Section R9-22-1104. Mitigating Circumstances

AHCCCS shall consider any of the following to be mitigating cir- cumstances when determining the amount of a penalty, assessment, or penalty and assessment.

1.        Nature and circumstances of a claim. 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 pat- tern of inappropriate claims for the services, and

e.         The total amount claimed for the services is less than

$1,000.

2.        Degree of culpability. The degree of culpability of a per- son who presents or causes to present a claim is a mitigat- ing circumstance if:

a.         Each service is the result of an unintentional and unrecognized error in the process that the person fol- lowed in presenting or in causing to present the ser- vice,

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.        Financial condition. 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.        Other matters as justice may require. 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.

Historical Note

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 Section repealed; new Section made by final rulemaking at 10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, effec-

tive February 4, 2012 (Supp. 11-4).