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. 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. Without outpatient services, people will relapse, said Robin Byrne, Purpose Healing co-founder. The OIG is designated as a criminal justice agency and is authorized by the Federal Bureau of A conviction for healthcare fraud or wire fraud carries a sentence of up to 20 years, a conviction for money laundering carries a sentence of up to 10 years, and a conviction for aggravated identity theft carries a mandatory, consecutive 24-month prison sentence in addition to hefty maximum fines for each offense. (MFCU) of the Arizona Attorney General, the Federal Bureau of Investigations (FBI), Drug Enforcement Agency (DEA), Health and Human Services (HHS) OIG, local police and law enforcement agencies, county . OIG Administrative Assistant, (602) 417-4193, General AHCCCS Information 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. While Auditor General Lindsey Perry says . 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. Medicaid Fraud Control Unit | Arizona Attorney General At least give us more time, King said. 12) Thomas Battle III, 43 In a statement, the agency acknowledged that some providers may see a reduction in reimbursement based on how they currently bill. The agency estimates the change would save $1.1 million over five months. The statistical population includes 127 teachers. A lot of people who are seeking recovery, this is going to hurt them a lot, he said. Proposition 211 is designed to unearth the ultimate source of all campaign funding. Main Office: 10) Keyana Carter, 29 AHCCCS supported the investigations of 62 successful prosecutions of either members or providers. CASE NUMBER: CR 21-000601-PHX-DJH Submit all potential quality issues using the Arizona Complete Health Quality of Care Notification Form (PDF)to the following: AzCHQOC@AZCompleteHealth.com. Flagstaff: (928)556-0833 PDF AHCCCS Coordination of Benefits and Third Party Liability - azahcccs.gov Share sensitive information only on official, secure websites. This material may not be published, broadcast, rewritten, or redistributed. (AHCCCS) Quality Management System (QMS) Portal is used for the . The proposal affects outpatient alcohol and drug treatment programs. Investigations often take considerable time to obtain these details, sometimes years, depending on the specific case circumstances. Finally, AHCCCS risks compromising its ability to gather evidence and follow leads that might become stale as cases age.. Phoenix, AZ 85004, Phoenix: (602) 514-7500 Quality of Care | Arizona Complete Health The agency estimates the change would save $1.1 million over five months. The agency said those visits resumed in January. Today, he is studying to be an electrician technician. 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 Its absolutely horrific, he said of the proposal. AHCCCS declined an interview request with ABC15. Out-of-State Toll Free: 1-800-523-0231, How to Apply PDF 446 GRIEVANCES AND INVESTIGATIONS CONCERNING PERSONS WITH - Arizona OIG conducts thorough civil and criminal investigations while adhering to its federal, state and contractual requirements. ;~F` i_-|tI?=WOpTa#R}w]=lNDP` @ 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 . New home buyers can sue over construction defects even if they signed waivers not to do so, the Arizona Supreme Court says in a new ruling. AHCCCS, formed in 1982, is the states Medicaid program. R9-20-203 or in A.A.C. 11) Sharon Lawson, 48 41-1092 et seq. Their work was vital to these investigations.. 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. local police and law enforcement agencies, county prosecutors, contracted health plans, and other state agencies. Secure .gov websites use HTTPS Share sensitive information only on official, secure websites. fraudulent, abusive, or wasteful activity involving the state Medicaid program. Yuma:(928) 314-6410. A U.S. Title 9 Chapter 21, Article 4. 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. AHCCCS receives data from Motor Vehicle Division (MVD) and Industrial Commission to assist with third party liability identification. Im living proof. How to Create Positive New Habits in our New World, Provider Accessibility Initiative COVID-19 Web Series, Overview of the Arizona Public Health System, Covered Services and Related Program Requirements, Medical Management/Utilization Management Requirements, Credentialing and Re-Credentialing Requirements, Specific Physical Health Provider Requirements, Behavioral Health Network Provider Service Delivery Requirements, Health Plan Coordination of Care Requirements, Specific Behavioral Health Program Requirements, Training and Peer Support Supervision Requirements, Provider Engagement Specialist Feedback Survey, AzAHP Child and Family Team (CFT) Initiatives Notification, Incorrect Member Cost Share Application- Provider Overpayment, Cultural Competency and Health Equity Reminders, Potential Quality Issue (PQI) Referral Form (PDF), Nondiscrimination and Accessibility (PDF). Attorney General Mark Brnovich Announces 13 Individuals and 14 Related 01 Participant Initiated Changes. action, hearing timelines, the provision of informal settlement conferences, and other general agency obligations. The Office of Inspector General (OIG) is responsible for the integrity of the AHCCCS budget, nearly $18 billion in State Fiscal Year 2023. Flagstaff: (928)556-0833 Make no mistake, the FBI will actively pursue those seeking to fraudulently profit from the pandemic. Investigations must be conducted pursuant to A.A.C. News & Press Releases, Can't find what you're looking for? Conduct investigations, Manage time effectively, deal . 