Arizona Gov. Katie Hobbs and other top state officials announced a crackdown Tuesday on Medicaid fraud, particularly honing in on illegitimate group homes.
The Hobbs administration said many of those homes target tribal community members and have defrauded the state out of hundreds of millions of dollars.
An investigation that involved the FBI and the U.S. Attorney’s Office has resulted in at least 45 indictments by the office of Arizona Attorney General Kris Mayes.
Mayes said $75 million has been seized or recovered related to the schemes.
Authorities said the money was paid out by the state’s Medicaid program — the Arizona Health Care Cost Containment System — and the illegal activity involved billing for mental health treatment and addiction rehabilitation that never was provided.
They also said illegal activity also involved billing for mental health treatment and addiction rehabilitation that was never provided.
AHCCCS has since suspended payments to more than 100 providers and the agency expects more in the coming months.
New actions announced include a third-party forensic audit examining mental health and addiction provider claims since 2019, new processes for concerning or unusual claims and an overhaul of the fraud detection methods used.
“Prior to my administration, AHCCCS had taken a piecemeal approach to targeting these fraudulent providers,” Hobbs said. “Under my administration this will change… Together, we are going to bring about the systemic reforms we need to root out this problem and deliver true accountability.”
Daniel Scarpinato, who served as chief of staff for Hobbs’ predecessor, Republican Gov. Doug Ducey, was critical of the announcement of the crackdown.
“The investigation revealed today has been underway for several years, well before the current occupants took office,” Scarpinato said.
Hobbs and Mayes appeared at a news conference that also included representatives of 13 tribes from around the state.
1 thought on “Arizona’s governor and attorney general announce crackdown on Medicaid fraud – Associated Press”
Let’s take a closer look at this AP article. It raises more questions than it provides answers.
First of all, this article says that at least 45 indictments by the office of Arizona Attorney General Kris Mayes is the result of this “crackdown” on billing for mental health treatment and addiction rehabilitation that was never provided. This is all good but what is the magnitude of this problem in the AHCCCS system? Are these 45 or so indictments just a drop in the bucket and will there be meaningful prosecution of this fraud? If these indictments result in plea bargains where the fraudsters just receive a slap on the wrist this will have little deterrent effect on this type of fraud. Without meaningful sanctions these bad actors will just reemerge if there is still money to be made with this type of fraud.
Hobbs promises, “To bring about the ‘systemic reforms’ we need to root out this problem and deliver true accountability.” Only time will tell if she keeps her word.
Daniel Scarpinato from the Ducey administration said, “The investigation revealed today has been underway for several years, well before the current occupants took office.” If so, what did they do about it? Hobbs said, “Prior to my administration, AHCCCS had taken a piecemeal approach to targeting these fraudulent providers.” Will Hobbs’ “crackdown” also be “piecemeal” or will it be vigorous enough to have a meaningful deterrent effect?
This “crackdown” is focused on one type of Medicaid fraud: fraudulent billing for mental health treatment and addiction rehabilitation. Are there other forms of Medicaid fraud such as prescription drug fraud that also need to be addressed? If so, are there also going to be efforts to clamp down on these fraudulent activities?
We need more than political news conferences and press releases to clean up fraud in the Medicaid program. We need concrete results. Historically, fraud in the Medicaid program has been rampant because of lack of oversight by the government agencies administering these programs.
Politicians continuously promise us the world. Will Hobbs’ plan to root out this type of fraud in the AHCCCS program bear real results or is this just going to be more empty political rhetoric?
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