Arizona AG: State's sober living scheme has 'international criminal connections'
PHOENIX - Arizona's Medicaid agency, known as Arizona Health Care Cost Containment System (AHCCCS), has already suspended payments to more than 300 behavioral health providers accused of defrauding the state of nearly a billion dollars.
"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," Arizona Attorney General Kris Mayes said. "I personally believe the number will top a billion dollars when it’s all said and done."
Mayes says money is clearly the motive in the sober living scheme.
New suspension notices obtained by FOX 10 reveal more detailed allegations like "misdiagnosing patients for benefit of payment," providing payments for business, billing for incarcerated members and billing under another national provider ID.
Sober living scheme has 'criminal ties': AZ AG
Arizona's Medicaid agency, AHCCCS, has already suspended payments to more than 300 behavioral health providers accused of defrauding the state of nearly a billion dollars, but the state's Attorney General says they still have a long way to go. FOX 10 Investigator Justin Lum reports.
"This is about turning the spigot off, because these criminals know that there’s a honey pot at AHCCCS that they can go to – a Medicaid honey pot in Arizona," she said.
The alleged schemers are targeting vulnerable people fighting addictions, mainly recruiting Native Americans off tribal reservations to sign up for the American Indian Health Plan under AHCCCS.
Last December, we saw several more suspects charged with patient brokering, accused of negotiating lucrative deals with undercover agents to send 75 patients to a fake rehab center costing $300 per person, per day.
FOX 10's reporting showed how victims are enticed by alcohol, drugs and money.
MORE: He left home to get sober & change his life. Why was he found dead in a motel?
Is this scheme linked to organized crime out of the country?
"We are aware of national and international criminal connections," Mayes said.
AHCCCS has told FOX 10 that it continues to overhaul its systems to recognize red flags and fraud. Mayes says more can be done.
"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," she said.
She's also recommending that behavioral health billers be monitored.
"I’d like them to have to be on camera when they’re billing and that’s one of the reforms that I think we still need to implement," Mayes said.
Does she think that we’re just scratching the surface as far as reform?
"It’s a lot. We’ve got more than 250 ongoing cases right now in my office alone," she said. "I believe we are just scratching the surface when it comes to reform, but we need to make more progress and do it faster."