Florida Medicaid Agency Lax in Punishing and Deterring Fraud, Report Finds
The agency that runs Florida's Medicaid program has not adequately recovered money lost to fraud and "rarely punishes violators," according to a legislative report released on Sept. 13. The Tallahassee Democrat reports that the Florida Legislature's Office of Program Policy Analysis and Government Accountability (OPPAGA) analyzed how the state Agency for Health Care Administration has handled Medicaid fraud and abuse over the past six years. The report -- the first of four that OPPAGA is conducting on AHCA's Medicaid practices -- concluded that the agency:
- Recovered only $96.7 million of the estimated $2.1 billion to $4.3 billion "lost to fraud and abuse over the past six years."
- Imposed fines in less than 10% of cases where providers were determined to have overbilled the state. In most of these instances, the offenders simply had to repay the excessive funds and were not "dissuaded from repeating abusive behavior," according to the report. Also, in only 4.5% of roughly 7,600 cases of overpayments were companies fined.
- Has used "imprecise" methods to identify cases of fraud; in a three-year period, "the agency opened 6,420 cases of possible fraud or abuse and found problems in only 43% of them." The Democrat reports that while AHCA officials said this figure "showed an efficient use of staff, OPPAGA noted that investigators spent about the same amount of time on each case."
