1 hour ago
4
Florida's sweeping Medicaid fraud crackdown has helped drive a nearly $1 billion reduction in projected annual spending on behavioral therapy services alone, according to state officials, after investigators uncovered suspicious billing practices.
Tallahassee’s internal crackdown — which included discoveries of providers billing Medicaid for more hours than there are in a day — comes amid heightened federal scrutiny of Medicaid fraud, including investigations and payment reviews involving Minnesota.
The DeSantis administration said its approach aims to stop suspicious Medicaid claims before taxpayer dollars are paid out rather than trying to recover improper payments afterward. The strategy mirrors a call from HHS Secretary Robert F. Kennedy Jr. to move away from traditional "pay-and-chase" models.
"This year, we announced the most significant Medicaid integrity initiative in the history of our state, and today, I was proud to announce some of the results from these efforts," Gov. Ron DeSantis said in a news release.
VANCE TURNS UP HEAT ON STATES WITH FEDERAL CASH THREAT OVER MEDICAID FRAUD CRACKDOWN
More than 220 Medicaid providers have been terminated for fraud, waste or abuse, while more than 260 have faced payment restrictions or suspensions. The state has also referred more than 150 suspected fraud cases to the attorney general's office over the past year.
Annual Medicaid spending on Applied Behavior Analysis (ABA), a therapy commonly used for children with autism, had been projected to reach $3.86 billion but is now expected to total $2.88 billion in fiscal year 2026-27, according to the governor's office. Officials attributed the nearly $980 million reduction to a combination of fraud enforcement, managed care and utilization management efforts.
Florida's Agency for Health Care Administration (AHCA) told Fox News Digital that its expanded monitoring uncovered providers billing Medicaid for services through every weekend and holiday for months, including instances in which providers billed for more than 24 hours of services in a single day.
"Protecting Medicaid means protecting the people it was created to serve," AHCA Secretary Shevaun Harris said in a statement.
"For children, pregnant women, the disabled, and our seniors, it means making sure they have access to high-quality care while ensuring taxpayer dollars are not lost to fraud or abuse. AHCA will continue taking decisive action to strengthen program integrity, hold bad actors accountable and safeguard these critical services for Floridians," she said.
Harris’ agency provided additional details on its crackdown to Fox News Digital, including how its new fraud-protection mechanisms work.
SIGN UP TO GET THE POLITICS NEWSLETTER
Through a pilot program with identity-verification firm SentiLink, Florida is screening for stolen or fake identities and hidden ownership structures among Medicaid providers. Separately, the state has imposed enrollment moratoriums on certain high-risk provider categories.
AHCA also told Fox News Digital that it has issued more than 1,000 adverse decisions involving Medicaid provider enrollment or re-enrollment since January 2026, part of its effort to prevent suspicious providers from entering or remaining in the program.
The agency has conducted 400 site visits to providers since January, including providers in high-risk categories such as applied behavior analysis, medical equipment and adult day care.
"Medicaid fraud is a national problem, and it is growing more sophisticated everywhere," AHCA told Fox News Digital.
"Florida is not waiting to be told what to do. We are building the model: prevent fraud at the front door, verify every provider, and follow the data. We welcome partnership with CMS and other states, because a fraudulent provider stopped in Florida is a scheme that does not move on to the next state."
English (US) ·