The Brief
State lawmakers held a third oversight hearing with the new AHCCCS director regarding the recent massive Medicaid fraud crackdown.
Behavioral health providers claim they are now struggling to get paid, leading to two provider closures this week that could impact thousands of patients.
Advocates testified that many tribal members affected by the fraud and ensuing displacement crisis have gone missing or died.
PHOENIX – It’s been almost two years since the state initiated a massive crackdown on Medicaid fraud that cost taxpayers nearly $3 billion. The sober living crisis grew as countless people fighting addiction became displaced.
What we know
On Nov. 12, lawmakers held a third oversight hearing to question the Arizona Health Care Cost Containment System (AHCCCS), the state’s Medicaid agency. This time, the new director of the state’s Medicaid agency was in attendance to speak to lawmakers.
Virginia Rountree, the AHCCCS Director, was recently chosen by Gov. Katie Hobbs to take over for Carmen Heredia.
Republican state Sen. Carine Werner continued to call out concerns made by struggling behavioral health providers who feel they have been impacted by the crackdown and retaliated against for the massive fraud that has transpired.
Dig deeper
The scheme involved targeting vulnerable people searching for addiction treatment—a majority of them part of the Native American population, and fraudsters billed the state on behalf of patients’ plans, while not providing real services.
Now, providers who have not been suspended by AHCCCS claim they’re not getting paid for legitimate services provided.
As for the solution, AHCCCS said support for behavioral health providers will improve, as will the timeline for processing claims. Officials presented an improvement plan to the committee.
What they’re saying
Advocates for tribal members said too many have already gone missing or ended up dead due to negligence.
“This is our deceased and missing file here, so to say that we have not reported anything, we have these reports here. They’ve been documented, they’ve been sent to AHCCCS, the FBI, the OIG, anyone we can get these to,” said Reva Stewart of Turtle Island Women Warriors.
“I also observed the frustrations, as madame chair of this committee, and the frustrations of providers related to authorizations of services, as well as untimely or nonpayment. I observed, the serious concerns and frustrations with AHCCCS, related to implementation and changes,” Rountree said.
What’s next
Senator Werner says that two legitimate providers closed down this week, which could impact thousands of patients.
The Source
This information was provided by the Arizona State Legislature.