Comprehensive Legal Support for Providers Facing AHCCCS Suspensions and Criminal Investigations

As a dedicated healthcare provider, you’ve committed yourself to delivering quality care to your community. However, when you find yourself entangled in the intricate web of the Arizona Healthcare Cost Containment System (AHCCCS) suspension process, you need a legal ally that not only specializes in these cases but also offers unwavering support in related criminal investigations.  AHCCCS is referring every suspension to either the Arizona Attorney General’s Office or the United States Attorney for possible criminal prosecution.   It is impossible to tell who will be prosecuted or when that prosecution will occur.  It is important to keep in mind that the government has 7 years to bring charges against you.  Just because that has not happened yet, does not mean that it will not happen in the future.

Our Process:

  1. In-Depth Case Assessment: If AHCCCS concludes that there is a “credible allegation of fraud” (referred to as a CAF) then all state Medicaid payments will be suspended. See 42 C.F.R. § 455.23(a)(1). As a provider, you know how voluminous billing records are.  These records play an important role in corroborating the services that you provided and refuting any allegation of fraud.  Our first course of action is to open a line of communication with Access.  This includes receiving discovery and deciphering what, if anything, the CAF is based on.  Examples include, but are not limited to: ghost billing, unbundling, double billing, and kickbacks to behavioral health residential facilities.
  2. Rigorous Investigation: Once our attorneys have thoroughly reviewed AHCCCS’s investigation, we begin our own. This includes a thorough review of your own documentation and medical records, discussions with patients and employees, and is intended to arm us with the facts that the government may not know. Once this is complete, we evaluate the case and determine whether to proceed with informal settlement discussions.
  3. Expert Negotiation: We are seasoned negotiators who understand the nuances of AHCCCS procedures. Whether it’s negotiating for reduced penalties, repayment terms, or alternative resolutions, our aim is to protect your professional interests and to give you the best chance at continuing to provide patient care.
  4. Robust Representation: Should an appeal be necessary, our experienced litigators step in to provide steadfast representation. Crafting compelling arguments and leveraging our courtroom proficiency, we are always ready and able to force the government to prove their case.

Comprehensive Support in Criminal Investigations:

Our commitment goes beyond AHCCCS suspensions. We’re prepared to provide comprehensive legal support should related criminal investigations arise.  Given the rampant fraudulent billing that occurred between 2021 and 2023, these cases are being aggressively prosecuted.    Our services encompass:

Criminal Defense: If you’re facing criminal charges related to your AHCCCS suspension case, our skilled defense lawyers are well-versed in navigating the intricacies of criminal law. We’ll fiercely protect your rights and advocate for your best interests.

Evidence Analysis: Our team conducts a thorough analysis of evidence, ensuring no detail is overlooked. We work tirelessly to build a solid defense strategy tailored to your unique circumstances and are uniquely suited to representing you, both in front of AHCCCS and – if need be – a jury.

Strategic Advocacy: From negotiations to courtroom representation, we’re dedicated to securing the best possible outcome for your criminal case. Our proven track record speaks to our ability to effectively advocate for providers like you.

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