Arizona Laws 36-2918.01. Duty to report fraud or abuse; immunity
A. All contractors, subcontracted providers of care and noncontracting providers shall notify the director or the director’s designee immediately in a written report of any cases of suspected fraud or abuse. The director shall review the report and conduct a preliminary investigation to determine if there is sufficient basis to warrant a full investigation. If the findings of a preliminary investigation give the director reason to believe that an incident of fraud or abuse has occurred, the matter shall be referred to the attorney general.
Terms Used In Arizona Laws 36-2918.01
- Action: includes any matter or proceeding in a court, civil or criminal. See Arizona Laws 1-215
- Complaint: A written statement by the plaintiff stating the wrongs allegedly committed by the defendant.
- Contractor: means a person or entity that has a prepaid capitated contract with the administration pursuant to section 36-2904 or chapter 34 of this title to provide health care to members under this article or persons under chapter 34 of this title either directly or through subcontracts with providers. See Arizona Laws 36-2901
- Department: means the department of economic security. See Arizona Laws 36-2901
- Director: means the director of the Arizona health care cost containment system administration. See Arizona Laws 36-2901
- Fraud: Intentional deception resulting in injury to another.
- Noncontracting provider: means a person who provides health care to members pursuant to this article but not pursuant to a subcontract with a contractor. See Arizona Laws 36-2901
- Person: includes a corporation, company, partnership, firm, association or society, as well as a natural person. See Arizona Laws 1-215
B. Any person making a complaint or furnishing a report, information or records in good faith pursuant to this section is immune from any civil liability by reason of that action unless that person has been charged with or is suspected of the fraud or abuse reported.
C. Any contractor, subcontracted provider of care or noncontracting provider who fails to report pursuant to this section commits an act of unprofessional conduct and is subject to disciplinary action by the appropriate professional regulatory board or department.