Ariz. Admin. Code § 9-22-1104

Current through Register Vol. 30, No. 50, December 13, 2024

Section R9-22-1104 - Mitigating Circumstances

AHCCCS shall consider any of the following to be mitigating circumstances when determining the amount of penalties and assessments.

1. The following are mitigating circumstances:

a. All the services are of the same type,

b. All the dates of services occurred within six months or less,

c. The number of claims submitted is less than 25,

d. The nature and circumstances do not indicate a pattern of inappropriate claims for the services, and

e. The total amount claimed for the services is less than $1,000.

2. The degree of culpability of a person who presents or causes to present a claim is a mitigating circumstance, including but not limited to, if:

a. Each service is the result of an unintentional and unrecognized error in the process that the person followed in presenting or in causing to present the service,

b. Corrective steps were taken promptly by the person after the error was discovered, and

c. The person had a fraud and abuse control plan that was operating effectively at the time each claim was presented or caused to be presented.

3. The financial condition of a person who presents or causes to present a claim is a mitigating circumstance if the imposition of a penalty, assessment, or penalty and assessment without reduction will render the provider incapable to continue providing services. AHCCCS shall consider the resources available to the person when determining the amount of the penalty, assessment, or penalty and assessment.

4. AHCCCS shall take into account other circumstances of a mitigating nature, if in the interest of justice, the circumstances require a reduction of the penalty, assessment, or penalty and assessment.

Ariz. Admin. Code § R9-22-1104

Adopted effective October 1, 1986 (Supp. 86-5). Amended effective June 9, 1998 (Supp. 98-2). Section repealed; new Section made by final rulemaking at 10 A.A.R. 3056, effective September 11, 2004 (Supp. 04-3). Amended by final rulemaking at 17 A.A.R. 2615, effective February 4, 2012 (Supp. 11-4). Amended by final rulemaking at 30 A.A.R. 925, effective 4/25/2024.