What Is AHCCCS Fraud?

The regulations designed to promote the safe distribution of medical benefits are strict with the intent of protecting patients throughout Arizona. Unfortunately, the institutions that oversee medical practices, rehabs, and healthcare businesses throughout the state can prove overzealous.

Should you find yourself facing accusations of Arizona Health Care Cost Containment System (AHCCCS) fraud, your entire practice may be at risk. What’s more, you individually may face considerable fines on top of the threat of prison time. Fortunately, you’re not helpless. Suzuki Law Offices has helped healthcare businesses throughout Arizona challenge accusations of AHCCCS fraud. You can reach out to our Phoenix federal criminal defense attorneys today for help cultivating a strong defense. 

The AHCCCS As an Arizona Institution

The Arizona Health Care Cost Containment System (AHCCCS) provides Arizona residents with access to Medicaid and related programs designed to make it easier for in-need parties to get the medical attention they need. These programs primarily serve lower-income individuals and families who might otherwise not have the resources to address their health concerns.

Unfortunately, the AHCCCS has to diligently oversee both recipients and partner institutions in an effort to eliminate professional malpractice and the risk of fraud. As such, the auditing process established by overseers can often prove overzealous.

One overzealous audit may be all that stands between your business’s success and permanent professional consequences. 

Breaking Down Types of AHCCCS Fraud

Should auditors move against your business, you may find yourself facing accusations of a range of different types of fraud. The Office of the Inspector General (OIG) can bring investigations against individuals as well as entire businesses depending on its suspicions. That said, these investigations cannot move forward without evidence.

Some of the most common forms of fraud to appear in the Office of Inspector General’s audits can include the following:

Anti-User Fraud

The Office of the Inspector General can serve as a patient advocate in the face of alleged anti-user fraud. Forms of anti-user fraud can include the following:

• Eligibility fraud
• Resource misrepresentation
• Residency issues
• Household composition misrepresentation
• Citizenship status misrepresentation
• Unreported income
• Misrepresentation of health condition
• Failure to report third-party liability

Anti-Operations Fraud

Alleged criminal misconduct can also impact a business’s overall operations. Your business may suffer accusations of anti-operation fraud if the Office of the Inspector General suspects you or your employees of any of the following:

• Falsification of claims via alterations or incorrect coding
• Double billing
• Submission of false data
• False or fraudulent enrollment
• Billing fraud
• Misrepresentation or substitution of services

Consequences for AHCCCS Fraud

Accusations of AHCCCS fraud come with serious criminal consequences, particularly if you fail to challenge them. Working with a Phoenix federal criminal defense attorney can limit or eliminate the impact of these accusations on your business.

Should you fail to challenge the accusations of AHCCCS fraud brought against you, state prosecutors can accuse you of violating the False Claims Act. The federal penalties for that violation can see you face fines of up to $11,000 per reportable offense. You may also face probation, incarceration, and permanent registration as a fraudulent business owner.

Accusations of gross misconduct that go on challenged can see you pay triple damages or face additional penalties. 

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You Can Work With Professionals to Defend Yourself Against Accusations of AHCCCS Fraud

The effort that goes into the audits that reveal fraudulent behavior can come from a place of good intentions. That said, the intensity with which the federal government can do Arizona businesses and residents significant harm. 

If you want to minimize the impact these accusations can have on your personal life and professional practice, you can secure representation from an experienced criminal defense attorney.

We Can Provide You With Consummate Representation

Suzuki Law Offices offers an immediate response to accusations of fraudulent conduct in the medical sphere. You can count on our team to manage your communications with the authorities investigating your business.

We can similarly ensure that said institutions do not attempt to accuse you of a lack of cooperation. We ensure that documents requested during discovery make it into the prosecution’s hands – but that the prosecution doesn’t overstep its bounds when making its requests.

At the same time, we can sit down with you to tailor a defense to suit your needs. You can continually count on us to fight in good faith for your right to continue practicing in Arizona. Should the need arise to go to trial, our team can prepare you for the process while keeping the door open for good-faith resolutions. 

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Book a Case Evaluation With Suzuki Law Offices Today

Arizona healthcare facilities treating Native American patients have recently seen an influx of federal interest. Suzuki Law Offices has already helped institutions throughout Arizona contest accusations of AHCCCS fraud. We’re prepared to offer our representation to you in the face of accusations of criminal misconduct.

You can count on our criminal defense attorneys to see you through OIG, CMS, and FBI investigations questioning the validity of the services you offer to Arizona residents. We can help you navigate accusations of Medicare and Medicaid fraud as well as accusations of False Claims Act and Anti-Kickback Statute violations.

Don’t let accusations of AHCCCS fraud get away from you. Contact us today to discuss the nature of the charges brought against your institution. Our team can help you defend yourself and your practice.

Call or text 602-682-5270 or complete a Free Case Evaluation form