The False Claims Act (FCA) exists to protect taxpayers and prevent fraud in government-funded programs like Medicare and Medicaid. Although these laws are strict, healthcare fraud continues across the country, including in Arizona. Fortunately, whistleblowers—individuals with firsthand knowledge of fraud—play a key role in exposing misconduct. If you suspect healthcare fraud in Arizona, speak with a healthcare whistleblower attorney to understand your rights and potential protections under federal and state law.
Arizona and Federal False Claims Laws
Fraudulent medical claims are addressed at both the federal and state level:
Federal Law
The United States False Claims Act (31 U.S.C. §§ 3729–3733) allows private citizens to bring a lawsuit on behalf of the government when they know about fraud involving federal funds. These lawsuits are called qui tam actions. If the case succeeds, the whistleblower may receive between 15 and 30 percent of the money recovered. Because these cases follow specific procedures, legal guidance is essential.
Arizona State Law
Arizona enforces the Arizona Health Care Cost Containment System (AHCCCS) Fraud statutes, particularly under Ariz. Rev. Stat. § 36-2918, which prohibits false claims in the state Medicaid program (AHCCCS). Arizona also enacted a version of the False Claims Act (Ariz. Rev. Stat. §§ 36-2918.01 to 36-2918.08) that applies specifically to Medicaid fraud.
Penalties include fines of up to $11,000 per false claim, plus treble damages. Arizona’s law does not include a formal qui tam provision for Medicaid-related claims, but whistleblowers can still pursue claims under the federal FCA for fraud involving federal Medicaid funds.
What Is “Qui Tam”?
The term “qui tam” comes from a Latin phrase meaning “he who sues on behalf of the king as well as for himself.” In today’s legal system, a qui tam action allows individuals to bring lawsuits on behalf of the government if they uncover fraud against public programs. These whistleblowers, known as relators, may receive a percentage of the funds recovered. However, to qualify for financial rewards and legal protections, relators must follow proper procedures and consult with a qualified attorney.
Recent Healthcare Fraud Cases in Arizona
United States v. Carondelet Health Network – In 2021, Carondelet Health Network, a hospital system based in Tucson, agreed to pay $5.7 million to resolve allegations that it submitted false inpatient rehabilitation claims to Medicare and Medicaid. The claims involved services that did not meet coverage criteria. The case was brought under the False Claims Act by a whistleblower, who received a portion of the settlement.
Arizona Oncologist Convicted of Billing Fraud – In 2023, a Mesa-based oncologist was sentenced for submitting hundreds of false claims for chemotherapy services that were never provided. The investigation revealed that some of the “patients” were deceased at the time the services were billed. The case involved both AHCCCS and Medicare funds, and the doctor was sentenced to federal prison and ordered to repay over $2 million.
Arizona Regions Where Healthcare Fraud Occurs
Fraud can occur anywhere in the state, but certain areas are more closely monitored due to population size, healthcare infrastructure, and program use:
Phoenix – Arizona’s largest metro area, home to large hospital networks and Medicare billing volume
Tucson – A healthcare hub with a strong presence of both public and private facilities
Mesa and Chandler – Suburban growth has brought increased oversight for AHCCCS and Medicare billing practices
Flagstaff – Rural and tribal healthcare centers in the region receive significant federal funding
Yuma – Cross-border care and public health programs require careful monitoring
What To Do If You Suspect Healthcare Fraud in Arizona
If you suspect someone is committing healthcare fraud in Arizona:
- Speak with a healthcare fraud attorney experienced in federal and state claims.
- Keep your suspicions confidential and avoid discussing them with coworkers or supervisors.
- Secure and document any evidence related to the fraud, such as billing records, emails, or reports.
- Understand your protections and rights under the federal FCA and Arizona Medicaid law.
Whistleblowers who act carefully and responsibly may be entitled to financial rewards and protection against retaliation.
Note: While this guide focuses on Arizona, the same legal protections and options apply to whistleblowers across the United States.