The Medicaid Fraud Control Unit is a federally funded unit charged with investigating and prosecuting: Medicaid (AHCCCS) fraud; fraud in the administration of the Medicaid program; and abuse, neglect or financial exploitation occurring in Medicaid facilities or committed by Medicaid providers or their employees. The suspect must work for a Medicaid provider, such as a doctor, nursing home, hospital, adult care home, or home health agency. The unit is located in the Attorney General's Office, 2005 N Central Avenue in Phoenix. The unit consists of attorneys, investigators, an auditor, a nurse investigator, paralegal and support staff.
AHCCCS Fraud can take a variety of forms. Common examples include:
- Billing for services not rendered
- Billing for a higher level of service than was performed
- Billing for unnecessary services
- Kickbacks
- Double billing
- Denial of necessary services or procedures, or denial of access to specialists
- Embezzlement
If you suspect that AHCCCS fraud has occurred, please contact the Medicaid Fraud Control Unit promptly.
Abuse
Abuse can be physical, emotional or sexual. Abuse can result in physical injury such as:
- Bruising
- Fractures
- Welts
- Burn marks
- Redness and/or swelling
Examples of assaultive acts include, but are not limited to:
- Slapping
- Punching
- Shoving
- Choking
- Shaking
Neglect is a pattern of conduct without the person=s informed consent resulting in deprivation of food, water, medication, medical services, shelter, cooling, heating or other services necessary to maintain minimum physical or mental health.
Examples include, but are not limited to:
- Malnutrition
- Dehydration
- Pressure sores
- Unsafe, dangerous or unsanitary living conditions
- Untreated medical problems
If you suspect that a vulnerable adult has been abused or neglected, report it immediately to Adult Protective Services at 1-877 SOS ADULT.
Reporting to the Medicaid Fraud Control Unit
If you suspect that Medicaid fraud has occurred, or abuse, neglect or exploitation has occurred in a Medicaid facility or by someone working for a Medicaid provider, immediately report the incident to the Medicaid Fraud Control Unit Monday - Friday 8:00-5:00pm at the Office of Attorney General:
2005 N Central Ave
Phoenix, Arizona 85004
602.542.3881
602.364.0411 (fax)
If the incident needs immediate attention, and it is not during regular business hours, call 911 immediately.
Obtain a copy of the Medicaid Fraud Control Unit Complaint Form.