AHCCCS Fraud Investigation
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Questions and Answers

What are some of the fraudulent billing practices mentioned in the text?

Billing for services not provided and 'ghost billing'

Who were the alleged fraudulent activities targeting primarily?

Indigenous peoples, primarily Navajo individuals

How did the operators recruit Native Americans for the fraudulent scheme?

By having them enter their facilities as in-patient or out-patient clients

What are some of the tactics used to target Tribal Members for fraudulent activities?

<p>Targeting unhoused, low-income, alone, or intoxicated Tribal Members and transporting them to fraudulent facilities after promising to provide food, housing, and access to care</p> Signup and view all the answers

How long has the investigation into the fraudulent activities been ongoing?

<p>Since 2019</p> Signup and view all the answers

What are some of the fraudulent billing practices associated with the alleged fraudulent activity targeting Indigenous peoples?

<p>Billing for services not provided, and 'ghost billing' using personally identifying information for individuals for whom services were not provided.</p> Signup and view all the answers

How did the operators recruit Native Americans for the fraudulent scheme?

<p>Operators recruited Native Americans to enter their facilities as in-patient or out-patient clients and then billed AHCCCS for treatment that is partially or never provided.</p> Signup and view all the answers

What tactics were used to target Tribal Members for the fraudulent activities?

<p>Perpetrators targeted unhoused, low-income, alone, or intoxicated Tribal Members and transported them to fraudulent facilities after promising to provide food, housing, and access to care.</p> Signup and view all the answers

What triggered the multi-agency review and investigation of potential fraud, waste, and abuse?

<p>Significant increases in billing for outpatient behavioral health services triggered the multi-agency review and investigation of potential fraud, waste, and abuse.</p> Signup and view all the answers

How are some providers involved in the fraudulent activities described in the text?

<p>Some providers partially delivered the services they billed for; others fed tribal members’ addictions in order to keep them under control and as clients.</p> Signup and view all the answers

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