Governor Ron DeSantis Announces Results of Florida's Medicaid Integrity Initiative

~ Florida's Agency for Health Care Administration has conducted more than 400 provider site visits since January as part of an expanded effort to detect fraud, waste and abuse in the state's Medicaid program, Gov. Ron DeSantis said.

The visits have focused in part on provider categories flagged as higher risk through data and billing patterns, including Applied Behavior Analysis, durable medical equipment and adult day care, according to the agency.

The state projects annual Medicaid spending on Applied Behavior Analysis services will be $2.88 billion in fiscal year 2026-27, down from a previous projection of $3.86 billion, the announcement said. The state attributed the change to moving the services into managed care, utilization management and efforts to address fraud, waste and abuse. Florida also established an Applied Behavior Analysis Task Force earlier this year.

Over the past year, the agency has referred more than 150 cases to the Attorney General's Office based on allegations of fraud, the announcement said. More than 260 providers have been placed under payment restrictions or suspended from receiving payments, while more than 220 have been terminated from Medicaid for fraud, waste or abuse. Those terminated providers accounted for more than $230 million in Medicaid billing in 2025, according to the state.

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The agency said its oversight has identified providers billing for excessive service hours, including services on consecutive days through weekends and holidays. In some cases, providers billed for more than 24 hours of services in a single day, the announcement said.

In June, DeSantis announced what the state described as its most significant Medicaid integrity initiative. The effort aims to shift from a "pay-and-chase" approach toward preventing improper payments, through stronger provider screening, expanded data analysis and claims monitoring, enrollment moratoriums for certain high-risk provider categories, and a statewide revalidation of active providers.

The agency has also launched a pilot with SentiLink to help identify stolen or fake identities, concealed ownership structures and other suspicious activity among new and existing providers.

"Protecting Medicaid means protecting the people it was created to serve," Agency for Health Care Administration Secretary Shevaun L. Harris said, adding that the agency would continue to pursue action against providers when appropriate while seeking to preserve access to care.

The state said its enforcement measures are aimed at bad actors, not legitimate providers delivering necessary services.

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