Two years after Arizona officials found a $ 2.5 billion Medicaid fraud, which was aimed at the Indians who sought to treat dependencies, the state resumed only part of taxpayers lost fraud.
Arizona Prosecutor General’s Office conducts a criminal investigation into a network of healthcare providers and sober live houses, which from 2019 to 2023 exploit the American Indian Health Program to obtain inflated Medicaid payments. Investigators found that fraudulent operators did not provide the services for which they were exhibiting, and sometimes allowed patients to continue the use of the substances they sought for treatment.
So far, the state has accused more than 100 people and occupied $ 125 million – or about 5% of the funds that the state -owned estimates she paid to the bad subjects.
At the press conference on May 1, Prosecutor General Chris Macy said he hoped to get “at least hundreds of millions” from fraudsters. But she warned that “difficult because what is happening is … criminals get money, they buy lush houses, they buy some expensive cars, they hide the money on the shore, they spend money in a way that it is impossible.”
“My team works day by day to capture these assets,” said Macy.
The system of holding the health care costs in Arizona fought for strengthening frauds under two governors, leaving more than 11,000 people vulnerable to the next chaos. Pre -report of the Arizona and Propublica Investigation Center found that it discovered it revealed At least 40 inhabitants As the state had an answer.
Damage also stretched out in the field of health care for the state, which was almost stopped when the agency suspended about 300 suppliers and accepted a policy that stopped or substantially delayed payments to those who are still valid. These reforms included advanced control when checking and compensating suppliers.
Democrat, Governor Katie Hobs, recently signed the legislation a further increase in the supervision of sober live houses, demanding that the funds promptly report the death of residents. But fans such as Reva Stewart, Diné activist, who assisted the victims of the indigenous residents of this scheme through her group of stolen benefits, do not think that the state has done enough.
“I feel like I am on the wheels of hamsters and we are still in the beginning,” Stewart said. “They have a lot of accusations and people who are accused, but at the same time … They just get into a wrist.”
The US Department of Justice has also accused several persons and conducts parallel investigations in falsification of accounts in accordance with federal statutes.
But despite these state and federal efforts, it is likely that most stolen taxpayers will not be restored.
From 2019 to 2023, the Arizona health care system allowed about 13,000 unlicensed providers to enter their system, including some that exploit weak supervision, overcoming or chargeing services that have never been provided.
The agency also did not act decisively when the decisions on fraud were proposed internally. Initially, he was pressure from special interest groups related to the healthcare industry, which claimed that the reforms for the US Indian Service Plan threaten their financial interest.
Now AHCCS states that his efforts to dissolve the crisis can take many years, describing his investigation as “a very complicated and manual process”.
Officials should review incorrect payments, regardless of whether they received fraud or not, in each case. Although suppliers are obliged to repay AHCC as soon as they learn about overpayments, they often can’t do it for one single amount. Payments can occur for months or years.
As Medicaid state agencies receive most of their financing from the federal government, incorrect payments come with additional financial consequences: states must repay the federal government for their share.
In Arizona, the federal government covered 70% to 76% of Medicaid costs between 2019 and 2023. The rate was even higher for people who received services through the American Indian Health Program.
According to the press -secretary of Havon Havon Havon Havon Havon Havon Havon Havon Havon Havon Havon Havon Havon Havon Havon Havon Havon Horsifield, who had left the agency since time. This amount will probably grow because AHCCS continues to consider fraudulent cases.
However, the agency is not required to cover the federal government for overpayments made indoors that are now bankrupt or not work. Of the 322 providers suspended on suspicion of fraud, 90 closed, AHCCS reports.
The agency cannot give an estimate of how many these suppliers have been overpaid, but stated that this was reported by the Attorney General when the provider is out of business and provides information to support criminal cases against them.
State Senator Teresa Hotatley, a Democrat from Mesa coal mine to the Navakh Nation, has a critical attitude to the state response and continues to call for more severe regulation of sober premises. During the voting in March, she expressed disappointment about the reforms that Hobb’s later subscribed to the law, claiming that they did not go far enough.
“It’s time to stop the protection of bad actors or even those who continue to allow bad actors to go back,” she said.
As the state slowly works to unleash fraud and recover taxpayer funds, national debates over the Medicaid future intensify. In the national majority, both in the Arizona and Congress legislative body are pushing Medicaid to compensate for Donald Trump to compensate for tax reducing. Among them are justifications – fraud and system abuse.
However, experts on health policy say that most costs on Medicaid pay for legitimate assistance, and that fraud is usually carried out by a small number of suppliers – not patients.
Instead of the current system, where the federal government covers a large share of Medicaid in the smaller level of income, conservatives are in favor of restriction of Medicaid financing related to inflation, a model that would move more for state budgets.
Arizona-one of the nine states where such a change can cause the end of Medicaid extension, which currently provides 648,000 low-income residents, or about 30% of AHCCS recipients.
Despite the uncertain Medicaid future, Arizona’s officials press forward, trying to solve the strong damage to scandal with fraud inflicted by tribal communities. In November, Myes announced a grant initiative of $ 6 million, which offers up to $ 500,000 for the organization to finance the victims and housing support for resettlement or otherwise affected by fraudulent centers. The recipients include tribal countries and native health organizations.
But Stewart says the state’s work is far from over, and many of those who have suffered do not see real responsibility and support.
“They call it a trap … And they want to get justice,” she said. “But where is the justice when it comes to the number of deaths we have, the number of relatives who are still missing?”
Christopher Lamkukh, Roy U. Howard’s fellow at the Arizona Center for Reporting Investigation, reported.
