Current through Register Vol. 48, No. 14, April 8, 2022
This Article applies to prohibited acts as described under A.R.S. §
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
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. §
This Article includes the process and time-frames used by a person to request a
State Fair Hearing.
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
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
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. §
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.
Ariz. Admin. Code §
October 1, 1986 (Supp. 86-5). Amended subsection A. effective May 30, 1989
(Supp. 89-2). Amended effective September 29, 1992 (Supp. 92-3). Amended
effective June 9, 1998 (Supp. 98-2). Amended by final rulemaking at 10 A.A.R.
3056, effective September 11, 2004 (Supp. 04-3). Amended by final rulemaking at
17 A.A.R. 2615, effective February 4, 2012 (Supp.