Medicaid fraud in Florida highest for home health services

Fraud recoveries equaled about 2% of the state's Medicaid budget in fiscal year 2009.

By — Posted Jan. 27, 2010

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Florida recovered hundreds of millions in fraudulent Medicaid payments, but that was probably still only a fraction of the total, according to an annual report released Jan. 7 by the Florida Agency for Health Care Administration.

Florida recovered $287 million in fraudulent Medicaid claims in fiscal year 2009, which ended July 1. That figure represents slightly less than 2% of the Medicaid program's $15.7 billion budget for the year. However, Medicaid fraud likely accounts for 5% to 20% of the state's Medicaid budget, or $785 million to $3.2 billion, according to a February 2009 analysis by the Florida Office of Program Policy Analysis and Government Accountability.

Home-based and community-based health services and pharmaceutical manufacturers were the most frequent entities involved in fraud cases, the same as in the previous fiscal year, the report found. Physicians were third on the list in fiscal 2009, after not appearing in the top five the previous year.

Florida Medical Assn. spokeswoman Erin VanSickle said Florida Attorney General Bill McCollum and AHCA Secretary Thomas W. Arnold take fraud seriously, but that there is always room for improvement. "We are confident that they will continue to aggressively seek out and find ways to more effectively prevent and prosecute those who take advantage of the system," VanSickle said.

Florida has the nation's fourth-largest Medicaid program, with an enrollment of about 2.6 million people, according to AHCA.

The report is available online (link).

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