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. of AHCCCS system for the date(s) of service but at a later date eligibility was posted retroactively to cover the date(s) of service. 2) Kevin Maulson, 60 3) Russell Freeman, 51 4) Paul . The contractor maintains more than 17 billion records on individuals and businesses which AHCCCS uses as background information in its investigations. The birth mothers should not have qualified for AHCCCS benefits because they were not Arizona residents. >. Young Adult Program; Young Adult Resources; Youth Empowerment Council; . o SMI Grievance Investigation and decision letters for Special Assistance members -Available upon occurrence. ACOM POLICY 442 - OPT OUT REQUEST FOR A MEMBER WITH A SERIOUS MENTAL ILLNESS DESIGNATION. The AHCCCS is able to use a large contractor database, which combines personal data from multiple public and private databases, in developing fraud and abuse cases. Note: At this stage the redaction process is the same as the QOC . Application for Enrollment into AHCCCS CRS. by Amy Silverman October 22, 2021. "As promised, you're . After nearly three hours of testimony, where investigators make it clear they are going after Petersen, authorities released Jennet. Stat. Veit also will pay a $15,000 investigation fee to the Attorney General's . Arizona Health Care Cost Containment System . 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." CAREERS Virtually everything Arizona state employees do affects the quality of life for our residents and guests. 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. "AHCCCS conducted an extensive internal investigation and determined that, due to a programming error, 3,146 IRS 1095-B Forms . 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- 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. How to Apply Covered Services Pay Your Premium Health Insurance for Children . Mobile crisis responders provide an alternative to police and paramedics. . AHCCCS Director helps lead the National Association of Medicaid Directors (NAMD) Executive If you are being investigated by the DSS/HRA, contact an attorney immediately. 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. Another man, Michael Cameron, was arrested in connection with the investigation, but Garcia said he was not a state employee. The court affirmed the lower court's decision on two grounds. The Investigation Revenue and Enforcement Administration Bureau of Fraud Investigation has professionals working for them. The AHCCCS Office of Data Analytics has a management team as well as five units to perform these functions: . Veit worked at AHCCCS for 27 years before his arrest, according to Monica Coury, the agency's assistant director. Fraud is misrepresentation with the intent to deceive. 2) Kevin Maulson, 60 3) Russell Freeman, 51 4) Paul . 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 Young Adult Program; Young Adult Resources; Youth Empowerment Council; . CRSApplicationInstructions_18.pdf. Such investigation shall be completed within 60 days from The couple was counted earlier this month by the . CAREERS Virtually everything Arizona state employees do affects the quality of life for our residents and guests. (A person doesn't have to be Medicaid-eligible (Title XIX) to receive services. The Health Plan follows the investigation process described in Arizona Administrative Code Title 9, Chapter 21 (9 A.A.C. AHCCCS realized over $1 billion in avoided and recovered costs as a result of coordination of benefits, third party recoveries, and OIG activities. 5. Two suspects are in custody . R9-21-402 et seq. AHCCCS, Arizona's Medicaid agency, helping provide rides to COVID-19 vaccine appointments. ACOM POLICY 442. 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. AHCCCS should improve its recovery processes Arizona Health Care Cost Containment SystemMedicaid Fraud and Abuse Prevention, Detection, Investigation, and Recovery Processes REPORTA copy of the full report is available at: HIGHLIGHTS PERFORMANCE AUDIT September 2012 Report No. PHOENIX State officials have announced a first-in-the-nation approach to helping vulnerable . o Any documentation formally requested via the IOC Request for The review of DHS' responsibilities found that DHS needs to improve its licensure and complaint investigation processes for home health agencies. Investigations and OCWI; Office of Licensing & Regulation (OLR) Young Adult. Howard Fischer Capitol Media Services. Ducey issued a statement Wednesday morning saying AHCCCS is launching . 2 FTP Server - IOC Reports/Documents o Special Assistance Report - Available the 25th day of the month. 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. 5. For health plan fraud, you can reach aHCCCS via: -888-ITS-NOT-OK (888-487-6686) AZ Complete health via: - 1-888-788-4408 to report your claims.In order to contact AHCCCS, call or email AHCCCSFraud@azahcccs.com. OSI administration is located in Phoenix with field offices in Flagstaff Attached with the form, shall be all pertinent information to assist AHCCCS in its investigation process. 