of Inspector Arizona Auditor General's Office finds AHCCCS is not sufficiently ) or https:// means youve safely connected to the .gov website. PDF 446 GRIEVANCES AND INVESTIGATIONS CONCERNING PERSONS WITH - Arizona 21), Article 4, and in AHCCCS ACOM 446 (Grievance and Investigations Concerning Persons with Serious Mental Illness). Download the free version of Adobe Reader. PDF 446 GRIEVANCES AND INVESTIGATIONS CONCERNING PERSONS WITH - Arizona AHCCCS appeared to finish its investigation of the incident in September, according to records reviewed by ABC15. 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. Evidence that potential fraud occurred during the current or previous application period (initial or renewal). Two Renaissance Square 40 N. Central Avenue, Suite 1800 He wasnt even sure what day it was. These appeal rights, as set forth in the Arizona Uniform Administrative Hearings Procedures, (A.R.S. But Perry said if the agency does not investigate and resolve cases in a timely manner, it potentially continues to pay thousands of dollars each year to provide health care coverage for a member who may have obtained this coverage fraudulently., Untimely investigations could also delay efforts to recover fraudulent payments and make recovering improper payments more difficult, the report states. Email ABC15 Investigator Anne Ryman atanne.ryman@abc15.com, call her at 602-685-6345, or connect onTwitterand Facebook. These are intensive services, provided at least three hours a day and at least three days a week. The proposal affects outpatient alcohol and drug treatment programs. State v. Zeitner, 436 P.3d 484 | Casetext Search + Citator A lock ( A Standard Reporting. endstream endobj 573 0 obj <>stream 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. action, hearing timelines, the provision of informal settlement conferences, and other general agency obligations. And that, said Auditor General Lindsey Perry, comes at a cost. Share sensitive information only on official, secure websites. 362903). The first complaint charges Abdul Raheem Abdul Jabbar, Nohad Loabneh, and Abedelhalim Lawabni with conspiring to commit health care fraud. The Medicaid Fraud Control Unit is a federally funded unit charged with investigating and prosecuting: Medicaid (AHCCCS) fraud; fraud in the administration of the Medicaid program; and abuse, neglect or financial exploitation occurring in Medicaid facilities or committed by Medicaid providers or their employees. AHCCCS declined an interview request with ABC15. 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. Nai# A lot of people who are seeking recovery, this is going to hurt them a lot, he said. Our investigation indicated that about 36.7% of accidents were caused by exposures to electricity transmission networks during in buildings (10%) and during unauthorized construction operations of residential houses in the areas of Medium Voltage (MV) and Lowest Voltage (LW) lines (26.7%). The agency said those visits resumed in January. AHCCCS said the proposed change may impact about 223 providers or about 10 percent of more than 2,200 providers. 5. Hn0:@%Y]QIS KVl ;5G9ika 8$EH=`"'iXS}0,3''GWsCf~0%9SDM ypY{Q_F\eU7\yc@q}`?Wh @H R#r+wo 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. The second complaint charges Miguel Denga, Husam Alsadi, and Tamarria Denga with conspiring to commit health care fraud. information in our investigations. persons under oath to obtain evidence for investigations. The agency estimates the change would save $1.1 million over five months. District of Arizona The problems, the report says, are not limited to patients. The indicted defendants are listed below: 2) Kevin Maulson, 60 relevant to official investigations. 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. 6) Charles Temple, 36 The report found some incidents that auditors decided to single out for special mention. Rehab center scams are targeting Indigenous people, advocates say Common examples include: If you suspect that AHCCCS fraud has occurred, please contact the Medicaid Fraud Control Unit promptly. In November 2020, AHCCCS upheld part of Contreras' grievance, noting that surveillance footage backed up his claim about being kept in restraints. 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. Official websites use .gov A locked padlock 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. As noted above, after the Governor of Arizona and the President of the Navajo Nation both declared COVID-19 public emergencies, the need for non-emergency medical transports dramatically decreased. 331 Research article EMHJ - Vol. (AHCCCS) Quality Management System (QMS) Portal is used for the . %PDF-1.6 % Outpatient rehab in jeopardy for Native Americans under Medicaid proposal And if it is not, Perry said, AHCCCS should work with the legislature to provide more funds. Perry said that AHCCCS, as allowed by its process, did not assign it for investigation until October 2018. And its only the Fee-For-Service Program thats facing these proposed cuts. All rights reserved. Provider Compliance Investigator - REMOTE OPTIONS, Arizona, United Medicaid Fraud Control Unit | Arizona Attorney General Residential rehab centers, which arent subject to the proposed cuts, worry about what will happen once they discharge their patients. Officials with Sunrise Native Recovery are hoping AHCCCS will postpone making the change until it can be thoroughly discussed. Fish and Wildlife Service program designed to restore Mexican wolves to Arizona fails to follow federal law, conservation groups say. Share sensitive information only on official, secure websites. 