Arizona Medicaid: Update to fraud and abuse requirements
Last modified: August 12, 2021
The Arizona Health Care Cost Containment System (AHCCCS) has updated its fraud and abuse requirements for subcontractors, effective Oct. 1, 2021. These requirements are referred to as “Minimum Subcontract Provisions”.
Subcontractors are any health care provider, group biller, pharmacy benefit manager, administrative services organization or any other third party that has a contract with UnitedHealthcare Community Plan or another Managed Care Organization (MCO).
Effective Oct. 1, 2021, the following updates are being made to the Minimum Subcontract Provisions regarding fraud and abuse:
AHCCCS/Office of the Inspector General (OIG) has the sole authority to handle and dispose of any matter involving fraud, waste and/or abuse
The subcontractor must assign to AHCCCS/OIG the right to recoup any amounts overpaid to a provider resulting from fraud, waste and/or abuse
If the subcontractor receives anything of value that could be construed to represent the repayment of any amount expended due to fraud, waste and/or abuse, the subcontractor must forward that recovery to AHCCCS/OIG within 30 days of receipt
Failure to forward the recovery to AHCCCS/OIG within 30 days will be deemed an overpayment subject to set off in the amount received by subcontractor