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State: ‘Sober’ homes getting drunk on tax dollars

Gov. Katie Hobbs and Attorney General Kris Mayes said last week the state has been the victim of massive fraud in its health care program and blamed their Republican predecessors Arizona Gov. Katie Hobbs and Attorney General Kris Mayes have released the names of 100 providers whose payments have been suspended for “credible allegations of fraud” and blamed their Republican predecessors for ignoring it. They also released names of those whose payments were suspended for fraud. The Arizona Health Care Cost Containment System, the state’s Medicaid program, was billed for the “services’ involved signing up Native Americans, often on the street, with the promise of treatment. When they got there, there was no treatment and some had to “escape out of windows and jump over fences in the middle of the night just to access a phone to reach the outside world. Mayes said that the investigations revealed today had been underway for several years, well before the current occupants took office. She also acknowledged that there have been more than 40 prosecutions and $75 million recovered during the past three years, long before Hobbs & Mayes took office in January. She said that under federal law, services to Native Americans are provided on a fee-for-service basis, but that this makes it attractive for sober living homes to seek out and sign them up for care. She estimated that in the past 3.4 million residents enrolled are in health care plans which are paid a flat fee of federal and state dollars for all care, and that most of this went undetected and unprosecuted.

State: ‘Sober’ homes getting drunk on tax dollars

ที่ตีพิมพ์ : 10 เดือนที่แล้ว โดย Capitol Media Services, Howard Fischer ใน

Gov. Katie Hobbs and Attorney General Kris Mayes said last week the state has been the victim of massive fraud in its health care program and blamed their Republican predecessors for ignoring it.

They also released the names of 100 providers whose payments have been suspended for “credible allegations of fraud” – including one in Ahwatukee at 3546 E. Windmere Drive operated by Simon George, according to state records.

The scheme for at least some of the “sober living homes’’ involves signing up Native Americans, often on the street, with the promise of treatment.

But when they got there, there was no treatment and, according to Hobbs, some had to “escape out of windows and jump over fences in the middle of the night just to access a phone to reach the outside world.’’

Yet, the governor said, the Arizona Health Care Cost Containment System, the state’s Medicaid program, was billed for the “services.’’

Mayes said it even involved scammers just using the names of Native Americans – some who were dead – to bill for services that were never provided.

All this, both contend, occurred because AHCCCS, under the direction of someone appointed by Doug Ducey, and the Attorney General’s Office run by Mark Brnovich failed to adequately address the problems.

“This is what you get when you have a governor who didn’t care about governing,’’ Mayes said.

“The investigations revealed today had been underway for several years, well before the current occupants took office,’’ said Daniel Scarpinato, who had been Ducey’s chief of staff.

He pointed out that even Mayes acknowledged that there have been more than 40 prosecutions and $75 million recovered during the past three years – long before Hobbs and Mayes took office in January.

“Our office prosecuted a record amount of health care fraud cases,’’ he said.

But Mayes said that the prosecutions of the past amounted to a “whack-a-mole’’ approach of going after individual fraudsters but never recognizing or addressing how to prevent the problem in the first place.

In each of these cases the fraudulent claims involve care for Native Americans. And the reasons is the nature of AHCCCS.

Most of the more than 2.4 million residents enrolled are in health care plans which are paid a flat fee of federal and state dollars for all care.

But under federal law, services to Native Americans are provided on a fee-for-service basis. And Mayes said that makes it attractive for sober living homes to seek out and sign them up for care.

Mayes said that, however, is only part of the scam.

“They simply purchased lists of names and dates of birth of people and used those to bill AHCCCS,’’ Mayes said. And there even were cases where the state was billed for services she said that were “impossible to render,’’ like 13 hours a day of alcohol rehab services for a 4-year-old for whom they had that child’s AHCCCS identification card.

“This poor child was not in one of the facilities and did not need alcohol rehabilitation,’’ Mayes said. She said there were similar billings, like $1 million for treating a woman and her children over the course of a year.

There also were services for “patients’’ who were dead, in jail, or clearly not in Arizona at the time.

Most of this went undetected and unprosecuted, Mayes said, despite what she said were complaints registered by investigators for AHCCCS and within the office she inherited from Brnovich.

“This never should have been allowed to happen,’’ she said.

Mayes estimated that in the past three years there has “hundreds of millions of dollars’’ lost due to fraud. But she declined to put a figure on it.

“I wish I could be more specific about that,’’ Mayes said. “I don’t think it is too much to say this is one of the biggest scandals in the history of the state of Arizona when it comes to our government.’’

“The previous administrations were asleep at the switch, asleep at the wheel,’’ Mayes said. “The Ducey administration was, at best, negligent while they allowed scam artists and fraudsters to take advantage of the antiquated, outdated systems and incompetent management of AHCCCS.’’

Carmen Heredia, now head of AHCCCS designated by Hobbs, said, “We have suspended payments to approximately 100 Medicaid providers based on credible allegations of fraud.”

Mayes said that in 2019, there was $53.5 million billed to AHCCCS under the code of outpatient behavioral health services. That more than doubled to $132.6 million the following year, to $291 in 2021, and hit $668 million in the 2022 fiscal year.

Mayes made it clear there were some efforts to pursue the problem before she took office in January. In fact, she was the one who acknowledged that more than 40 people were indicted in the past three years and the state has recovered $75 million.

But the problem, she said, is that no one in either AHCCCS or her office undertook a systematic review.

And that goes to her claim and that of Hobbs that the failure starts at the top.

Mayes said that prosecutors and investigators in what is now her office have been “screaming from the rooftops’’ for some time now, “trying to get the leadership of the Attorney General’s Office and the leadership of AHCCCS to shut down the money’’ as a way to address the problem. And she said similar alarms were being raised by investigators in AHCCCS.

Instead, she said, Brnovich and AHCCCS went after individual offenders as they were found. And all that did, Mayes said, is result in those people simply forming a new corporate entity to go back in business.

“You can’t prosecute your way out of this problem,’’ she said.

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