The Arizona Problem
Starting in 2022, dozens of new providers appeared in Arizona and immediately began billing Medicaid for millions of dollars. Many operated for less than a year before disappearing from the data. The concentration in Phoenix and its suburbs is striking.
46
New AZ providers
$913.1M
Total spending
14
Avg months active
30
Active ≤12 months
Something unusual happened in Arizona starting in early 2022. Dozens of new providers — many with no prior Medicaid billing history — registered NPIs and began submitting claims. Within months, some were billing at rates that would put them among the top providers in the entire country.
The top biller: $62M in 11 months
The highest-billing new entrant in Arizona billed $62.3M in just 11 months — averaging $5.7M/month. Their first billing month was 2022-09, and by 2023-07 they had served 14K beneficiaries with 97K claims.
The geographic concentration is remarkable. 20 of 46 providers are based in Phoenix alone. Add Mesa (8), Scottsdale, Tempe, and other Maricopa County suburbs and the vast majority are clustered in the greater Phoenix metro area. This pattern is consistent with what fraud investigators call "geographic clustering" — where fraudulent operators set up multiple entities in the same region.
Short lifespans, big billing
30 of 46 providers were active for 12 months or less. One provider billed $14.3M in just 4 months. Another billed $48.3M in 6 months. Legitimate healthcare providers typically take years to build patient volume to these levels.
Arizona's behavioral health system has faced scrutiny before. The state expanded Medicaid under the ACA and later expanded access to behavioral health services, creating opportunities for both legitimate providers and bad actors. The pattern here — new NPIs, rapid billing ramp-up, short operational lifespans, and geographic clustering — matches profiles seen in previous Medicaid fraud cases in other states.
Context: Not all are necessarily fraudulent
Some of these providers may be legitimate clinics that expanded rapidly to meet demand, rebranded from existing practices, or took over contracts from other providers. However, the combination of new registration, immediate high-volume billing, and short operational periods warrants investigation. Several of these providers bill for only 1-3 procedure codes, suggesting narrow service models.
Top 20 Arizona New Entrants
SCOTTSDALE, AZ · First billed: 2022-02
$42.9M
35 months active
All 46 Arizona New Entrants (2022+)
Key Takeaways
- ▸46 new Arizona providers that first appeared in 2022 or later have billed a combined $913.1M.
- ▸The average time active is just 14 months. 30 providers were active for 12 months or less.
- ▸Phoenix (20), Mesa (8), and Scottsdale account for the majority — a classic geographic clustering pattern.
- ▸The top biller earned $62.3M in just 11 months — averaging $5.7M/month.
Source: HHS Medicaid Provider Spending Data (2018–2024) · 227M records