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Report: Florida officials closed more than 1,300 Medicaid fraud cases in 2022


(The Center Square) — According to a recent report, the Florida Legislature’s research arm found that state officials closed more than 1,300 Medicaid fraud cases in 2022.

The Office of Program Policy Analysis and Government Accountability released its biennial review of the Agency for Health Care Administration’s oversight of fraud and abuse in Florida’s Medicaid Program in late January.

The agency provides health care for low-income families and individuals while assisting those living with disabilities and the elderly with care costs for nursing facilities, and long-term expenses.

OPPAGA noted in its report that the Office of Medicaid Program Integrity is responsible for fraud and abuse monitoring within the program and collaborating with state and federal entities to detect, prevent, and deter fraud.

During fiscal 2021-22, the agency closed 1,397 fraud and abuse cases — 48.8% were identified as overpayments and providers — with the majority being the fee-for-service program and amounted to $22.5 million. The report also said that the agency handled more than 13,000 abuse and fraud complaints.

The Legislature appropriated $41 billion for Medicaid program operations in fiscal year 2023-24.

Statewide, 65% of Medicaid’s total expenditures came from Medicaid Managed Care accounts, while the remaining 35% of expenditures came from the fee-for-service program.

According to the report, Medicaid enrollment in the Sunshine State grew substantially after the COVID-19 pandemic because of federal legislation. Between March 2020 to April 2023, total Medicaid enrollment increased by 54% or from 3.8 million to 5.8 million.

However, after new legislation ended the changes, federal funding was decreased and states returned to previous eligibility and enrollment operations, Florida began this redetermination in April 2023. By October, the agency reported that Florida had the ninth-lowest termination of coverage rate among states.

The report states that the program serves approximately 4.4 million people each month as of October, and the agency states that 4.6 million recipients will have their cases redetermined by the state Department of Children and Families over a 12-month period ending March 2023.

By August, 2.2 million enrollees had their cases redetermined, 67% or 1.5 million recipients were deemed eligible, while 32% or 746,000 recipients were disenrolled after being deemed ineligible. Fifty-five percent of those disenrolled were done so for procedural reasons while 45% were terminated due to eligibility.

In Feb. 2023, the U.S. Department of Health and Human Services Office of the Inspector General estimated that $6.9 million had been paid in Medicaid, for recipients enrolled in Florida and residing in another state.