Arizona Administrative Code
Title 9 - HEALTH SERVICES
Chapter 22 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ADMINISTRATION
Article 11 - CIVIL MONETARY PENALTIES AND ASSESSMENTS
Section R9-22-1104 - Mitigating Circumstances

Universal Citation: AZ Admin Code R 9-22-1104

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

AHCCCS shall consider any of the following to be mitigating circumstances when determining the amount of penalties and assessments.

1. The following are mitigating circumstances:

a. All the services are of the same type,

b. All the dates of services occurred within six months or less,

c. The number of claims submitted is less than 25,

d. The nature and circumstances do not indicate a pattern of inappropriate claims for the services, and

e. The total amount claimed for the services is less than $1,000.

2. The degree of culpability of a person who presents or causes to present a claim is a mitigating circumstance, including but not limited to, if:

a. Each service is the result of an unintentional and unrecognized error in the process that the person followed in presenting or in causing to present the service,

b. Corrective steps were taken promptly by the person after the error was discovered, and

c. The person had a fraud and abuse control plan that was operating effectively at the time each claim was presented or caused to be presented.

3. The financial condition of a person who presents or causes to present a claim is a mitigating circumstance if the imposition of a penalty, assessment, or penalty and assessment without reduction will render the provider incapable to continue providing services. AHCCCS shall consider the resources available to the person when determining the amount of the penalty, assessment, or penalty and assessment.

4. AHCCCS shall take into account other circumstances of a mitigating nature, if in the interest of justice, the circumstances require a reduction of the penalty, assessment, or penalty and assessment.

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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