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. Outpatient rehab in jeopardy for Native Americans under Medicaid proposal 605 0 obj <>stream Follow the U.S. Attorneys Office, District of Arizona, on Twitter @USAO_AZ for the latest news. Attorney General Mark Brnovich is asking Gov. Obtain a copy of the Medicaid Fraud Control Unit Complaint Form. %PDF-1.6 % Office of Special Investigations (OSI)/AHCCCS Office of Inspector 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. 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. hWmOF+T}t9zj!`)w=}Y` )Cew;;I{&CNOXDxI(hD3`6 hI3%R)ksB0 !HA1*` h>|?++^3vGW8]Ur9y4Uw Miguel Denga and Alsadi own and operate Philia Homecare, LLC. 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. Residential rehab centers, which arent subject to the proposed cuts, worry about what will happen once they discharge their patients. AHCCCS has a contract for unlimited searches for a basic monthly charge. But he said the solution is not to change the funding for all providers. A subscription helps you access more of the local stories that keep you connected to the community. prevent, investigate and prosecute any provider, subcontractor, member, entity, or employee involved in Additionally, the OIG works closely with federal, state, and local law enforcement agencies to detect, 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. Patients file grievances, experts want reforms at Arizona State Hospital 8) Aaron Wright, 40. rG ")_6S:NRjFjLAphzFF&yKBn~'!lVK"uL8 UUYgyWHjHTE8|+y,u^Ey^]r@p( s?z Mansour Ahmadi | Counter Extremism Project Copyright 2023 Centene Corporation, LLC. {2@3 9)TgOx,d7?y,F77gw]w"_7Tj[Oo A new report found that AHCCCS has taken more than a year to initiate or complete preliminary investigations for more than a half of its potential fraud and abuse cases. 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, A lock ( Tucson: (520) 620-7300 211 targets 'dark money' in Arizona campaigns, Instagram mom convicted for fabricating story about kids' kidnapping, King Charles and Queen Camilla's will use thrones recycled from King George VI's coronation, Rare images captured of butterflies taking flight after emerging from chrysalis, Ride like royalty! Those services could now be in jeopardy because of proposed cuts. United States Attorney's Office Announces Charges in Fraud Cases The OIG is designated as a criminal justice agency and is authorized by the Federal Bureau of Investigation and the . ), include requirements for the types of agency actions that must provide hearing rights, the format of the notice of the agency The Criminal Division's mission is to protect the citizens of Arizona by successfully investigating and aggressively and fairly prosecuting criminal cases within the State of Arizona and in representing the State in capital and non-capital appeals. 362903). He predicts the proposed change will have an absolutely massive impact on the ability for some people to get outpatient treatment. One goes back to August 2014 with allegations that another adult was living in and contributing financially to the household. 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. The couple was charged earlier this month by the federal grand jury in a 58-count indictment. 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. An official website of the United States government. An indictment is simply a method by which a person is charged with criminal activity and raises no inference of guilt. It exists to prevent, detect, and recover improper payments due to Medicaid fraud, waste, and abuse. The second complaint charges Miguel Denga, Husam Alsadi, and Tamarria Denga with conspiring to commit health care fraud. All rights reserved. The indicted defendants are listed below: 1) Dale Henson, 53. RELEASE NUMBER: 2020-053_COVID Fraud. Questionnaire is the . AHCCCS is primarily federally funded, and it provides healthcare programs for Arizonas low-income residents. ) or https:// means youve safely connected to the .gov website. %%EOF A .gov website belongs to an official government organization in the United States. We remain committed to rooting out and prosecuting any individual who would use this crisis as an opportunity to defraud individuals or the government.. The office has statutory authority to issue subpoenas and place The general public and participants may submit their requests through any of the following methods: Two departments are responsible for acting on the requests. The OIG also conducts unannounced site visits at certain providers' offices. AHCCCS conducts pre-approval investigations to ensure its members are eligible to receive benefitsThe 4) Paul Flaa, 56 583 0 obj <>/Filter/FlateDecode/ID[<4704BC82282EC0439DECB24A83985C10>]/Index[567 39]/Info 566 0 R/Length 84/Prev 129300/Root 568 0 R/Size 606/Type/XRef/W[1 2 1]>>stream Fee-for-Service Fee Schedules, Contact Us King said the proposed change appears to be an attempt to crack down on AHCCS funding abuse. 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. The investigator must: a. PDF 446 GRIEVANCES AND INVESTIGATIONS CONCERNING PERSONS WITH - Arizona General Questions and Fraud Reporting Investigation and the Arizona Department of Public Safety to access criminal justice information R9-21-406. 13) Kayla Sol, 34 The report found some incidents that auditors decided to single out for special mention. IADs must be submitted by the provider within 2 business days of the incident. 