Office of Program Policy Analysis and Government Accountability
Office of Program Policy Analysis and Government Accountability

Progress Report: AHCA Takes Steps to Improve Medicaid Program Integrity, But Further Actions Are Needed, November 2004

Report 04-77, November 2004




Report Summary

  • Since our 2001 report, the Legislature and the Agency for Health Care Administration (AHCA) have taken steps to address fraud and abuse in the Medicaid program. The Legislature has changed state law to establish additional provisions to prevent and deter fraud and abuse, authorized AHCA to study the extent of improper Medicaid payments, and increased agency staffing for program integrity functions. During this same time, AHCA has reorganized the program integrity office, hired additional staff, and developed a new provider case tracking and management system.
  • However, AHCA has not fully implemented our recommendations to combat fraud and abuse, and it has also been slow to implement legislative directives to sanction providers that over-bill Medicaid or violate Medicaid policies. In addition, return on investment for program integrity functions has fallen since Fiscal Year 2001-02.
  • To ensure that AHCA improves its efforts to protect Medicaid dollars, the 2004 Legislature required OPPAGA to biennially review these efforts. Our next report will be provided to the President of the Senate and the Speaker of the House in January 2006 on agency efforts to prevent, detect, deter, and recover Medicaid dollars lost to fraud and abuse.


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Copies of this report in print or alternate accessible format may be obtained by email OPPAGA@oppaga.fl.gov, telephone (850) 488-0021, or mail 111 W. Madison St., Room 312 Tallahassee, FL 32399-1475.
Copies of this report in print or alternate accessible format may be obtained by email OPPAGA@oppaga.fl.gov, telephone (850) 488-0021, or mail 111 W. Madison St., Room 312 Tallahassee, FL 32399-1475.
social services, medicaid, program integrity, fraud, abuse, health, child abuse, dependent children, children's mental health, residential treatment, qualified evalutors, agency for health care administration, dependent, department of children and families, assessments