In 2022, state officials in Florida closed over 1,300 Medicaid fraud cases, as reported by the Florida Legislature’s research arm.
In late January, the Office of Program Policy Analysis and Government Accountability conducted its biennial assessment of the Agency for Health Care Administration’s supervision of fraud and abuse in Florida’s Medicaid Program.
The agency offers healthcare services to low-income families and individuals, providing assistance to those with disabilities and the elderly in covering nursing facility costs and long-term expenses.
The Office of Medicaid Program Integrity, as highlighted by OPPAGA in its report, is tasked with the responsibility of monitoring fraud and abuse within the program. It works in collaboration with state and federal entities to effectively detect, prevent, and deter instances of fraud.
The agency took action on 1,397 cases of fraud and abuse during fiscal year 2021-22. Among these cases, 48.8% were determined to be overpayments made to providers, with the fee-for-service program being the most impacted. The total amount of overpayments identified in these cases amounted to $22.5 million. Additionally, the agency received and addressed over 13,000 complaints related to abuse and fraud.
In fiscal year 2023-24, the Medicaid program operations received an appropriation of $41 billion from the Legislature.
In terms of total expenditures, Medicaid Managed Care accounts contributed to 65% of the statewide Medicaid budget, while the fee-for-service program accounted for the remaining 35% of expenses.
Medicaid enrollment in the Sunshine State experienced significant growth following the COVID-19 pandemic, primarily due to federal legislation. From March 2020 to April 2023, the total number of individuals enrolled in Medicaid expanded by a staggering 54%, soaring from 3.8 million to 5.8 million.
In April 2023, when new legislation ended the changes and federal funding decreased, Florida took the initiative to start the redetermination process. By October, the agency reported that Florida had one of the lowest termination of coverage rates among states, ranking ninth.
According to the report, the program is currently assisting around 4.4 million individuals on a monthly basis since October. Furthermore, the state Department of Children and Families plans to review and reassess the cases of approximately 4.6 million recipients within a 12-month timeframe, concluding in March 2023.
In August, the cases of 2.2 million enrollees were reviewed and reevaluated. Out of these, 67% or 1.5 million recipients were found to be eligible for continued enrollment, while 32% or 746,000 recipients were deemed ineligible and subsequently disenrolled. Among those who were disenrolled, 55% were removed due to procedural issues, while 45% had their enrollment terminated due to eligibility concerns.
According to a report by the U.S. Department of Health and Human Services Office of the Inspector General in February 2023, Medicaid payments totaling $6.9 million were made to recipients who were enrolled in Florida but living in another state.
Read More:
- Attorneys general from Wyoming, Alaska, and Ohio demand a test of presidential immunity
- Audit in California reveals state is in financial crisis with $55 billion more debt than available funds