B Reports of Fraud or Abuse
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B Reports of Fraud or Abuse

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MA1801

 

Procedures

There are two common sources of information about potential fraud:

 

1) Fraud reported by a third party

Refer people calling to report alleged fraud by an AHCCCS customer to the AHCCCS Fraud Hotline at: (602) 417-4193 or (888) 487-6686 (for callers who are outside the Phoenix area). You can also refer them to the online form on the AHCCCS website at https://www.azahcccs.gov/Fraud/ReportFraud/onlineform.aspx.

When the person is willing to use the Fraud Hotline, transfer the call or ask the complainant to call directly. This phone is answered during normal working hours, Monday through Friday. Voicemail is available on this phone after hours to record messages.

When a complainant does not want to use either of these options and prefers to report the alleged fraud or abuse to you in person or by phone, take the following actions:

Step

Action

1

Tell the complainant that if they choose to identify themselves, AHCCCS keeps their identity confidential but may release it to the prosecutor in the event the case is prosecuted. We cannot promise complete confidentiality.

NOTE     Due to Privacy Act restrictions, AHCCCS cannot inform individuals reporting acts of fraud or abuse of the investigative results.

2

Obtain as much information as possible to identify the customer or representative the complainant is reporting (Name, date of birth, Social Security Number, address, etc.).

3

Ask the complainant specific details on how the complainant believes the customer or representative is defrauding or abusing the AHCCCS program.

4

Call the AHCCCS Fraud Hotline on the complainant’s behalf at (602) 417-4193 in Maricopa County or 1-888-ITS-NOT-OK (888-487-6686), or complete the online form at https://www.azahcccs.gov/Fraud/ReportFraud/onlineform.aspx.

 

2) Potential fraud discovered by AHCCCS or DES staff

Complete the following steps when you suspect fraud, receive a report of fraud or make a referral to Adult Protective Services (APS) or the Department of Child Safety (DCS):

Step

Action

1

Document the case file in detail to help the investigator determine the accuracy of your determination and the reason that information provided by the customer or representative is considered questionable or indicates fraud.

2

Have your immediate supervisor review the case file documentation and all relevant information and documents that relate to the suspected fraud.

All employees are encouraged to immediately report any type of suspected fraud or abuse of the AHCCCS system.

NOTE     A supervisor’s permission is not required to make a referral.

3

Make a referral to the AHCCCS Office of the Inspector General:

  • Call the Fraud Hotline at (602) 417-4193 in Maricopa County or 1-888-ITS-NOT-OK (888-487-6686) from outside Maricopa County; or

  • AHCCCS Employees: Submit an electronic referral by completing the online form at https://www.azahcccs.gov/Fraud/ReportFraud/onlineform.aspx

  • DES Employees: Email a completed FAA-1181A form using secure email to FPU@azahcccs.gov for all counties.

 

3) Reporting potential abuse of a customer

When a referral to the Arizona Department of Child Safety (DCS) or the Arizona Adult Protective Services (APS) is appropriate, you may discuss the issue with your supervisor before or after you make the referral. However, a supervisor’s permission is not required to make a referral.