Arizona Administrative Code
Title 9 - HEALTH SERVICES
Chapter 22 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ADMINISTRATION
Article 11 - CIVIL MONETARY PENALTIES AND ASSESSMENTS
Section R9-22-1101 - Basis for Civil Monetary Penalties and Assessments for Fraudulent Claims; Definitions

Universal Citation: AZ Admin Code R 9-22-1101

Current through Register Vol. 30, No. 38, September 20, 2024

A. Scope. This Article applies to prohibited acts as described under A.R.S. § 36-2918(A), and submissions of encounters to the Administration. The Administration considers a person who aids and abets a prohibited act affecting any of the AHCCCS programs or Health Care Group to be engaging in a prohibited act under A.R.S. § 36-2918(A).

B. Purpose. This Article describes the circumstances AHCCCS considers and the process that AHCCCS uses to determine the amount of a penalty, assessment, or penalty and assessment as required under A.R.S. § 36-2918. This Article includes the process and time-frames used by a person to request a State Fair Hearing.

C. Definitions. The following definitions apply to this Article:

1. "Assessment" means a monetary amount that does not exceed twice the dollar amount claimed by the person for each service.

2. "Claim" means a request for payment submitted by a person for payment for a service or line item of service, including a submission of an encounter.

3. "Day" means calendar day unless otherwise specified.

4. "File" means the date that AHCCCS receives a written acceptance, request for compromise, request for a counter proposal, or a request for a State Fair Hearing as established by a date stamp on the written document or other record of receipt.

5. "Penalty" means a monetary amount, based on the number of items of service claimed or reported, that does not exceed $2,000 times the number of line items of service.

6. "Person" means an individual or entity as described under A.R.S. § 1-215.

7. "Reason to know" or "had reason to know" means that a person, acts in deliberate ignorance of the truth or falsity of, or with reckless disregard of the truth or falsity of information. No proof of specific intent to defraud is required.

Disclaimer: These regulations may not be the most recent version. Arizona may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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