Provider Suspensions and Terminations
AHCCCS performs terminations in accordance with A.R.S. § 36-2930.05 and the terms of the Provider Participation Agreement each provider must sign to register with AHCCCS. AHCCCS may terminate 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, along with instructions for response. 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. The below list only includes terminations AHCCCS is required to report to CMS, following the conclusion of a CAF investigation.
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 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. AHCCCS will remove the Notice of Termination or CAF Suspension from the below list if it is lifted or rescinded.
The document below provides a list of active suspensions of providers starting with FFY 2020 to the present.
Provider Terminations & Active Suspensions (Updated 6/1/2023)