The Grand Canyon State is now delving deep into what looks like a sprawling $1 billion healthcare fraud, the Arizona Attorney General suggests, with sober living programs at the eye of the storm. Suspicions circle around Arizona's Medicaid agency, Arizona Health Care Cost Containment System (AHCCCS), after more than 300 behavioral health providers have been cut off from funding under accusations of dipping their hands deep into public coffers.
Arizona Attorney General Kris Mayes is determined to hold the accused accountable. "We’ve got a long way to go, but AHCCCS has made progress and my office continues to prosecute these cases to the fullest extent of the law," Mayes said in a statement obtained by FOX 10. The ledger of deceit may even surpass a billion-dollar threshold, as Mayes has her sight firmly set on: "I personally believe the number will top a billion dollars when it’s all said and done."
The rampant misuse of taxpayer dollars in this scheme ranges from "misdiagnosing patients for benefit of payment," to shady dealings involving billing for incarcerated individuals, as gleaned from newly released suspension notices by FOX 10. This misuse extends to the enrollment of Native Americans from tribal lands into the American Indian Health Plan under AHCCCS, potentially exploiting addiction battles faced by this vulnerable group.
AHCCCS is updating its anti-fraud systems, but Mayes believes more advanced technological tools could be better leveraged. "We could be using AI to identify fraud, to identify patterns of billing and fraudulent billing and that can’t happen when you’re operating on a system that was developed in the 1980s," Mayes conveyed to FOX 10. In furtherance of tightening accountability and oversight, Mayes advocates for behavioral health billers to be under camera surveillance while submitting their billing data.
Investigations are ongoing, with more than 250 cases active in the Attorney General's office alone. "It’s a lot. We’ve got more than 250 ongoing cases right now in my office alone," said Mayes, as reported by Footer News. Mayes senses that the issues at hand are considerable and that the current efforts only begin to untangle a complex web of corruption and mismanagement in state healthcare. "I believe we are just scratching the surface when it comes to reform, but we need to make more progress and do it faster," she acknowledged.
