D. Conducting Investigations of Grievances 1. R9-20-203 or in A.A.C. In November 2020, AHCCCS upheld part of Contreras' grievance, noting that surveillance footage backed up his claim about being kept in restraints. Before treatment, the 36-year-old didnt have a home or a job. As a result, AHCCCS has continued, for nearly eight years, to pay hundreds of dollars every month in capitation payments for members who may be ineligible for health care coverage, Perry said. AHCCCS supported the investigations of 62 successful prosecutions of either members or providers. Provider Compliance Investigator - REMOTE OPTIONS, Arizona, United Criminal Division | Arizona Attorney General 602.364.0411 (fax). Nez received outpatient services through Sunrise Native Recovery, an outpatient drug-and-alcohol treatment center. PDF 446 GRIEVANCES AND INVESTIGATIONS CONCERNING PERSONS WITH - Arizona 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. Share sensitive information only on official, secure websites. The Criminal Division is comprised of eight sections: endstream endobj 571 0 obj <>stream 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. RELEASE NUMBER: 2021-054_Hensons. An indictment is simply a method by which a person is charged with criminal activity and raises no inference of guilt. 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. Subscribe to stay connected to Tucson. And ultimately what will happen is without that support, they will most likely use or drink again, said Gabriel Tomaeno, co-founder of Purpose Healing Center, a residential treatment center with locations in Phoenix and Scottsdale. All rights reserved. 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. These statutes provide for a computerized central database tracking system to track the The agency said those visits resumed in January. Copyright 2023 Centene Corporation, LLC. AHCCCS said it was having difficulty in subpoenaing needed information from the member and the members employer because the member had moved and changed jobs multiple times since 2014. 41-1092 et seq. The first complaint charges Abdul Raheem Abdul Jabbar, Nohad Loabneh, and Abedelhalim Lawabni with conspiring to commit health care fraud. 7) Allen Jeter, 57 And its only the Fee-For-Service Program thats facing these proposed cuts. The charges include healthcare fraud, wire fraud, money laundering, and aggravated identity theft. 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. Rehab center scams are targeting Indigenous people, advocates say R9-21-402 et seq. But he said the solution is not to change the funding for all providers. 10) Keyana Carter, 29 Yuma:(928) 314-6410. General Questions and Fraud Reporting Investigation and the Arizona Department of Public Safety to access criminal justice information For more information on the U.S. Attorneys Office, District of Arizona, visit http://www.justice.gov/usao/az fraud actions related to the suspension of providers; and, when necessary, terminates providers in Fee-for-Service Fee Schedules, Contact Us 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. FAA6.A Changes. We will have nowhere to send these patients. Loabneh, and Lawabni own and operate A&N Services, LLC. relevant to official investigations. 14 Arizona businesses indicted for alleged health care fraud - KPNX AHCCCS conducts pre-approval investigations to ensure its members are eligible to receive benefitsThe The indictment alleges that the couple used their medical billing company to bill AHCCCS for services not actually rendered.