In April 2023, AHCCCS contracted with Berry Dunn, to analyze AHCCCS data, identify trends, and make recommendations on what they should do to prevent future Medicaid fraud moving forward. The audit focused on AHCCCS’ claims and enrollment processes.
Berry Dunn made 25 programmatic recommendations. AHCCCS says they’ve implemented 20 of the 25 recommendations and is in the process of implementing another five.
AHCCCS Sober Living Fraud Website
As Stephanie Innes points out in her story last week (see: Audit on big Arizona Medicaid fraud focuses on processes, not people) the report: “… does not name any individuals responsible for ongoing fraud against the agency but rather name process and procedural issues to help prevent abuse in the future.”
However, that doesn’t mean that the persons who oversaw AHCCCS’ American Indian Health Plan (former Assistant Director Markay Adams and former Deputy Director Shelli Silver) are off the hook (Ms. Silver is retired & Ms. Adams is in senior leadership at Blue Cross Blue Shield of Arizona).
The criminal investigation by the Attorney General is still underway. One has to believe that the AG investigators are examining emails and other internal AHCCCS records to determine whether this crisis was facilitated by former staff criminal misconduct.
You can contact the AHCCCS Office of Inspector General with questions about fraud [email protected]