The magnitude of this healthcare scam is troubling. How could it go on for a period of time it did? It is apparent the state agency in charge of contracting did not follow up on these facilities for reasons unknown at this time. And i was easy to ignore due to the ethnicity of the people targeted.
The state contracts with private and non-profit managed care organizations (MCOs) who are the health insurance providers for Medicaid beneficiaries. The MCOs supposedly use market leverage to negotiate rates with their own network of providers. Instead of paying for each service rendered, as Fee for Service dictates, AHCCCS pays a monthly capitated rate to the MCOs. Not the most cost-effective or efficient way of delivering healthcare as coming from corporate entities. No state checks and balances of verification on the delivery of healthcare or the facilities. So, fraudulent business did what it does best, take the money and do reports if required.
The State failed to follow up on the placements for which they were paying. I did not include the entire article as I am sure you will get the picture.
Navajo officials start ‘Rainbow Bridge’ to offer help in rehab scam, azcentral.com, Arlyssa Becenti
Harland Cleveland, special operations coordinator for the Navajo Nation Police, along with officers from the Navajo Nation Police Department, arrived in Phoenix a week ago to help tribal members displaced by fraudulent rehab centers that have targeted the Native population. They would take them to these homes or centers.
Navajo Nation officials launched Operation Rainbow Bridge to help people who were caught up in the scams get home or find the services they need. Gov. Katie Hobbs announced last week the state would take action against over 100 fraudulent rehab centers that allegedly defrauded the state’s Medicaid program of hundreds of millions of dollars by preying on and scamming Indigenous people using the Arizona Health Care Cost Containment System.
Navajo authorities, along with Harland Cleveland, held a forum Wednesday evening to outline information about the operation and to update the public on what has been happening. Cleveland told the audience at the forum . . .
“We’ve made several contacts with people on the street. We are working with our local law enforcement partners. We are making contact with people who have been displaced from these treatment centers.”
With the launch of Operation Rainbow Bridge, Navajo Nation Attorney General Ethel Branch said people who are in need of assistance can call 2-1-1 and partners will drive to meet the callers. Afterward, people will be taken to a safe place, such as a hotel or to the Rainbow Bridge command center if they choose. If they want to go home, that will be arranged for them.
The vastness of the scam became more apparent last week when Arizona Attorney General Kris Mayes said Goodyear alone is suspected to have at least 119 sober living homes in the city. She also said the scam may have begun in Nevada and spread to Arizona.
The number of victims is not known, but the facilities with allegations against them have billed between 7,000 and 8,000 names, either names of real people or names from a list, scammers bought, AG Mayes adds . . .
“It became like a franchise industry. Where people began to understand that it was like a pot of gold at AHCCCS that was not being supervised.”
Steven Duplissis, from Mayes’ office, said they have indicted 45 individuals and have seized over $70 million.
As Cleveland was out in the field this week looking for those who have found themselves displaced by the fraudulent centers, he said there were many who come from various tribal communities, such as Hopi, White Mountain Apache and the Gila River Indian Community. He said they had made contact with about 300 people. Cleveland:
“It’s one of those situations where you have to watch your surroundings. You’ll come across people who are on some type of drug, intoxicated, the biggest concern is Fentanyl. It’s so high up here, so we make sure to carry Narcan in the event one of us gets exposed.”
Authorities warn, ‘beware the white van’
State Sen. Theresa Hatathlie, D-Coal Mine Canyon, said she had always heard of the white vans or non-medical transport traveling into communities on Navajo land and talk with unsuspecting individuals, especially during the height of the COVID pandemic.
As State Senator Hatathlie details, the monitoring of private enterprise is lax.
“These issues have been raised to our local leaders and it continues. I was appointed to my current position more than a year ago, and I started working with the previous administration. But many of those complaints fell on deaf ears in the name of capitalism. Going forward we are going to address it on a larger scale so something like this won’t happen again.”
Local tribal officials had taken it upon themselves to warn their members to be wary of individuals who were trying to “recruit” them. The warning would usually go out through posts on social media. In December, the Pascua Yaqui Police Department posted a public awareness alert on the issue, stating they had become aware of the recruiters associated with off-reservation behavioral health treatment facilities in Phoenix and other metropolitan areas.
“The tribe has also received reports of the same or similar individuals offering tribal members gift cards, cell phones, cash payments or other incentives to refer family or friends to these same facilities,” the post said. “Tribal members who do accompany these recruiters to the Phoenix metropolitan area are often left stranded with no means of returning home and/or are unable to contact family members regarding their whereabouts.”
Gila River Health Care posted a scam warning in December to patients warning them to be vigilant for recruiters from possible fraudulent behavioral health services. The warning said the Gila River Indian Community and other tribes had become aware at that time of recruiters, associated with off-reservation behavioral health residential facilities, soliciting individuals.
The state of Arizona and local authorities are waking up to the issues with Rehab Scamming.
The balance of the story can be read here: Rehab Scam, AZ Central News.