In what Arizona Attorney General Chris Mays called “a staggering failure of the government,” state officials said criminals posing as health care providers extorted “hundreds of millions of dollars” from Arizona taxpayers. It said it had taken advantage of and sacrificed indigenous peoples.
This misconduct included claims for mental health treatment and addiction rehabilitation that were never provided. The money, which Mays could only identify as hundreds of millions of dollars, was paid by the Arizona Health Care Cost Control System, the state’s Medicaid program.
In some cases, treatment was reportedly given to people who died, were in prison, or were children. Mays cited the example of a bill submitted to AHCCCS calling for “impossible to provide” services such as alcohol rehabilitation for a 4-year-old who is not in any institution and needs treatment.
Criminals who run phony treatment centers target vulnerable Arizona Natives, using gas stations, grocery store parking lots and bus stops outside Indian Health Service clinics, according to tribal and state officials. It is said that he actively solicited them.
In some cases, indigenous targets had to jump out of windows or scale walls to escape the facilities, which were usually located in the Phoenix area, state officials said.
Arizona Governor Katie Hobbs and representatives of Arizona’s 13 tribes made the announcement at a news conference Tuesday morning. The investigation, which also involved the FBI and the U.S. Attorney’s Office, led Mays’ office to indict at least 45 cases. Mays said $75 million had been seized or recovered in connection with the scheme.
“When it comes to the Arizona government, I think it’s safe to say that this is one of the biggest scandals in Arizona history,” Mays told reporters.
“The human impact of this scam is most heartbreaking of all. These scammers are using random IDs to charge millions of dollars in services, yet thousands of Arizonans are truly They need help, and some of them are living in these facilities and homes, even though they are not protected.” We provided the services they needed. ”
Mays told the Arizona Republic that the firm believes the fraudulent claims scheme was started by a criminal gang that came to Arizona from Nevada and was conducting similar activities there.
“Nevada shut it down over there. They came here and realized we had the same vulnerability, and they transferred from there,” Mays said. “It’s a lot like a franchise business, where you just keep expanding, expanding, expanding knowing you’re going to make big bucks.”
Arizona has a hotline for victims and families
Hobbes said AHCCCS has been conducting claims audits since 2019.
“We will prosecute existing bad actors, ensure that wraparound services are provided to those affected by provider closures, and reform the AHCCCS billing system to eradicate this type of fraudulent billing in the future. will be enacted,” the governor quickly said. Admitting personal injury due to fraud.
“To the individuals and families affected by these suspensions, my heart is broken by the pain you have had to endure. Arizona believes in you and we are committed to you. and we are committed to working with you to resolve this issue.” And please get people home safely. ”
Most of the health care provided through AHCCCS is handled by managed care organizations, but a program called the American Indian Health Program is a fee-for-service program. That is, the provider is paid directly by her AHCCCS for the individual services she performs, and the services are not bundled. .
In other words, the suspected fraudulent behavioral health provider is billing AHCCCS directly for the alleged treatment.
Arizona has a dedicated hotline for victims of fraud centers. If you are a victim, call 2-1-1 and press 7 for help. Navajo Attorney General Ethel Branch told reporters on Tuesday that the Navajo is setting up a command center for families.
“We plan to set up an onsite emergency operations center here in the Valley,” Branch said. “Many of those affected are expected to be members of the Navajo tribe, so we will be picking up relatives and escorting them to a licensed facility where they will actually receive the services they thought they would receive. so that you can move to
The Republic has heard four grand jury indictments related to alleged claim schemes from Maricopa County Superior Court. The indictment accuses multiple people of various crimes, including conspiracy, unlawful control of a company, theft, money laundering, and conspiracy to defraud.
A continuous and regularly updated list of registered providers subject to suspension or termination of payments is available at: AHCCCS General Directorate of Inspection Provider Suspension Webpage. Officials with the Arizona Department of Health Services, which licenses sober housing, behavioral problem housing, and outpatient clinics, said in a statement that they would find it easier to “keep the bad guys out of the health system for behavioral problems.” ‘I’m working on it,’ he said.
Arizona Residents Recommend Checking Out AZCareCheck.com To verify the status of licensed facilities.
Hobbes and Mays criticize Ducey administration
Mays said providers have attempted to bill the state 3,000 to 4,000 times since May 3 using medical codes that the state repealed as part of the crackdown.
“It gives you a sense of scope,” she said.
Each Democratic leader criticized his Republican predecessor for his lack of action on the issue, but in different tones.
