Annual Medicaid Fraud Report released

Annual Medicaid Fraud Report released

TALLAHASSEE, FL – Attorney General Bill McCollum and Agency for Health Care Administration Secretary Holly Bensonreleased the state’s annual Medicaid fraud report Monday, highlighting the importance of increased vigilance against Medicaid fraud.

The agencies’ combined efforts have prevented more than $100 million in Medicaid overpayments over the past three years and the Attorney General’s Medicaid Fraud Control Unit recovered over $56.7 million during fiscal year 2007-08, which includes court judgments, fines and civil penalties.

"Medicaid fraud diverts valuable health care resources away from those who truly need the assistance, and we will not permit that to go unnoticed and unaddressed," said Attorney General McCollum. "Our resources are best utilized when we cooperatively combat this issue and I look forward to continued progress made on this front."

The Attorney General’s Medicaid Fraud Control Unit (MFCU) and the Agency for Health Care Administration (Agency) continue to work together on joint investigative projects, Medicaid program issues, enhancement of processes and development of protocols for improved coordination. The Agency and MFCU have also committed to improving the referral process for allegations of fraud and abuse.

"Fraudulent and abusive providers jeopardize the delivery of quality health care for Floridians," Secretary Benson said. "It is disheartening to realize that there are individuals who would steal from taxpayers in order to make a living, but it is even more disappointing to realize that they are also depriving those who really do need health care. Every day our team is on the front lines working with MFCU to build cases against the fraudulent providers and restore the integrity of the program."

A copy of the annual report for the 2007-2008 fiscal year is available online at: http://myfloridalegal.com/webfiles.nsf/WF/MRAY-7MLQFJ/$file/2007-08MFCUReport.pdf.  

In addition to the cooperation between the Agency and the Attorney General’s Office, strong partnerships with other state agencies are critical to ensuring high-quality referrals are made following investigations. Partnerships with the Florida Department of Health, the Agency for Persons with Disabilities and the Federal Centers for Medicare and Medicaid Services, among others, ensure that the appropriate regulatory entities are notified of the actions of those they oversee. Referrals are now staffed monthly, making the referral move to a case a quicker process.

The AHCA Inspector General’s Bureau of Medicaid Program Integrity (OIG-MPI) is responsible for minimizing fraud and abuse losses in the Medicaid program. MPI carries out fraud and abuse preventive activities, performs detection analyses, conducts audits, imposes sanctions as appropriate and refers certain providers to the Medicaid Fraud Control Unit and to other regulatory and investigative agencies. The Medicaid Fraud Control Unit is responsible for policing the Medicaid Program, as well as investigating allegations of corruption and fraud in the administration of the program. For fiscal year 2007-08, 88 arrests were made, of which 62 resulted from Medicaid Fraud investigations.

The Medicaid Fraud Control Unit also investigates the abuse, neglect and exploitation of the elderly, as well as ill and disabled residents of long-term care facilities, such as nursing homes, facilities for the mentally and physically disabled and assisted care living facilities. Random spot-check visits to these types of facilities help determine whether Medicaid policy and procedures are being followed. Other entities that attend these visits include the Agency for Persons with Disabilities, Department of Health, Ombudsmen, Building Code Compliance officials, local fire inspectors and the Health Quality Assurance Division of the Agency for Health Care Administration, which licenses and regulates this industry. Of the 88 arrests made during fiscal year 2007-08, 26 resulted from abuse and neglect investigations.

The Agency for Health Care Administration is committed to better health care for all Floridians. AHCA administers Florida’s Medicaid program, licenses and regulates more than 32,000 health care facilities and 37 health maintenance organizations, and publishes health care data and statistics. For more information, please visit http://ahca.myflorida.com.

The Attorney General’s recent efforts to combat Medicaid fraud include the launch of a statewide initiative to educate citizens and health care providers about the dangers and costs of Medicaid and other health care-related fraud. Intended to foster a spirit of cooperation and raise awareness of how to report and avoid fraud and abuse, the presentations will be given by members of the Attorney General’s Medicaid Fraud Control Unit at hospitals, senior centers and other venues around Florida. Additional information about the Attorney General’s Medicaid Fraud Control Unit is available online at: http://myfloridalegal.com.