Medicaid Integrity Initiative results are in

Gov. Ron DeSantis speaking in West Palm Beach, Tuesday. -Courtesy Photo

Florida’s efforts are already producing significant results

Staff

Tuesday, in West Palm Beach, Governor Ron DeSantis announced results from Florida’s enhanced Medicaid program integrity efforts to combat fraud, waste and abuse, protect taxpayer dollars, and ensure Medicaid resources are directed toward legitimate health care services for eligible Floridians.

“Florida’s Agency for Health Care Administration’s Medicaid integrity initiative is delivering results,” said Governor DeSantis. “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.”

Florida’s efforts are already producing significant results:

•Nearly $1 billion less in projected annual ABA expenditures. Medicaid spending on ABA services had been projected to reach $3.86 billion. Following Florida’s transition of ABA services into managed care, utilization management efforts, and AHCA’s efforts to combat fraud, waste and abuse, annual ABA expenditures are now projected at $2.88 billion in Fiscal Year 2026-27. Florida also established the Applied Behavior Analysis Task Force earlier this year to strengthen accountability within the program.

•More than 150 referrals to the Attorney General’s Office over the last year based on allegations of fraud.
•More than 260 providers placed on payment restrictions or suspended from receiving payments.
•More than 220 providers terminated from Florida Medicaid for fraud, waste or abuse, accounting for more than $230 million in Medicaid billing in 2025.

The AHCA enhanced oversight has also identified troubling billing practices. Providers have billed Medicaid for excessive hours of service, including months of consecutive days of service through weekends and holidays. In some instances, providers billed Medicaid for more than 24 hours of services in a single day.

Florida will continue using enhanced data analytics, provider screening, site visits, claims monitoring, and other program integrity tools to identify suspicious activity and bad actors. AHCA will continue taking action when appropriate, including payment restrictions, suspensions, terminations, and referrals for investigation. These efforts are focused on bad actors who exploit the Medicaid program, not legitimate providers delivering necessary care to Floridians.

In June, Governor DeSantis announced the most significant Medicaid integrity initiative in Florida history, shifting the state away from a “pay-and-chase” model toward preventing fraud before taxpayer dollars are spent. The Agency for Health Care Administration (AHCA) strengthened provider screening and oversight, expanded data analytics and claims monitoring, imposed enrollment moratoriums on certain high-risk provider categories, and launched a statewide revalidation effort for active Medicaid providers.

As part of the initiative announced in June, AHCA:
•Launched a pilot program with SentiLink to strengthen provider screening and identify stolen identities, fake identities, hidden ownership structures, and other suspicious activity among new and existing providers;
•Strengthened oversight of high-risk Medicaid providers, including enrollment moratoriums on certain high-risk provider categories;

Launched a statewide revalidation effort requiring active Medicaid providers to verify their credentials and identity; and
•Expanded the use of data analytics, claims monitoring, background screening, and other tools to identify bad actors and potentially fraudulent billing practices.