Fraud, Waste, & Abuse

What is Fraud, Waste, & Abuse?

Fraud is purposely giving wrong or misleading information in order to receive a benefit or some type of service. Waste is over using services or misusing resources or practices. Abuse of the Program is provider practices or member practices that result in an unnecessary cost to the AHCCCS program.

 Unfortunately, Fraud, Waste, and Abuse are not as uncommon as you would think. Please see some of the most common examples.

Member Fraud, Waste, and Abuse include, but are not limited to:

  • Lending or selling your AHCCCS Identification Card to anyone
  • Not stating true income or living arrangements
  • Providing false materials or documents
  • Leaving out important information
  • Failing to report another insurance that you have
  • Continuing to use AHCCCS for services when you move out of the state or out of the country

    Provider Fraud, Waste, and Abuse include, but are not limited to:

    • Billing for a service they didn't provide
    • Ordering test, lab work, or x-rays that aren't necessary
    • Charging for medical services not provided
    • Billing multiple payers and receiving double payments
    • Using billing codes that pay higher rates to get more money even though those services weren't provided
    • Billing for services under a member that is not their member

    How to Report Fraud and Abuse

    Anyone can report fraud - there are no restrictions. Fraud, Waste, and Abuse hurts everyone. If you suspect a possible case, please report it immediately.

    If you suspect a BUFC/ACC provider or member of fraud, waste or abuse, please contact us at any of the following:

    Customer Care Phone: (800) 582-8686

    Compliance Officer's Phone: (520) 874-2847

    Compliance Department Fax: (520) 874-7072

    Compliance Department Email:

    BUHPCompliance@bannerhealth.com

    Compliance Department Mail:

    Banner - University Family Care/ACC

    Compliance & Audit Department

    2701 E. Elvira Rd., Tucson, AZ 85756

    Confidential and Anonymous Compliance (ComplyLine) Hotline: (888) 747-7989

    You can also report directly to AHCCCS, Office of the Inspector General at:

    Provider Fraud: (602) 417-4045 or (888) 487-6686

    Member Fraud: (602) 417-4193 or (888) 487-6686

    Penalties

    A person who is suspected of fraud and/or abuse of the AHCCCS system will be reported to AHCCCS. Penalties for people involved in fraud and/or abuse may be both civil and criminal.