Arizona Attorney General’s Health Care Fraud and Abuse Section Ranked Second Highest in the Nation

Improved Upon Third Place Ranking in Previous Year

PHOENIX – The Office of the Arizona Attorney General's Medicaid Fraud Control Unit (MFCU) is ranked second highest in the nation according to data provided to the U.S. Department of Health and Human Services ("HHS"). MFCU, housed in the Criminal Division of the Attorney General's Office, is also commonly referred to as the Health Care Fraud and Abuse (HCFA) section in Arizona. The Arizona Attorney General's Office was ranked third highest in the nation in the previous year based on data provided to HHS.

Earlier this year, the HHS published its MFCU statistical summary for Fiscal Year ("FY") 2018, which listed the number of indictments obtained by each of the nation’s 50 MFCU's. Adjusting for differences in staff size, Arizona’s MFCU emerged as the second most productive in obtaining criminal indictments. In FY 2017, the Unit was ranked third in the nation for most indictments/convictions per capita. 

"The Arizona Attorney General's Office is a shining example nationwide for prosecuting criminals who commit Medicaid fraud against the government," said Attorney General Mark Brnovich. “Since 2015, our dedicated team has been among the top three productive units in the country in terms of bringing criminal charges against those that commit Medicaid fraud and abuse patients cared for in Medicaid-funded facilities and has returned millions of dollars to taxpayers.”

In FY 2018, Arizona's MFCU initiated over 200 investigations and indicted 83 individuals; 74 for fraud and 9 for abuse/neglect. Also during the same year, 63 individuals were convicted; 56 for fraud and 7 for abuse/neglect, according to statistical data. HCFA's 27 employees were able to recover $11,973,830 in fraudulent funds that were returned to the government.

In addition to being ranked second in the nation, HCFA was also ranked number one for western states. The rankings are determined by statistical data comparing the number of indictments produced by the number of staff members in each of the 50 Medicaid Fraud Control Units in the country.

HCFA also participated with other states’ MFCUs and the United States Department of Justice in 55 civil cases that targeted national health care and pharmaceutical companies alleged to have engaged in improper trade practices in FY 2019. In FY 2019, six cases reached settlements. As a result of HCFA’s participation, $6,340,085 was recovered from these companies and returned to the government, with $1,996,692 provided directly to the Arizona AHCCCS program and $4,343,393 returned to the federal government.

MFCU is a federally funded unit charged with investigating and prosecuting Medicaid (AHCCCS) fraud, fraud in the administration of the Medicaid program, abuse, and neglect or financial exploitation occurring in Medicaid facilities or committed by Medicaid providers or their employees. 

In addition to working collaboratively with federal and local law enforcement agencies, HCFA regularly receives referrals from state health care licensing agencies. The referrals have led to the filing of criminal charges against licensed health care professionals engaging in illegal drug diversion in Arizona. HCFA saw an increase in direct referrals from two hospital groups in FY 2019.

During FY 2019, HCFA received 159 allegations/complaints regarding fraud, patient abuse, and the financial exploitation of vulnerable adults. As a result, 129 new cases were opened for investigation, including 109 fraud cases and 20 patient abuse/financial exploitation cases. HCFA improved upon their 2018 numbers and charged 100 defendants and convicted 72 defendants last fiscal year.

Below are recent examples of Arizona Attorney General HCFA cases:

The U.S. Department of Health and Human Services will release FY 2019 data in 2020.

If anyone believes they or someone they know has been the victim of or have information of 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 employee, they can fill out a complaint form.

The complete FY 2018 rankings.