Florida implements new safeguards to fight Medicaid fraud

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Florida is implementing new safeguards to prevent Medicaid fraud, Gov. Ron DeSantis announced Friday.

The Medicaid integrity initiative includes stronger oversight with provider screenings, enrollment moratoriums and tools to identify potentially fraudulent billing.

“Today, we announced major actions to strengthen the integrity of Florida’s Medicaid program and crack down on fraud,” said DeSantis. “In Florida, we work to ensure that taxpayer dollars are spent responsibly and that public programs serve the people they are intended to serve.”

As part of the initiative, the Florida Agency for Health Care Administration, or AHCA,  is launching a program to improve provider screening and detect fraud schemes like stolen identities and hidden ownership structures. Enrollment moratoriums will be imposed on some high-risk provider categories like durable medical equipment suppliers and adult day care providers.

Additionally, all Florida Medicaid providers will be required to revalidate their credentials. Those who don’t comply will be removed from the program.

“The Medicaid program exists to meet the health care needs of pregnant women, children, seniors, and some of our most vulnerable populations,” said Florida Agency for Health Care Administration Secretary Shevaun Harris. “Every dollar stolen through fraudulent schemes is one less dollar available to meet the needs of those who rely on the program most. That’s why we are working harder than ever to make sure the right people get the care they need, and everyone trying to exploit this program will be stopped.”

The agency is also deploying new tools to help identify fraudulent billing practices and work with law enforcement.

Combatting Medicaid fraud has become a growing priority as the Trump Administration has called for stronger oversight. The agency recovered over $61 million in overpayments, fines, costs, and claim reversals last year and identified more than $42 million in overpayments, according to a report on Florida’s efforts to control Medicaid fraud and abuse.

The Attorney General’s Medicaid Fraud Control Unit, or MFCU, received over 3,600 complaints during fiscal year 2024-2025 related to fraud and patient abuse. Of nearly 400 cases MFCU closed during that period, there were 50 referrals for prosecution, 49 arrest warrants, and 31 convictions. It also removed 146 providers for fraud or abuse and prevented more than 1,400 providers from enrolling or re-enrolling in Medicaid due to prior terminations or concerns.

Earlier this year, the Office of the Attorney General announced arrests related to a Medicaid scheme where two people fraudulently billed the program for more than $65,000 in medical services that were never provided.