About Provider Suspensions and Terminations
AHCCCS terminates providers from the Medicaid program in accordance with A.R.S. § 36-2930.05 and the terms of the Provider Participation Agreement that each provider must sign when they register with AHCCCS. AHCCCS may terminate a provider for a variety of reasons including, but not limited to, lack of licensure, quality of care concerns, and lack of disclosure of certain information or persons. Providers are informed of the reason for their termination in a Notice of Termination letter, along with instructions for response and their due process rights. Under 42 CFR § 455.416, AHCCCS is required to report terminations for reasons that may include, but are not limited to, fraud, integrity, or quality. Use the Provider Listings search tool to determine whether a provider is an active AHCCCS provider. This search engine pulls information from the AHCCCS database. Terminated providers will not be included in the search results.
Under 42 C.F.R. § 455.23 and the terms of the Provider Participation Agreement, AHCCCS may suspend payments to a provider if a Credible Allegation of Fraud (CAF) has been identified. Providers are informed of the reason for their suspension in a Notice of CAF Suspension. CAF suspensions are based on preliminary findings of reliable indicia of fraud and may be lifted if AHCCCS determines there is no fraud occurring and/or good cause has been established under 42 C.F.R. § 455.23. Upon the conclusion of an investigation, AHCCCS may terminate a provider and/or lift their suspension at that time.
Providers have due process rights, beginning with the right to a state fair hearing, in order to appeal either their termination or suspension, and those rights are laid out in the notice that is sent to the provider when AHCCCS takes these actions and outlined in this Provider Due Process flier. When a suspension is lifted or rescinded, AHCCCS will remove the provider's name from the suspension list.
The document below provides a list of active suspensions of providers starting with FFY 2020 to the present.
Current Provider Suspensions (Updated 2/7/2024)