June 20, 2023
Changes to AHCCCS Provider Enrollment and Billing System Close Ability for Fraudulent Behavioral Health Claims Payments
In response to the discovery of significant fraudulent Medicaid behavioral health billing in Arizona, AHCCCS has made numerous system changes to stop deceptive providers who bill for services that are or were not provided, not appropriate, or not necessary. See the Provider Payment Suspensions Fact Sheet updated 6/14/2023.
Some of the holistic, system-wide improvements to the Medicaid payment system include:
- Added ability to flag concerning claims,
- Ended ability for providers to bill on behalf of others, and
- Imposed prepayment review for various scenarios including multiple providers billing the same client on the same day for similar services, excessive number of hours per day, and the age of patients.
A few of the changes to the AHCCCS provider enrollment process include:
- Moved three behavioral health provider types to the high risk category which requires a Fingerprint Clearance Background Check and site visit, and
- Received federal approval for a 6-month moratorium on all new provider enrollments for Behavioral Health Outpatient Clinics, Integrated Clinics, Non-Emergency Transportation providers, Behavioral Health Residential Facilities, and Community Service Agencies providers.
Anyone can report suspicion of provider or member fraud using the Report Fraud web page or by calling 602-417-4045 or, outside of Arizona, 888-ITS-NOT-OK (888-487-6686).
Any AHCCCS member who needs help because of a sober living home closure can call 2-1-1 (press option 7).
