Florida’s aggressive crackdown on Medicaid fraud has resulted in a staggering projected reduction of nearly $1 billion in annual spending on behavioral therapy services alone, as state officials uncovered rampant suspicious billing practices, including providers claiming impossible hours, such as billing for more than 24 hours in a single day and services on every weekend and holiday for months. This initiative, championed by Governor Ron DeSantis, moves away from a reactive ‘pay-and-chase’ model to a proactive approach that prevents fraudulent claims before taxpayer dollars are disbursed. The state has terminated over 220 providers for fraud, waste, or abuse, restricted or suspended payments to more than 260, and referred over 150 suspected fraud cases to the attorney general’s office. Specifically, projected annual spending on Applied Behavior Analysis (ABA) therapy has been revised down from $3.86 billion to $2.88 billion for fiscal year 2026-27, a decrease of approximately $980 million, attributed to enhanced fraud enforcement, managed care, and utilization management. The state’s Agency for Health Care Administration (AHCA) is employing advanced techniques, including a pilot program with identity-verification firm SentiLink to screen for stolen identities and hidden ownership structures, alongside imposing enrollment moratoriums on high-risk provider categories and conducting hundreds of site visits. AHCA has also issued over 1,000 adverse decisions on Medicaid provider enrollment or re-enrollment since January 2026, aiming to prevent bad actors from entering or remaining in the program, demonstrating Florida’s commitment to safeguarding essential services for its most vulnerable populations while combating sophisticated, growing Medicaid fraud nationwide.
Adapted from: Latest Political News on Fox News
