.

Please see attached report from HHS OIG

@Frank_Walsh @Tamara_McNatt @Joan_Senatore @lstiles

Bumping this to our membership base so they can see this. Thank you in advance if you choose to submit information.

We do. We are on our 3rd annual Employee Celebration. Our awards include the following:

•Mentorship Award = Employee who has provided training and guidance to others and didn’t have to be asked to do it. Volunteer, not “Voluntold”.

•Creative Problem Solving Award = Saw a problem or process that was not working and came up with a…

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January 2026

Monthly Fraud Trends Notifications

Hi Dustin,

Every year we send out a call for submissions for the conference. This would be a perfect topic for what you are suggesting. We ask for a variety of presentations and items and this sounds like it would be a great addition!

I’ve already shared with Hawaii but also sharing here:

<font color=”#000000″>We (AZ) house our policy for denials and terminations in the same policy. Based on this discretionary language, if we identify fraud, waste, and abuse concerns, or health and safety concerns when going through the screening process for a provider seeking to enroll, we…

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We were able to get our UPIC to introduce a new step. We have the IFR, introduced the EFR (exit findings report), and FFR won’t be issued until 1)the provider agrees to pay the monies back or 2) a final court finding is issued.

We pushed and purposely designed this so the State wouldn’t be on the hook for monies prior to the judicial processes…

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Hi There! Let me know if you have time to chat and AZ will make time to share our relationship dynamics with our MFCU and how we interact.

vanessa.templeman@azahcccs.gov

Since the provider self identified the overpayment, you may want to consider creating a self disclosure process to incentivize providers to return payments. Here is ours:

https://www.azahcccs.gov/Fraud/Downloads/SelfDisclosure.pdf

We also send out letters to providers advising them of their incorrect balance billing. We’ve had one instance of a provider who refused to reimburse the member so we did issue a Civil Monetary Penalty as a result.

Here is a term we have in our provider contracts that addresses both balance billing and collecting cash in lieu of charging AHCCCS:

The Provider shall not bill, nor attempt to collect payment directly or through a collection agency from a person who is or claims to be AHCCCS eligible without first receiving verification from AHCCCS that the…

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Here is some language from our template letter in AZ:

……. uses data analytics to identify unusual billing patterns among providers within the same specialty and geographic area.

The attached claims/encounters data, submitted under your provider ID, revealed an unusual pattern of billing that may have resulted in an overpayment. You…

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Please find Arizona Telehealth policies and breakout of audio only, audio and visual combined, etc. referenced by Dr. Megan Woods during her discussion:

https://www.azahcccs.gov/AHCCCS/Initiatives/Telehealth/

Hi @kari-engelkewisconsin-gov

Happy to share what we outline in our policies. Trying to keep it somewhat high level here but happy to discuss further if needed.

Let me link and share a few things:

• ACOM 103 (

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Here in AZ we use TLO, Asset Verification, Skip tracing, etc. Not sure if this is the type of information you were looking for.

https://www.powelltribune.com/stories/not-guilty-jury-acquits-men-of-all-counts-in-medicaid-fraud-case,38987?fbclid=IwAR2o_-sytBYJBIa3EBUaGaLyVSv9SQRjtADKnopjsO1D9hI3Rqrgdbt6p44

Sharing the article I came across, curious if anyone else has something similar, or other items worth reading?

NAMPI Region 3 has no representative! The previous representative left state service a few months ago and this region is currently missing out on several NAMPI items. If you are from any of the state of Region 3 (PA,WV,MD,VA,DE,DC), and are interested in being the Regional Representative, please let me know. You will need to have…

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Hi Gene, I spoke to our EVV design person and received the following answer:

There is a bill in Congress to remove the location detection. Our contract with Sandata states that we don’t allow geo-tracking, but the system detects location just at the moment the DCW logs in and out. We require the same for the alternate vendors, but do allow…

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thought this would be interesting to see

HHS published its MFCU statistical summary for FY2020, which listed the number of indictments obtained by each of the nation’s 53 MFCU’s (including District of Columbia, Puerto Rico, and U.S. Virgin Islands). The rankings are determined by statistical data comparing the number of indictments produced by the number of staff members in each of the…

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