News

Jun 01, 2023

Medical biller for accused AHCCCS fraud companies speaks

Next up in 5 Example video title will go here for this video PHOENIX — The vice president of a medical billing company linked to 10 companies suspected of AHCCCS fraud by the State of Arizona said he

Next up in 5

Example video title will go here for this video

PHOENIX — The vice president of a medical billing company linked to 10 companies suspected of AHCCCS fraud by the State of Arizona said he has no idea what his clients do or don't do.

Mark Stanley is vice president of medical billing company ProMD Solutions.

Stanley said ProMD Solutions also helps set up medical businesses.

According to documents from Arizona Corporation Commission, ProMD Solutions has been the statutory agent for 10 businesses now accused of defrauding AHCCCS and the State of Arizona.

RELATED: Who are the providers suspended for alleged AHCCCS fraud?

Stanley told 12News he only helps people set up the businesses by helping them file paperwork and get approval as vendors.

“My responsibility was to just get their business approved, being an agent, and that's all I did," Stanley said over Zoom.

ProMD Solutions website shows an address in California, the Arizona address listed with the Corporation Commission is in Sedona, and Stanley told 12News the company is based in Fairfax, Virginia.

But in addition to helping people set up businesses, ProMD is also a medical billing company.

Stanley said his clients mark down the services they provide, and ProMD submits those bills to AHCCCS.

“I'll make it very simple," he said, "I'm just a copy paste machine. I'm going to copy it from there, paste it into the other software and just bill for the services.”

Stanley said it is not possible for him to see how his clients arrive at the amounts they bill patients.

Medical billing works based on codes. Each code is a specific service performed. AHCCCS has rules regarding how often a code can be used for a specific patient, either per day, week or month.

"I'll be very honest to say none of my clients have ever billed for more than AHCCCS guidelines," Stanley said.

However that is exactly what the Arizona Attorney General has accused those businesses of doing.

RELATED: AHCCCS providers accused of billing for dead patients, double billing and more

According to the Credible Allegation of Fraud (CAF) letters sent to at least 108 businesses, 10 of which used ProMD as a statutory agent, officials are accusing them of overbilling, billing for patients who are dead, billing for more hours than there are in a day, even billing all of the patients for the exact same services.

One of ProMD's clients, the owner of Focused Family Services, told 12News she looked at the billing she sent to ProMD to be submitted to the state and found no errors in it.

Stanley said they're working it out with her, but he has no way of checking to see if the billing is accurate, or if the patient is even alive.

Catch up on the latest news and stories on the 12News YouTube channel. Subscribe today.