Fraud, Waste & Abuse

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Banner – University Family Care/ALTCS (B – UFC/ALTCS) is committed to preventing Fraud, Waste, and Abuse (FWA). If you suspect a B – UFC/ALTCS provider or member of fraud, waste, or abuse - please contact B – UFC/ALTCS.

What is Fraud, Waste, & Abuse?

Fraud is purposely giving wrong or misleading information in order to get a benefit or some type of service. Waste is overusing services or misusing resources or practices. Abuse is provider practices or member practices that result in an unnecessary cost to the AHCCCS program. Unfortunately, Fraud, Waste, and Abuse are not as uncommon as you would think. Please see some of the most common examples.

Examples of Fraud, Waste, and Abuse

Member Fraud, Waste, and Abuse include, but are not limited to:

  • Lending or selling your AHCCCS ID Card to anyone.
  • Using someone else's AHCCCS ID Card to obtain services.
  • Changing prescriptions written by any B – UFC/ALTCS provider.
  • Not stating true income or living arrangements.
  • Providing false materials or documents.
  • Leaving out important information.
  • Failing to report another insurance that you have.
  • Continuing to use AHCCCS for services when you move out of the state or out of the country.

Provider Fraud, Waste, and Abuse include, but are not limited to:

  • Ordering tests, lab work, or x-rays that aren't needed.
  • Charging for medical services not provided.
  • Billing multiple payers and receiving double payments.
  • Using billing codes that pay higher rates to get more money even though those services weren't provided.
  • Billing for services under a member who is not their member.
  • Providing unnecessary medical services leading to unnecessary costs to the program.
  • Use of the Medicaid system by someone who is unqualified, unlicensed, or has lost their license.

NOT REPORTING HOUSEHOLD CHANGES TO AHCCCS COULD BE CONSIDERED FRAUD.

How Do I Report Changes?

If you need to report a change of where you live, mailing address, your income, number of household members, or change of job, contact the place where you applied for AHCCCS, see list below or call B – UFC/ALTCS Customer Care Center.

Penalties

A person who is suspected of fraud and/or abuse of the AHCCCS system will be reported to AHCCCS. Penalties for people involved in fraud and/or abuse may be both civil and criminal. 

How to Report Fraud, Waste, and Abuse:

Anyone can report fraud - there are no restrictions. Fraud, Waste, and Abuse hurts everyone. If you suspect a possible case, please report it right away. If you suspect a B – UFC/ALTCS provider or member of fraud, waste or abuse, please contact B – UFC/ALTCS at any of the following:

Phone

  • Customer Care Center
  • Confidential and Anonymous Compliance (ComplyLine) Hotline:
    (888) 747-7989 (24 hours a day / 7 days a week)
  • Compliance Officer:
    (520) 548-7862

Mail

  • Banner – University Family Care/ALTCS
    Compliance Department
    5255 E Williams Circle, Ste 2050,
    Tucson, AZ 85711

Fax

  • Compliance Department:
    (520) 874-7072

Email

You can also report directly to AHCCCS, Office of the Inspector General at:

Provider Fraud: (602) 417-4045 or (888) 487-6686
Member Fraud: (602) 417-4193 or (888) 487-6686
www.azahcccs.gov
Mail: Inspector General
801 E. Jefferson Street MD 4500
Phoenix, AZ 85034