Two years after Arizona officials revealed a medical fraud scheme of $ 2.5 billion that attacked the Native Americans who sought treatment for addictions, the State has recovered only a fraction of the funds of the taxpayers lost by fraud.
The Arizona Attorney General’s Office leads criminal investigation in the Behavior and Housing Health Suppliers Network that from 2019 to 2023 exploited the American Indian health program to obtain inflated medical payments. The researchers found that fraudulent operators did not provide the services they had billed and sometimes allowed patients to continue the use of substances for what they had sought treatment.
Until now, the State has accused more than 100 people and has recovered $ 125 million, or approximately 5% of the funds that the State estimates that it paid the bad actors.
Attorney General Kris Mayes said at a press conference on May 1 that he hopes to recover “at least hundreds of millions” of scammers. But he warned that “it is difficult, because what happens is that these … criminals get the money, buy luxurious houses, buy multiple expensive cars, hide money on the high seas, they spend money unrecoverable.”
“My team works day after day to take advantage of the assets,” Mayes said.
Arizona’s medical cost containment system fought to control unbridled fraud under two governors, leaving more than 11000 people vulnerable to the chaos that followed. Previous reports from the Arizona and Propublic Research Center discovered that at least 40 indigenous residents of homes and sober treatment facilities in the Phoenix area died when the state balanced their response.
The damage also extended through the state’s health industry, which almost stopped when the agency suspended some 300 suppliers and promulgated policies that arrested or delayed delayed payments to which they were still up to date. These reforms included a better scrutiny when evaluating and reimbursement of suppliers.
Governor Katie Hobbs, a Democrat, recently signed legislation further increasing the supervision of sober homes by demanding that the facilities quickly denounce resident deaths. But defenders such as Reva Stewart, a Diné activist who has helped the indigenous victims of the scheme through their stolen group to stolen people, do not think that the State has done enough.
“I feel that I am in a hamster wheel, and we are still at first,” Stewart said. “They have many accusations and bees of people collected, but at the same time … they are only weakly in the wrist.”
The United States Department of Justice has also accused several people and is conducting parallel investigations on fraudulent billing schemes under federal statutes.
However, despite the state and federal efforts of the thesis, most of the taxpayers’ stolen money will be recovered.
From 2019 to 2023, the Arizona Medical Care Containment System allowed some 13,000 suppliers without a license to enter their system, including some that exploited the weak supervision by loading the services that were never delivered.
The agency also did not act decisively when the solutions to express fraud proposed internally. Initially, he yielded to the pressure of special interest groups connected to the behavior health industry, which argued that reforms to the health plan of the American Indians threatened their financial interests.
Now, AHCCCS says that its Efravel, the crisis could take many years, describing its research as a “highly complex and manual process.”
Officials must review inadequate payments, which were bothered by fraud or not, case by case. It is required that pagen AHCC suppliers as soon as they realize excessive payments, cannot do so in a global sum. Refunds can occur for a few months or years.
Because Medicaid state agencies receive much of their federal government funds, inappropriate payments come with additional financial consequences: states must pay the federal government for their participation.
In Arizona, the federal government covered 76% of Medicaid’s costs between 2019 and 2023. The rate was equally higher for people who received services through the American Indian Health program.
AHCCCS has paid $ 49.1 million to the federal government since January 2023, according to spokesman Havona Horssefield, who has since left the agency. That amount will probably grow as AHCCS continues to review fraudulent cases.
The agency does not request, however, reimburse the federal government for excessive payments made to the facilities that are now bankrupt or out of the business. Of the 322 suppliers suspended under suspicion of fraud, 90 have closed, according to the AHCCC.
The agency could not provide an estimate of how much suppliers were paid in excess, but said it notifies the attorney general when a supplier does not do so and provides information to support criminal cases against them.
State Senator Theresa Hatathlie, a Democrat of the coal table in the Navajo nation, has been critical of the state’s response and continues to request a stricter regulation of sober life facilities. Duration A vote on the floor of March, expressed its frustration for the reforms that Hobbs then promulgated law, stating that they were not far enough.
“It’s time to stop protecting bad actors or only those people who continually allow bad actors to continue to return,” he said.
As the State works slowly to unravel fraud and recover taxpayers’ funds, national debates on the future of Medicaid are intensive. Republican majorities both in the Arizona Legislature and in Congress are pressing to reduce Medicaid to compensate for the tax cut proposed by President Donald Trump. Among its justification are fraud and system abuse.
However, health policy experts say that most Medicaid expenses pay for legitimate care, and that fraud is usually committed by a small number of suppliers, not patients.
Instead of the current system where the Federal Government covers a majority of Medicaid’s costs in low -income states, conservatives advocate limiting Medicaid funds linked to inflation, a model that would change more than the cost to state budgets.
Arizona is one of the nine states where such change could trigger the end of Medicaid’s expansion, which currently ensures 648,000 low -income residents, or about 30% of AHCCCC receptors.
Despite the uncertain future of Medicaid, Arizona’s officials are advancing with the efforts to address the lasting damage that the fraud scandal inflicted into tribal communities. In November, Mayes announced a $ 6 million subsidy initiative that offers up to $ 500,000 per organization to finance the compensation of victims and housing support for those displaced or affected by fraud treatment centers. The recipients include tribal nations and native health organizations.
But Stewart says that the state’s work is far from finishing, and many of those injured have not yet seen real responsibility or support.
“They call it a threeth … and want to get justice,” he said. “But where is justice when it comes to the amount of deaths we have, the amount of native relationships that are still missing?”
Hannah Bassett and Christopher Lomahquahu, a member of Roy W. Howard at the Arizona Research Center, contributed reports.
