Arizona’s Medicaid Agency Delayed Fraud and Abuse Investigations

Arizona’s Medicaid Agency Delayed Fraud and Abuse Investigations

By Corinne Murdock |

Last Thursday, the Arizona Auditor issued a report finding that the state’s Medicaid agency, the Arizona Health Care Cost Containment System (AHCCCS), failed to fulfill four major aspects of its services, including a year delay on average to investigate over half of fraud or abuse incidents. 

AHCCCS provides health care coverage to over 2.4 million Arizonans: about 33 percent of the population. 

In all, the audit report determined that AHCCCS also failed to: review health plans every three years as required, make correct eligibility determinations, ensure that health plans oversaw providers in two key areas, and establish oversight processes for its Housing Program and Administrator.

In order to remedy these issues, Auditor General Lindsey Perry issued 22 distinct recommendations. AHCCCS agreed to implement all 22 of Perry’s recommendations without contest. 

AHCCCS explained that no federal or state regulations mandated the completion of preliminary investigations within 3 months, like Perry recommended, but agreed it was best practice and would adopt that protocol. Likewise, AHCCCS explained it would adopt a self-auditing process to review eligibility determinations, despite there not being any federal or state regulations for such quality assurance reviews. 

AHCCCS also noted that its lack of eligibility reviews was due to understaffing caused by the COVID-19 pandemic. 

The audit may also result in a change to state law. AHCCCS noted that it wasn’t able to create a monthly report as required by statute. This report — which was to be sent to the governor, the house speaker, and the senate president — was meant to include Title XIX and non-Title XIX categories that outlined the persons served, the units of service, and the amount of funding provided for client services and the amount provided for regional behavioral health authority administration and case management expenses. 

In addition to the negative findings of the audit report, AHCCCS is facing a lawsuit filed by several federally-qualified health centers. The community health centers claim that AHCCCS is wrong to deny reimbursements for dentists, podiatrists, optometrists, and chiropractors. Earlier this month, the Ninth Circuit Court of Appeals reversed a decision dismissing the lawsuit.

Arizona Alliance for Community Health Centers sued AHCCCS, joined by Canyonlands Healthcare, Chiricahua Community Health Centers, Desert Senita Community Health Center, Mariposa Community Health Center, Marana Health Center, Mountain Park Health Center, Native Health, North Country Healthcare, Sun Life Family Health Center, Sunset Community Health Center, and United Community Health Center-Maria Auxiliadora.

Corinne Murdock is a reporter for AZ Free News. Follow her latest on Twitter, or email tips to

Arizona Senate Democrats Call Appropriations Committee ‘Garbage’

Arizona Senate Democrats Call Appropriations Committee ‘Garbage’

By Corinne Murdock

Despite the fact that the Senate Appropriations committee approved Democratic legislation to help with Arizona’s housing and diabetes crises, the Arizona Senate’s Democratic Caucus offered a pejorative nickname for the Senate Appropriations Committee, calling it a “garbage can.”

The caucus’ discontent may concern the fact that the committee schedule included bills that were rewritten to include language from other bills killed previously in the House. This included HB2637, prohibiting financial institutions from discriminating against others based on their “social credit score” — it took on the language of HB2656, a controversial bill killed on the House floor by Democrats with the help of two Republicans.

Insults aside, the committee passed several bills from Democrats on that day unanimously. These included HB2528, appropriating $100 million from the American Rescue Plan Act of 2021 (ARPA) to the Housing Trust Fund (HTF); and HB2083, requiring the Arizona Health Care Cost Containment System (AHCCCS) to cover costs of up to 10 annual program hours of diabetes self-management training (DSMT) services. 

The caucus then referred followers to the committee agenda for that day: 39 bills, and another two that were struck from the agenda. 

Noteworthy bills included HB2633, requiring hospitals to develop visitation policies for daily, in-person visitation; HB2637, prohibiting banks from discriminating against individuals based on their political affiliation or “social credit scores” including their environmental, social, governance, or similar values-based or impact criteria; HCR2001, altering the state constitution to prohibit compelled or solicited beliefs constituting critical race theory (CRT) tenets from K-12 and collegiate institutions; HB2493, establishing a $12 million election integrity fund; HB2278, eliminating Algebra II as a required course for high school graduation and instead requiring an alternative course such as personal finance, computer science, statistics, or business math; and HCR2027, asking voters to approve the difference of $1 million plus death benefits to the surviving spouse or defendant of a first responder killed in the line of duty. 

Corinne Murdock is a reporter for AZ Free News. Follow her latest on Twitter, or email tips to

Pandemic Prompted Expanded Telemedicine Use, Bill Expands Care And Codifies Pay Parity

Pandemic Prompted Expanded Telemedicine Use, Bill Expands Care And Codifies Pay Parity

By B. Hamilton

During the first months of the coronavirus pandemic shutdown, the use of telehealth increased significantly. In fact, overall, almost half of the people who were undergoing treatment when the pandemic shutdown began reported using some form of telemedicine.

From a new RAND Corporation study, those findings make the news of Governor Doug Ducey’s decision to sign telemedicine legislation all the more welcome to individuals still hesitant to venture out.

House Bill 2454, sponsored by Rep. Regina Cobb, will make telemedicine services provided to Arizonans through the Governor’s Executive Order last March permanent. The governor’s order required health care insurance companies to expand telemedicine coverage for all services that would normally be covered for an in-person visit.

The bill expands access to telemedicine for patients and ensures that doctors receive equal compensation from insurance companies for telemedicine services and allows out-of-state health care professionals to provide telemedicine in Arizona.

“Telehealth was an extremely valuable tool during the pandemic,” said Cobb. “It’s helped Arizonans get in contact with health care providers, mental health specialists, speech therapists, and more from the safety of their home. HB 2454 will continue those efforts and ensure that those living in Arizona receive medical service in a safe and convenient manner.”

According to findings published in the Journal of General, between mid-March and early May 2020, telehealth was used by more than 40% of patients with a chronic physical health condition and by more than 50% of those with a behavioral health condition, according to findings published in the Journal of General Internal Medicine.

Under the bill, medical examinations in the worker’s compensation space can also be conducted via telehealth if all parties consent. It also prohibits healthcare boards from enforcing any rule that requires a patient to visit in-person before being prescribed most medications.

“HB 2454 is a win for physicians and patients alike,” said Arizona Medical Association President Dr. Miriam Anand. “Every patient deserves access to the appropriate care needed to treat their medical conditions. HB 2454 will break down unnecessary barriers to telehealth and help facilitate the delivery of high-quality care to patients across Arizona.”

HB 2454 also requires medical insurers to provide payment parity for telehealth services using audio and visual features and allows health care providers who are licensed in other states to provide telehealth services into Arizona under certain conditions.

According to the JLBC, “the bill establishes the Telehealth Advisory Committee on Telehealth Best Practices which would be tasked with recommending other health care service that may be appropriately provided through an audio-only telehealth format. These services would be covered services starting January 1, 2022 but would not require payment parity.”

The bill does not apply to the Arizona Health Care Cost Containment System (AHCCCS) but does require health insurers to cover audio-only health care services if those services are covered by AHCCCS or Medicare.