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. 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. One goes back to August 2014 with allegations that another adult was living in and contributing financially to the household. PDF AHCCCS PROGRAM INTEGRITY - STRATEGIC PLAN - azahcccs.gov Subscribe to stay connected to Tucson. 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. Attorney General Mark Brnovich is asking Gov. AHCCCS needs to crunch down on what they're authorizing." Hatathlie said the sober living providers can make a lot of money by going through a process to become certified as an Indian Health . Indicted businesses are listed below: Assistant Attorneys General from the AGOs Health Care Fraud and Abuse Section and the Financial Remedies Section are prosecuting this case. 3) Russell Freeman, 51 Keep reading with a digital access subscription. An Investigation of Factors Affecting the Teachers' Job Performance in ) or https:// means youve safely connected to the .gov website. 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. zWW\[e@*e1i6@_VE>UO4)]-1e;nis$_aY>*Z#%Y :$DYG.E'_iM7.g ~hRB8~/= The other six defendants are scheduled to make their initial appearances in court on June 11, 2020. If you suspect that Medicaid fraud has occurred, or abuse, neglect or exploitation has occurred in a Medicaid facility or by someone working for a Medicaid provider, immediately report the incident to the Medicaid Fraud Control Unit Monday - Friday 8:00-5:00pm at the Office of Attorney General: 2005 N Central Ave Out-of-State Toll Free: 1-800-523-0231, How to Apply 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. The general public and participants may submit their requests through any of the following methods: Two departments are responsible for acting on the requests. Most of the accident victims were men (27 out of 30 or . Harmony then fraudulently submitted claims for reimbursement to Mercy Care, Arizonas health care benefit program, by billing for services that were medically unnecessary and for services provided in the names of physicians who had no role in the assessment. HV]oJ}G?Jw-U )W!1mPb(R q;`@]3>h gN ,_nGW~LHq&0_w;h-s v;0\-yI/2aOSOjb%m}|Gp9W.E !AD1,:M,` V^O*]dirz5%'u)q'b0U/r'LvHT\,1_pH+mg[c(As/a/Olz=PF+ii6lQsy-QcdGeSn8A{"9!/".n8PW R9-21-402 et seq. AHCCCS, formed in 1982, is the states Medicaid program. AHCCCS is primarily federally funded, and it provides healthcare programs for Arizonas low-income residents. We will have nowhere to send these patients. AHCCCS has a contract for unlimited searches for a basic monthly charge. Abuse can result in physical injury such as: Examples of assaultive acts include, but are not limited to: Neglect is a pattern of conduct without the person=s informed consent resulting in deprivation of food, water, medication, medical services, shelter, cooling, heating or other services necessary to maintain minimum physical or mental health. endstream endobj 572 0 obj <>stream Investigations often take considerable time to obtain these details, sometimes years, depending on the specific case circumstances. tG4!#T;vJ+5JJo=SNYD43cI(eJLo-(Wctfa[PEo+I;9VP)?Us{ccnjoe1GHWaXYV Q n'gT~4 wv-nSjs`kDWCjtJaoPTB;+"0.5"Sr]sUA&SbCZ,os6&(.37{ITm>EDW d Its heartbreaking.. 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. witness interviews, subject matter expert opinion analysis, and evidentiary review in order to determine preliminary findings. OIG often performs multiple preliminary reviews as each cases facts and evidence evolve. 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, AHCCCS had not completed a preliminary investigation of 87% of potential provider fraud or abuse to the Attorney General's Office within three months, the time frame established in an agreement . 7) Allen Jeter, 57 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 conducts pre-approval investigations to ensure its members are eligible to receive benefitsThe Now more than ever, the integrity of our healthcare system is paramount as we fight a global pandemic, said United States Attorney Michael Bailey. Obtain a copy of the Medicaid Fraud Control Unit Complaint Form. Wi?~GQwS}|mYMGVi6YAu5iy\Ed@uOJ^KS" 602.542.3881 4) Paul Flaa, 56 01 Participant Initiated Changes. Im 16 months sober, he said. AHCCCS receives County inmate data for more than 90% of the state to assist with eligibility compliance. Two Renaissance Square 40 N. Central Avenue, Suite 1800 Unlike some Medicaid fee-for-service programs that operate in other states, AHCCCS makes regular payments to provider organizations that, in turn, provide direct care to members. About 2.4 million Arizonans receive care under one of several AHCCCS programs; about 38% are children.

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