Quarles Law Firm: Providing Expert Legal Counsel

In Arizona, one of the largest behavioral health fraud schemes in the United States was recently uncovered. Kirti Reddy, a partner at Quarles & Brady and co-chair of the firm’s Government Enforcement Defense and Investigations team, wrote an article for the American Health Law Association discussing the fraudulent scheme that targeted homeless individuals and Native Americans for false substance use treatment.

Reddy shed light on two primary categories of fraud that were uncovered: fraudulent billings by behavioral health treatment providers and patient brokering. The treatment providers were found to be billing for services that were not provided or necessary to the Arizona Health Care Cost Containment System (AHCCCS). Patient brokering, which involves referring patients to addiction treatment providers in exchange for payment, was also a major component of the fraud.

The perpetrators of the scheme reportedly bribed victims by offering housing in unlicensed “sober living” homes, enrolled non-Native Americans in Arizona’s American Indian Health Program, and sent them to behavioral health treatment centers for billing purposes rather than proper treatment. This exploitation of vulnerable individuals is both disheartening and concerning, and the uncovering of this scheme highlights the need for increased oversight and accountability in the behavioral health industry.

By Editor

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