Will State Audit Lead to More Arizona Medicare Fraud Prosecutions?

by Ashley D. Adams

(June 2013) A state audit of the Arizona Health Care Cost Containment System (AHCCCS) says the agency needs to do a better job of handling Medicare fraud investigations. The review by the Auditor General’s Office found that AHCCCS takes too long to perform investigations and needs to be more aggressive in collecting settlements.

Despite the deficiencies noted in the report, the agency recovered $6.6 million in civil and criminal restitution settlements in fiscal year 2012. It also halted more than $21 million in illegal payments to providers, according to AZCentral.com.

However, the state auditor believes that Arizona’s Medicare fraud detection and prevention efforts can be improved. The audit revealed that 25 percent of the 300 investigations that were open as of July 3 had been active for more than a year. The auditors recommended that AHCCCS focus on better prioritizing cases and seeking federal reimbursement for uncollectable settlement debts.

Healthcare providers should expect that AHCCCS will be taking a more proactive approach when it comes to Arizona Medicare fraud and abuse. To avoid unnecessary scrutiny, health care providers are advised to review their policies and procedures to ensure full compliance with all Medicare regulations.

If you have any issues related to Medicare Fraud, please contact Ashley D. Adams, PLC at 480.219.1366 or aadams@azwhitecollarcrime.com, www.azwhitecollarcrime.com. Ashley is a criminal defense attorney in Scottsdale and a former federal prosecutor.