HCR 2058
AHCCCS; comprehensive claims audit
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Bill overview
This resolution calls for a comprehensive audit of Arizona’s Medicaid program, administered by AHCCCS, to identify and recover improperly paid claims. The audit will examine three years of payments and categorize misappropriations by provider type. Any unresolved issues will be referred to the Attorney General, and the audit findings and recovery amounts will be reported to the Governor, legislative leaders, and the Secretary of State.
Key provisions
- The Joint Legislative Budget Committee will issue a request for proposals for a comprehensive claim-level audit.
- The audit will review three years of Medicaid payments.
- The audit must categorize misappropriations by provider type and managed care organization.
- The audit report must redact personal and confidential information.
- The state will negotiate settlements for misappropriated claims with audit vendors.
- Recovered funds will be deposited in the state general fund.
- The audit results and recovery amounts will be reported to the Governor and the legislature.
- The audit will verify 100% of payments, including unbundling, upcoding, and medically unnecessary services.
Who is affected
- Arizona Medicaid recipients
- AHCCCS (Arizona Health Care Cost Containment System)
- Healthcare providers
- Managed care organizations
- State taxpayers
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