PHOENIX — Arizona's Medicaid system is making changes to stop more scammers from potentially taking advantage of a state program that provides health care to millions of Arizonans.
The state's elected officials announced last month they were suspending payments to over 100 healthcare providers who are suspected of defrauding the state by billing for nonexistent or unnecessary services.
"Credible evidence has been established that individuals were targeted and aggressively recruited with false promises of food, treatment, and housing, only to be taken to facilities where providers billed for services that were not provided," the agency wrote in a statement.
The Arizona Health Care Cost Containment System announced Tuesday it was making numerous reforms to prevent these types of deceptive billing practices from happening again.
The reforms include the following:
- Stop providers from billing on behalf of others
- Require certain providers to undergo site visits and fingerprint background checks
- Add the ability to flag concerning claims
- Set billing thresholds
- Implement a six-month moratorium on new provider enrollments for mental health outpatient clinics, community service agencies, integrated clinics, and behavioral health residential facilities.
Exemptions to the enrollment moratorium will be granted to applicants who meet certain requirements.
"This action is necessary to safeguard AHCCCS members, public funds and to maintain the fiscal integrity of the AHCCCS program," the moratorium document states.
The agency said it intends to make more reforms in the coming months.
Up to Speed
Catch up on the latest news and stories on our 12News YouTube playlist here.
>> Download the 12News app for the latest local breaking news straight to your phone.
>> Live, local, breaking. Download the 12News app