MedicaidAdministrativeHigh impact
Changes to AHCCCS Provider Enrollment and Billing System Close Ability for Fraudulent Behavioral Health Claims Payments
Arizona Medicaid - AHCCCS·AZ · Psychiatry·Claims & Billing
We identified it
Jun 17, 2026
Summary
AHCCCS has suspended payments to over 100 Medicaid providers due to fraudulent billing practices in behavioral health services, including billing for excessive hours, services not provided, and ghost billing. The agency has implemented new system-wide controls including elevated risk categories for behavioral health providers, new reporting flags, billing thresholds, and prepayment reviews to prevent future fraud.
Action Required
Immediately: Behavioral health providers must review billing practices to ensure compliance with new AHCCCS fraud prevention measures. Verify all behavioral health claims for accuracy including proper documentation of services provided, appropriate hours billed per day, and patient presence verification. Update billing procedures to comply with new per diem billing restrictions requiring daily separate billing rather than date ranges. Implement internal controls to prevent billing violations that could trigger payment suspensions.