Florida launches Medicaid fraud crack down initiative

WEST PALM BEACH, Fla. – Florida Gov. Ron DeSantis has announced a Medicaid integrity initiative that includes enhanced provider screening, advanced fraud detection technology, enrollment controls for high-risk provider categories, and a statewide revalidation of all active Medicaid providers.

“In Florida, we work to ensure that taxpayer dollars are spent responsibly and that public programs serve the people they are intended to serve,” he said.

The Trump Administration and the Centers for Medicare & Medicaid Services (CMS) have called on states to increase oversight, strengthen provider screening, and remove fraudulent actors from Medicaid programs.

As part of Florida’s Medicaid integrity initiative, the Agency for Health Care Administration (AHCA) will:

• Launch a pilot program with SentiLink: AHCA will partner with SentiLink to strengthen provider screening and detect sophisticated fraud schemes, including stolen identities, synthetic identities and hidden ownership structures before taxpayer dollars are lost.
• Implement enrollment moratoriums for high-risk provider categories: AHCA has imposed enrollment moratoriums on certain high-risk provider categories, including durable medical equipment suppliers and adult day care providers, while the agency strengthens screening procedures and oversight.
• Conduct a comprehensive statewide provider revalidation effort: All active Florida Medicaid providers will be required to revalidate their credentials and identities. Providers who fail to comply or do not meet program requirements will be removed from the Medicaid program.
• Enhance claims monitoring and enforcement efforts: AHCA will deploy additional tools to identify potentially fraudulent billing practices and work with state partners to support investigations, enforcement actions, and victim protection efforts.

DeSantis says the initiative represents one of the most significant anti-fraud efforts undertaken by the state and reflects its continued commitment to protecting taxpayers while ensuring Medicaid resources are available for those who legitimately need them.

• Related: Ohio Gov. DeWire signs executive order aimed at Medicaid fraud.