103 Fraud, Waste, and Abuse . Investigations 105 Modifications 105 Provisional Credentialing Process and Requirements 107 . The indicted defendants are listed below: 1) Dale Henson, 53. These statutes provide for a computerized central database tracking system to track the Completion of the form: Employee reporting the incident/accident completes ELECTRONIC document (faxed copies are no longer 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. Pursuant to 42 CFR 455.12-23 and an Intergovernmental Agreement with the Arizona Attorney General's Sep 26, 2012 Updated Sep 26, 2012. In addition, when DHS identifies licensing violations during home health agency inspections and complaint investigations, it does not How Do I Report Someone To Ahcccs? Form Name: Application for Enrollment into AHCCCS CRS. 21), Article 4, and in AHCCCS ACOM 446 (Grievance and Investigations Concerning Persons with Serious Mental Illness). AHCCCS 801 E Jefferson St Phoenix, AZ 85034 Find Us On Google Maps. . AHCCCS Allegation expected Death TERROS, General He*th (GMH) 2345 Download PDF Document Document Date: View Member IAD 7128/2020 PM Inquiry Form AHCCCS Arizona Health Care Cost Containment System INCIDENT, ACCIDENT OR DEATH REPORT MEMBER INFORMATION Member Name City Date Of Birth AHcccs ID CIS ID Eligibility Status C at ego ry Title Supervisor investigation and follow-up with signature. 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. Sep 26, 2012. functions for the AHCCCS Fee-for-Service population and is responsible for direct investigations and oversees contractor efforts related to credentialing and monitoring of health care acquired conditions and other provider preventable . The Supreme Court affirmed Defendant's convictions and sentences, holding that the Arizona Health Care Cost Containment System (AHCCCS) statutory scheme, Ariz. Rev. concerning persons with a Serious Mental We will help you with the process for initiating a grievance or requesting an investigation. Investigations and OCWI; Office of Licensing & Regulation (OLR) Young Adult. 362903). We have successfully defended clients in parallel investigations and proceedings conducted by the Office of Inspector General (state and . 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. This project was funded in part by support from the Fund for Investigative . A fraud investigation determines whether a scam has taken place and gathers evidence to protect the victims involved. AHCCCS Clinical Resolution Unit. The strategies here apply to Family Health Plus and Child Health Plus investigations as well. Healthcare Fraud & Regulation. 13-4062(4), in cases of suspected AHCCCS fraud. 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 . Please call the Arizona Department of Economic Security Fraud Hotline at (800)251-2436 (or (602)542-9449 (to report fraud or malpractice ) to fill out the following field. 5. 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. 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. 446 - Grievances and Investigations Concerning Persons with Serious Mental Illness; Attachment A - AHCCCS Appeal or Serious Mental Illness Grievance Form; 447 - Employment; The AHCCCS Contract and Policy Dictionary provides a centralized location for definitions that are found in the various ACOM and AMPM Policies. On September 2nd, 2015, special agents of the Arizona Attorney General's Office executed search warrants at four different locations in Maricopa County in conjunction with an ongoing investigation by their Health Care Fraud Special Investigation Section. The AHCCCS OIG's contract permits it to conduct unlimited searches for a basic monthly charge. 4. How Do I Report Fraud In Arizona? 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 . 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. How to Apply Covered Services Pay Your Premium Health Insurance for Children . EXPLOITATION For purposed of this Policy, the illegal or improper use of an AHCCCS Type: N/A. Their work was vital to these investigations." The indicted defendants are listed below: 1) Dale Henson, 53. If a claim for payment under Medicare as primary coverage has been initially (DES/DDD) contracted with Hacienda to provide medical and behavioral health services to members of AHCCCS. 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. To apply for the AHCCCS," Jennet said. (DHS) and the Arizona Health Care Cost Containment System (AHCCCS). 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. (DES/DDD) contracted with Hacienda to provide medical and behavioral health services to members of AHCCCS. That said, non-Title XIX recipients do not qualify for as much. information in its investigations. calendar days to the AHCCCS-OIG by completing and submitting the "Provider Self Disclosure" form, found on the AHCCCS-OIG webpage. functions for the AHCCCS Fee-for-Service population and is responsible for direct investigations and oversees contractor efforts related to credentialing and monitoring of health care acquired conditions and other provider preventable . 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. AHCCCS says they became aware of the breach on January 15, 2019. . 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. AHCCCS 801 E Jefferson St Phoenix, AZ 85034 Find Us On Google Maps. AHCCCS supported the investigations of 22 successful prosecutions of either members or providers. Effective Date: Monday, October 1, 2018. The Office of Special Investigations (OSI) was created by legislative action to investigate welfare fraud. 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 . PHOENIX - The Office of the Arizona Attorney General's Medicaid Fraud Control Unit (MCFU) is the top-performing unit in the nation in bringing criminal indictments according to data provided to the U.S. Department of Health and Human Services (HHS). The couple was counted earlier this month by the . 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 . Healthcare Professional - Pharmacist skilled in Operations, Compliance, Health Policy, Investigations & Inspections . 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. When the investigation is concluded, The Health Plan issues a decision letter to the grievant (and the . 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. Unsafe housing jeopardizes success of community living for chronically mentally ill. 36-2901 to -2999.57, abrogates and creates an exception to Arizona's statutory physician-patient privilege, Ariz. Rev. . 