Auditor General’s Office: AHCCCS not adequately investigating potential fraud or abuse

By Howard Fischer. || Capitol Media Services 

The state Auditor General’s Office in a new report found that the Arizona Health Care Cost Containment System is not doing a good job of investigating potential cases of fraud or abuse that providers or patients have committed.

Arizona’s healthcare program for low-income residents is not doing a good job of investigating potential incidents of fraud or abuse committed by providers or patients, the state Auditor General’s Office has concluded.

The new report finds that the Arizona Health Care Cost Containment System has taken more than a year to initiate or complete preliminary investigation of more than half of potential fraud and abuse cases that were open in May when auditors looked at the agency’s records. And that, said Auditor General Lindsey Perry, comes at a cost.

“Untimely fraud and abuse investigations could result in AHCCCS making unnecessary payments,” she wrote in the report. And Perry said there clearly are such cases.

She pointed out that in the last fiscal year, AHCCCS reported that it either recovered or saved about $48.1 million in state and federal funds. But Perry said if the agency doesn’t investigate and resolve cases in a timely manner it “potentially continues to pay thousands of dollars each year to provide healthcare coverage for a member who may have obtained this coverage fraudulently.”

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