The OIG is designated as a criminal justice agency and is authorized by the Federal Bureau of Official websites use .gov Follow the U.S. Attorneys Office, District of Arizona, on Twitter @USAO_AZ for the latest news. 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. 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. 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. 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. That would drop to $157 per patient per day under the proposal. The indictment alleges that the couple used their medical billing company to bill AHCCCS for services not actually rendered. Secure .gov websites use HTTPS The problems, the report says, are not limited to patients. 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. Suicide or significant suicide attempt by a Member; Unauthorized absence of a Member from a locked behavioral health inpatient facility; Sexual assault while a Member is a resident of a locked behavioral health inpatient facility; or. IADs must be submitted by the provider within 2 business days of the incident. Main Office: Did You Know Communications. 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. 605 0 obj <>stream 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. In-State Toll Free: 1-800-654-8713 (Outside Maricopa County) 49th Annual Peace Officers Memorial Service, Elder Abuse Information and Training Guide, Data Breach Notification Form Individuals, Medicaid Fraud Control Unit Complaint Form, Billing for a higher level of service than was performed, Denial of necessary services or procedures, or denial of access to specialists, Unsafe, dangerous or unsanitary living conditions. A Quality Incident can be detrimental to a members health or safety and may reflect that the care provided was below the professional standards of care. AHCCCS said the proposed change may . Im living proof. Hn0:@%Y]QIS KVl ;5G9ika 8$EH=`"'iXS}0,3''GWsCf~0%9SDM ypY{Q_F\eU7\yc@q}`?Wh @H R#r+wo OIG conducts thorough civil and criminal investigations while adhering to its federal, state and contractual requirements. %PDF-1.6 % Office of Special Investigations (OSI)/AHCCCS Office of Inspector General (AOIG). Get up-to-the-minute news sent straight to your device. R9-21-406. A lot of people are gonna fall through the cracks, said Allen King, Sunrises chief administrative officer. For more information on the U.S. Attorneys Office, District of Arizona, visit http://www.justice.gov/usao/az Have a question about Government Services? Conduct investigations, Manage time effectively, deal . The Office of Inspector General (OIG) is responsible for the integrity of the AHCCCS budget, nearly $18 billion in State Fiscal Year 2023. . The indicted defendants are listed below: 1) Dale Henson, 53. Careers 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. relevant to official investigations. For example, at Sunrise Native Recovery their reimbursement has been $1,300 per patient per day. grTkae`jK5]+wn_} Ox [hV2k1Y! @Uc$' x!Wmz I "|U;D&NL# Ce. 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. 602.542.3881 Their work was vital to these investigations.. You will need Adobe Reader to open PDFs on this site. 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. Now more than ever, the integrity of our healthcare system is paramount as we fight a global pandemic, said United States Attorney Michael Bailey. 362903). For more information on the U.S. Attorneys Office, District of Arizona, visit http://www.justice.gov/usao/az/ AHCCCS' Office of Inspector General (OIG) registers all of AHCCCS' medical providers, such as doctors and home healthcare agencies. Policy and procedures regarding referrals to OSI are outlined as follows: This site works best with JavaScript enabled, AHCCCS Office of Inspector General (AOIG), OSI - Potential Fraud Referral Requirements. While Auditor General Lindsey Perry says . The legislature's express provisions in the AHCCCS statutes granting AHCCCS broad authority to investigate matters of suspected fraud 36-2903 and -2918(G)necessarily imply an exception to the privilege for AHCCCS investigations and proceedings. Out-of-State Toll Free: 1-800-523-0231, How to Apply The couple was charged earlier this month by the federal grand jury in a 58-count indictment. law enforcement agency. 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. Arizona Health Care Cost Containment System, known as AHCCCS, is proposing to change the way it reimburses providers for outpatient treatment services through the Fee-For-Service program. Their work was vital to these investigations." 602.364.0411 (fax). PDF 446 GRIEVANCES AND INVESTIGATIONS CONCERNING PERSONS WITH - Arizona 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. 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 So we can figure things out and talk with the AHCCCS program, let them really understand.. 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. Uber offering horse drawn carriage rides in honor of royal coronation. Lock The unit consists of attorneys, investigators, an auditor, a nurse investigator, paralegal and support staff. The complaint alleges that Faber used Harmonys Facebook and other social media sources to offer free COVID-19 testing if patients also completed Harmonys Comprehensive Whole-Body Assessment. Tamarria Denga owns and operates COS 1, LLC. 331 Research article EMHJ - Vol. Fee-for-Service Fee Schedules, Contact Us 12) Thomas Battle III, 43 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 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. 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 An official website of the United States government. Obtain a copy of the Medicaid Fraud Control Unit Complaint Form. The state Auditor General's Office has found Arizona's Medicaid program is not sufficiently investigating potential cases of fraud. . The second complaint charges Miguel Denga, Husam Alsadi, and Tamarria Denga with conspiring to commit health care fraud. Grievance and Appeal System - AZ Complete Health Follow the instructions on the Potential Quality Issue (PQI) Referral Form (PDF) to submit Quality of Care concerns to the Medicare or Ambetter department. 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 . 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 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. hWmOF+T}t9zj!`)w=}Y` )Cew;;I{&CNOXDxI(hD3`6 hI3%R)ksB0 !HA1*` h>|?++^3vGW8]Ur9y4Uw These statutes provide for a computerized central database tracking system to track the The allegation was that had this persons income been included in the application, the household would not have been eligible for AHCCCS coverage. Perry, however, said AHCCCS needs to do more. R9-21-402 et seq. 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