Florida Medicaid Crackdown Cuts Projected Spending by Nearly $1 Billion
State officials attribute the reduction to efforts curbing fraudulent billing practices, including providers billing for impossible hours.
Florida's aggressive crackdown on Medicaid fraud has resulted in a projected decrease of nearly $1 billion in annual spending on behavioral therapy services. State officials announced the significant reduction, attributing it to investigations that uncovered suspicious billing practices, such as providers allegedly billing for more hours than exist in a day.
The strategy, implemented by the DeSantis administration, focuses on preventing fraudulent claims before taxpayer money is disbursed, a departure from traditional "pay-and-chase" recovery models. This approach aligns with federal calls to enhance program integrity.
"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," Governor Ron DeSantis stated in a press release. The state's efforts have led to the termination of over 220 Medicaid providers for fraud, waste, or abuse. Additionally, more than 260 providers have faced payment restrictions or suspensions, and over 150 suspected fraud cases have been referred to the attorney general's office.
Specifically, projected annual spending on Applied Behavior Analysis (ABA), a therapy often used for children with autism, has been reduced from an estimated $3.86 billion to $2.88 billion for fiscal year 2026-27. The Florida Agency for Health Care Administration (AHCA) reported that new monitoring mechanisms have uncovered instances of providers billing for services seven days a week, including billing for over 24 hours within a single day. The agency has also utilized a pilot program with identity-verification firm SentiLink to screen for stolen or fake identities and hidden ownership structures among providers.
AHCA Secretary Shevaun Harris emphasized the importance of protecting the integrity of the Medicaid program to ensure access to high-quality care for recipients, including children, pregnant women, the disabled, and seniors, while safeguarding public funds. The agency has also imposed enrollment moratoriums on certain high-risk provider categories and conducted numerous site visits to providers in sectors like ABA, medical equipment, and adult day care.
Florida officials noted that Medicaid fraud is a national challenge and stated that the state is actively developing a model to prevent fraud at the outset, verify all providers, and follow data-driven insights. They expressed a willingness to partner with federal agencies and other states to combat fraudulent schemes.