Hobbes said that under the previous administration, AHCCCS took a “step-by-step approach to targeting these fraudulent providers” and that the ability to defraud AHCCCS for many years without proper action was built into the system. said it had been
“The previous administration did this on a case-by-case basis and never did the institutional review necessary to eradicate this problem and failed to be truly accountable,” the governor said. “Unfortunately, this approach has allowed fraudulent providers to continue exploiting tribal communities for their own economic gain.”
Mays singled out former Gov. Doug Ducey and former Attorney General Mark Brunovich, both Republicans.
Mays said Brnovic ignored the concerns of his own deputy prosecutors who had long “begged” for drastic action to stop AHCCCS from further misconduct. Her fraud scheme “should never have been allowed,” she said.
“The Ducey administration has been negligent at best in making its antiquated and outdated system and incompetent administration of AHCCCS available to fraudsters and fraudsters,” Mays said. “As a result of their incompetence, some of our state’s most vulnerable people have suffered, and taxpayers have paid the price.”
Asked if he would consider legal action against the Ducey government, Mays said the investigation was ongoing and he was “not thinking about anything”.
“What happened is tragic and outrageous, and I speak for myself as the state attorney general. I believe Arizona owes the Tribal State an apology,” she said. Told.
Brnovic did not respond to messages seeking comment for this article.
A former Ducey aide tacitly agreed at a Democratic press conference that more than 40 indictments had been filed “well before the incumbent took office” and that the investigation had been ongoing for years. Mentioned.
Former Ducey Chief of Staff Daniel Scarpinato said, “Today’s grandstanding reveals a lack of interest in actual governance,” a former governor often repeated, “They just do their own thing.” You should work,” he repeated.
Of the 45 indictments so far, 28 have come under Brnovic’s term, according to Mays’ office. A Mays spokesperson said the remaining 17 indictments were served during Mays’ five-month term. Brnovic’s office had announced indictments in 2016 related to the fraud scheme. At least one news release from 2021 It contained a list of accused individuals and associated companies.
Mays said the firm was prepared to prosecute the perpetrators “to the fullest extent of the law.” When there is evidence of negligence on the part of behavioral health facility operators, and when a patient dies or is raped, “that too will be investigated by appropriate law enforcement officials.”
Indigenous Issues:Hobbes Calls on New Task Force to Seek Justice for Missing, Killed Indigenous Peoples
Advocates: Some of the Missing Indigenous Peoples Are Victims of Fake Clinics
Some proponents believe that fake treatment programs are leading to an increase in the number of missing indigenous peoples, so the Legislative Task Force for Missing and Killed Indigenous Peoples last year opened fake clinics. heard testimony on the issue of
Presented by State Senator Teresa Hattersley of D-Cole Mine Canyon Senate Bill 1661 It was proposed in Congress this week as an attempt to strengthen admission policies to behavioral health residential facilities.
In testimony before the state Senate Health and Human Services Committee on February 14, she said many of the facilities were “predatory” and “fraudulent.”
She told the story of an old Navajo man who went into a gas station and asked for help to escape recruiters who wanted to take him to a treatment center in Phoenix. Stories like this were common, she said, and in this case a petrol station employee helped and the man’s daughter was able to pick him up, and things ended well, she said. added. But others weren’t so lucky, the commission heard.
“Overall, there is a massive operation underway,” Mr Hattersley testified. “This is very sophisticated to say the least…many victims are afraid to come forward.”
Navajo First Lady Jasmine Blackwater Nygren told the commission that some tribal members would enter the facility and leave the facility so that the facility owner “can continue to receive” government funding. He said he was given alcohol and drugs to keep him from being robbed.
Hattersley testified that one individual can bring more than $7,000 in government funds to group homes a month. In some cases, people die in so-called rehabilitation facilities and are buried in the graves of the poor, without their families ever knowing what happened to their loved ones.
“This practice has been going on for years,” she said. “Now it’s finally clear.”
Since at least January, the FBI has been online callout form The group is seeking “victims who may have been recruited to live and receive services in a group home[behavioral health residential facility]in Phoenix” from January 2020 to the present.
The FBI’s appeal describes “organizers” who target Native Americans to live in group homes under the guise of treatment for mental illness and substance abuse, but group homes do not seek government assistance. Despite receiving it, therapy services are often not offered. .
“Organizers frequently visit community gathering places such as flea markets, trading posts, and medical centers to pick up customers,” the form said, adding that not only the Navajo, but also Arizona, New Mexico, The company is also finding customers from other tribal communities in South Dakota. Say.
Republic reporter Arlyssa Becenti contributed to this article.
Contact HealthCare Reporter Stephanie Innes. stephanie.innes@gannett.com or to 480-313-3775. follow her on her twitter @Stephanie Innes. Please contact reporter Stacy Berchanger. stacey.barchenger@arizonarepublic.com or 480-416-5669.please follow her twitter @sbarchenger.
