Bill aims to prevent Arizona Medicaid fraud after billions stolen

PHOENIX (AZFamily) — Republican state Sen. Carine Werner from Scottsdale introduced a new bill Thursday to fix the Arizona Health Care Cost Containment System (AHCCCS), our state’s Medicaid system, that’s been plagued by fraud.

“The system is so broken that there’s no going back. I believe that AHCCCS has failed,” said Werner.

Arizona’s Family has extensively covered the sober living home scandal, which led to preventable deaths and one of the biggest fraud cases in Arizona history.

Werner says AHCCCS cannot go on like this, and at this point, a major overhaul is the only way to solve the deep-rooted systemic issues.

If Senate Bill 1611 were to become law, it would allow AHCCCS to retain oversight authority, but all administrative and care coordination would be managed by another outside entity.

Thursday marked the fourth Senate oversight hearing meant to hold AHCCCS accountable after billions of dollars of fraud and fake sober living homes scamming the system were uncovered over the past few years.

Werner says she is still concerned about a lack of data, inaccurate reporting, prolonged payment delays to Indian health care providers, and unresolved complaints related to patient care.

“As a result of the fraud, you know, all kinds of actions had to be taken in order to stop it and that’s important and we have to continue to take actions and use our tools and our processes to ensure that we are mitigating as much as possible fraud, waste, and abuse in the system,” said Virginia Rountree, director of AHCCCS, during the hearing.

“Despite public exposure, investigations, lawsuits, media coverage and legislative attention, the same harmful practices remain active. The system has not been fixed; it has only adapted,” said Reva Stewart, an advocate with the Turtle Island Women Warriors during the hearing. “We really do need change. We don’t need any more excuses.”

During the hearing, concerns about everyone having to suffer for the actions of bad actors were discussed.

A few senators and a lawyer for legitimate behavioral health facilities say some changes AHCCCS has made have punished operators doing the right thing.

They say that’s forced many providers to close their small businesses which creates gaps in care for vulnerable people.

It’s a complex problem involving a critical system that serves nearly 2 million people in our state.

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