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. Loabneh, and Lawabni own and operate A&N Services, LLC. The Criminal Division is comprised of eight sections: OIG often performs multiple preliminary reviews as each cases facts and evidence evolve. Official websites use .gov 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. The sample size was determined using Cochran's formula, 110 teachers were selected, and 108 teachers completed the questionnaires. 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. These appeal rights, as set forth in the Arizona Uniform Administrative Hearings Procedures, (A.R.S. 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. 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 Phoenix Division of the Federal Bureau of Investigation conducted the investigation in this case. The suspect must work for a Medicaid provider, such as a doctor, nursing home, hospital, adult care home, or home health agency. That will just result in fewer services overall. The agency confirmed to ABC15 that most of the affected patients are Native American. Download the free version of Adobe Reader. AHCCCS is a nationally acclaimed model among Medicaid programs and a recipient of multiple awards for excellence in workplace effectiveness and flexibility.AHCCCS employees are passionate about their work, committed to high performance, and dedicated to serving the citizens of Arizona. Policy Manuals For more information on the U.S. Attorneys Office, District of Arizona, visit http://www.justice.gov/usao/az concerning persons with a Serious Mental 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%). But even then, she said, the agency did not complete its preliminary inquiry within the year as required under its policy. Healthcare Fraud & Regulation - Mitchell | Stein | Carey | Chapman AHCCCS Fraud can take a variety of forms. AHCCCS appeared to finish its investigation of the incident in September, according to records reviewed by ABC15. 3) Russell Freeman, 51 The agency confirmed to ABC15 that most of the affected patients are Native American. 602.542.3881 Fish and Wildlife Service program designed to restore Mexican wolves to Arizona fails to follow federal law, conservation groups say. 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. Examples include, but are not limited to: If you suspect that a vulnerable adult has been abused or neglected, report it immediately toAdult Protective Servicesat 1-877 SOS ADULT. witness interviews, subject matter expert opinion analysis, and evidentiary review in order to determine preliminary findings. And while the agency said it is bringing new people on board, it said it can take a year to properly train them. For non-Behavioral Health providers, potential quality of care incident reports should be submitted to the Quality of Care mailbox within the timeframes indicated above. The documents also show that the state used the station's reports as part of its . Evidence that potential fraud occurred during the current or previous application period (initial or renewal). RELEASE NUMBER: 2021-054_Hensons. The unit is located in the Attorney General's Office, 2005 N Central Avenue in Phoenix. 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. That, however, still left the issue of staff turnover and an insufficient number of investigators. 0 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. 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. Give Light and the People Will Find Their Own Way, proposing to change the way it reimburses providers. The complaint alleges that Abdul Jabbar, Loabneh, and Lawabni falsely billed Arizonas Health Care Cost Containment System (AHCCCS) for more than 9,000 non-emergency medical transports in April 2020 when those transports never occurred. 6) Charles Temple, 36 AHCCCS' Office of Inspector General (OIG) registers all of AHCCCS' medical providers, such as doctors and home healthcare agencies. For Star subscribers: The state can pursue its claim that the Biden administration acted illegally when it enacted policies allowing thousands. 2) Kevin Maulson, 60 3) Russell Freeman, 51 4) Paul . Phoenix, AZ 85004, Phoenix: (602) 514-7500 Covered Services PDF Arizona State Medicaid Health Information Technology Plan - azahcccs.gov . Pay Your Premium 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. 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. These statutes provide for a computerized central database tracking system to track the He wasnt even sure what day it was. For more information on the U.S. Attorneys Office, District of Arizona, visit http://www.justice.gov/usao/az/ And if it is not, Perry said, AHCCCS should work with the legislature to provide more funds. 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. If the incident needs immediate attention, and it is not during regular business hours, call 911 immediately. 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. 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. Officials with Sunrise Native Recovery are hoping AHCCCS will postpone making the change until it can be thoroughly discussed. 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. AHCCCS said the proposed change may impact about 223 providers or about 10 percent of more than 2,200 providers. AZ confirms case of sex misconduct at hospital - KNXV Follow the instructions on the Potential Quality Issue (PQI) Referral Form (PDF) to submit Quality of Care concerns to the Medicare or Ambetter department. 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