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. This report is in response to an October The MCFU, housed in the Criminal Division of the Attorney General's Office (AGO), is also commonly referred to as the Health Care Fraud and . 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). o SMI Appeal results for Special Assistance members - Available upon occurrence. PHOENIX - The state's Medicaid program needs to do a . The Contractor shall not delegate QOC investigation processes or onsite QOC visits. Division: AHCCCS. (PFIT) at Arizona Health Care Cost Containment System (AHCCCS) IADs must be submitted by the provider within 2 business days of the incident. The AHCCCS' contract 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. 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). Maricopa County Sheriff's Office deputies assisted with the execution of the search warrants at one location. We will help you with the process for initiating a grievance or requesting an investigation. Hacienda ran an Intermediate Care Facility and was contracted to . under investigation from fraud or abuse or claims under review for medical necessity. In January, a sampling done by federal auditors found 25 possible instances of . 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. 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. The Arizona Health Care Cost Containment System (AHCCCS) is the single state Medicaid Agency that provides funding to administer health care benefits for persons who are Title XIX/XXI of business. AHCCCS told to improve fight against fraud, abuse. The investigation has also uncovered duplicate payments to health-care providers which went unnoticed by AHCCCS. The AHCCCS Office of Data Analytics has a management team as well as five units to perform these functions: . Form Number: CRS App. AHCCCS in its investigation shall be attached to the form, c. Once the Division has referred a case of alleged fraud, waste, or abuse to AHCCCS-OIG, the Division must take no action to recoup or ---DEPARTM EN T OF ---CON OM l C SEC URITY Your Partner For A Stron9er Arizona . Title Reference: Statewide Behavioral Health and Appeals Coordinator. You need to have professionals working for you. Please call the Arizona Department of Economic Security Fraud Hotline at (800)251-2436 (or (602)542-9449 (to report fraud or malpractice ) to fill out the following field. information in our investigations. County: N/A. Hacienda ran an Intermediate Care Facility and was contracted to . a. The Office of Inspector General (OIG) at AHCCCS handles all alleged fraud investigations. CONTROLLED SUBSTANCES PRESCRIPTION MONITORING PROGRAM (A.R.S 362602; A.R.S. Second Criminal Investigation. . 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. state's reinvestigation showed the AHCCCS plans to be in compliance with the disclosure requirements. Arizona Health Care Cost Containment System (AHCCCS) and the Office of Quality of Care (QOC) . 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. One of the primary functions of the AHCCCS-OIG is to analyze and Following the October 2019 indictment, the Arizona Attorney General's Office opened a second criminal investigation against Petersen. Please see the provider manual section on IAD reporting for . 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. Email Address: [email protected] 1-800-867-5808. 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. AHCCCS 801 E Jefferson St Phoenix, AZ 85034 Find Us On Google Maps. Quality investigations shall not be delegated or performed by the staff of the provider agency/facility where the identified health and safety concerns, immediate jeopardy, or AHCCCS requested reviews have occurred. . Phone: 602-417-4000 In-State Toll Free: 1-800-654-8713 (Outside Maricopa County) The OIG is designated as a criminal justice agency and is authorized by the Federal Bureau of Investigation and the . 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. 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. With so many diverse roles, you can see why our employees join state service and never want to leave. 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. Armed only with compassion, mobile crisis teams respond to emergencies all over Maricopa County when people need immediate . 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. 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. 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. AHCCCS has a contract for unlimited searches for a basic monthly charge. Stat. 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 . 5 . This timeframe may be extended for good cause as determined by AHCCCS or the Contractor, as applicable, b. With so many diverse roles, you can see why our employees join state service and never want to leave. complaint to AHCCCS and/or DES for appropriate investigation. . In November 2020, AHCCCS upheld part of Contreras' grievance, noting that surveillance footage backed up his claim about being kept in restraints. The issue involves two kinds of cases. How Do I Report Fraud In Arizona? 12-06 www.azauditor.gov Contact person: Dot Reinhard (602 . Status: Open for Comment. 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. Quality of Care investigations- SMI/GMH/Child Seclusion and Restraint reports - SMI/GMH/Child SpecialAssistance active list maintained by OHR - SMI ONLY . Due Jun 20, 2022 05:00 PM (US/Arizona) Special agents with U.S. Immigration and Customs Enforcement's (ICE) Homeland Security Investigations (HSI) and officers with the Arizona . Between November 2015 and May 2019, AHCCCS paid for at least 29 births.
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