Florida effort to combat Medicaid fraud projected to save nearly $1B

Florida’s initiative to combat Medicaid fraud and abuse has saved nearly $1 billion, according to Gov. Ron DeSantis.Earlier this year, the Agency for Health Care Administration launched a statewide revalidation effort for Medicaid providers and increased its provider screening and claims monitoring.
On Tuesday, DeSantis announced that since June, the agency has made over 150 referrals to the Attorney General’s Office for allegations of fraud, over 260 providers have been placed on payment restrictions or suspended from receiving payments, and over 220 providers were terminated from Florida Medicaid for fraud, waste, or abuse.
The providers that were terminated represent over $250 million in Medicaid billing last year.
The effort uncovered “troubling” billing practices, like providers billing Medicaid for excessive hours of service, some for months of consecutive days through weekends and holidays. In some cases, Medicaid was billed for more than 24 hours of services in one day, according to the governor’s office.
“The waste in taxpayer dollars is concerning for sure, but what is most concerning is the disservice this does to families who rely on these providers and those who don’t even know that their Medicaid ID is being misused,” said AHCA Secretary Shevaun Harris. “What we’re seeing in many of these instances is providers that have a mixture of clients who legitimately need services and then those who don’t. So when you engage in these behaviors, you’re not just hurting the state and our coffers, you’re preying on vulnerable individuals. Because when we terminate you we now have to move all the recipients who you were providing services to a new legitimate provider in this space. In my opinion you are a predator and we will treat you as such.”
The AHCA zeroed in on areas where billing patterns highlighted heightened risk, including Applied Behavior Analysis.
DeSantis said Florida’s transition of ABA services into managed care along with efforts to combat fraud have led to a nearly $1 billion decrease in projected annual ABA expenditures. They were projected to reach $3.86 billion but are now projected at $2.88 billion for fiscal year 2026-2027.
Florida also set up the Applied Behavior Analysis Task Force to increase program accountability.
“Protecting Medicaid means protecting the people it was created to serve. For children, pregnant women, the disabled, and our seniors, it means making sure they have access to high-quality care while ensuring taxpayer dollars are not lost to fraud or abuse. AHCA will continue taking decisive action to strengthen program integrity, hold bad actors accountable and safeguard these critical services for Floridians,” said Harris.

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