Fla. Medicaid integrity initiative shifts toward prevention

WEST PALM BEACH, Fla. – Florida Gov. Ron DeSantis said the state’s enhanced Medicaid program integrity efforts to combat fraud, waste and abuse are “delivering results.”

In June, 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.

“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.”

Since January, AHCA has conducted more than 400 provider site visits as part of its heightened program integrity efforts, with particular attention to areas where data and billing patterns have identified heightened risk, including applied behavior analysis (ABA), durable medical equipment (DME) and adult day care.

The state says its efforts are already producing 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.

AHCA’s enhanced oversight has also identified troubling billing practices. The state says 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.