Arizona's sweeping crackdown on Medicaid fraud continues to produce criminal convictions and measurable declines in suspicious billing activity, nearly three years after state officials first exposed the sober living home scandal that exploited vulnerable Native Americans and cost Arizona's Medicaid program billions of dollars.
The...Arizona News
On Monday, Arizona Governor Katie Hobbs announced that a new artificial intelligence tool would be deployed to target offenders in the state's largest fraud scandal. The scheme targeting AHCCCS/Medicaid has defrauded the state of at least $2.5 billion and preyed on predominantly Native American individuals battling addiction.
The...Arizona News
A new federal healthcare fraud task force will tackle Medicare and Medicaid fraud on the West Coast, including states like Arizona and Nevada, in addition to California.
The Centers for Medicare and Medicaid Services (CMS) has a new data analytics system that will be deployed with the "West Coast Health Care Fraud Strike Force" to...National News
The effort, branded the Comprehensive Regulations to Uncover Suspicious Healthcare initiative, or CRUSH, was introduced at the White House by Vice President J.D. Vance, Health and Human Services Secretary Robert F. Kennedy Jr. and Centers for Medicare and Medicaid Services Administrator Dr. Mehmet Oz as part of a broader strategy aimed...
Federal prosecutors have charged seven individuals in Arizona in connection with alleged schemes to defraud Medicare and the Arizona Health Care Cost Containment System (AHCCCS) as part of the U.S. Department of Justice’s 2025 National Health Care Fraud Takedown. The coordinated enforcement action includes charges against 324...
Arizona's Democratic Governor Katie Hobbs accepted the resignations of AHCCCS Director Carmen Heredia and ADHS Director Jennifer Cunico the day before they were set to appear before the Senate Committee on Director Nominations (DINO), led by Republican Jake Hoffman, who had foreshadowed his torpedoing of both women's...National News
Two parallel reports, one focusing on Medicaid provider fraud and patient abuse or neglect, and the other targeting Medicaid state eligibility rules, provide readers with data based on annual 2024 data and case outcomes as well as estimates of eligibility fraud based on infrequent Payment Error Rate Measurement (PERM) audits.
The...Arizona News
Two wrongful death lawsuits have been filed against the state of Arizona for alleged mismanagement of sober living homes that led to the deaths of Indigenous men.
Investigators into the sober living home fraud scandal have said that Indigenous people were targeted for their unique payer status and social vulnerability. Under the...
And medical device manufacturers and durable medical equipment suppliers accounted for more civil settlements and judgments for medical and support services Medicaid fraud in FY 2023, according to Medicaid Fraud Control Units (MFCUs) that investigate and prosecute Medicaid provider fraud and patient abuse or neglect.
Settlements &...
More fraudulent sober living home operators were charged by the state of Arizona this week for patient referral kickback schemes. Arizona Health Care Cost Containment System (AHCCCS) Cabinet Executive Officer Carmen Heredia is calling for an overhaul of the state Medicaid system after spending the first year of her position focusing on...Arizona News
The Arizona Attorney General's Office is continuing its massive investigation into fraudulent substance abuse recovery homes that target Native Americans.
Last week, the AG's office announced that the Better You Wellness Center LLC's two owners and its biller were indicted on charges of fraudulently billing the Arizona Health Care...Arizona News
Hundreds of people are being left homeless after the rapid closure of sober living homes across the state, following an investigation into addiction recovery facilities that sought to defraud the Arizona Health Care Cost Containment System (AHCCCS) and target Native Americans.
A large sober living facility, Ocotillo Apartments and...
The Arizona Health Care Cost Containment System (AHCCCS) is reminding enrollees and other members of the public to report any suspicious activity when promised healthcare, residential services or transportation to such services - the agency is concerned that American Indians/Alaskan Natives on tribal lands are especially...
Last Wednesday, the Centers for Medicare and Medicaid Services (CMS) announced proposed payment policy changes for the Medicare Advantage and Part D programs for Calendar Year (CY) 2023. The proposal includes a 7.98% payment increase and health equity provisions for MA participation, for example in star ratings.
The advance notice was...
Several healthcare fraud cases have advanced or resolved this month, including the case of Elizabeth Holmes, who got state lawmakers and Governor Doug Ducey to change Arizona law in 2015 to financially benefit her company.
Holmes goes to trial this week on charges of fraud and conspiracy after she “knowingly misrepresented the...
On Tuesday, Feb. 5, former Hacienda Healthcare nurse Nathan Sutherland pleaded not guilty for raping and impregnating a disabled 29-year-old woman in a vegetative state for nearly two decades. Sutherland was arrested last month after the woman unexpectedly gave birth to a baby boy on Dec. 29.
The unprecedented birth in December...National News
To crack down on Medicaid fraud and waste, The Centers for Medicare & Medicaid Services (CMS) will conduct audits of state programs and private Medicaid managed care plans as part of an initiative announced Tuesday, June 26.
CMS administrator Seema Verma attributed these plans to the agency's reformation of Medicaid for "a...
