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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 No. 04-77, November 2004
 
Full report in PDF format


  • 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.  

What were our earlier findings?

Report No. 01-39 Justification Review: Medicaid Program Integrity Efforts Recover Minimal Dollars, Sanctions Rarely Imposed, Stronger Accountability Needed, published in September 2001.

Which Government Program Summaries contain related information?

Medicaid Health Care Services
Agency for Health Care Administration

What other OPPAGA-related materials are available?

  • Report No. 16-03 AHCA Reorganized to Enhance Managed Care Program Oversight and Continues to Recoup Fee-for-Service Overpayments,published in January 2016.
  • Report No. 14-05 Medicaid Program Integrity Recovers Overpayments in Fee-For-Service and Monitors Fraud and Abuse in Managed Care,published in January 2014.
  • Report No. 11-22 Agency for Health Care Administration Continues Efforts to Control Medicaid Fraud and Abuse,published in December 2011.
  • Report No. 10-32 Enhanced Detection, Stronger Sanctions, Managed Care Fiscal Safeguards, and a Fraud and Abuse Strategic Plan Are Needed to Further Protect Medicaid Funds,published in March 2010.
  • Report No. 08-08 AHCA Making Progress But Stronger Detection, Sanctions, and Managed Care Oversight Needed, published in February 2008.
  • Report No. 06-23 Enhanced Detection and Stronger Use of Sanctions Could Improve AHCA’s Ability to Detect and Deter Overpayments to Providers, published in March 2006.
  • Report No. 05-39 OPPAGA Report: Disabilities Groups Should Improve Coordination, But Duplication of Activities Appears to Be Low, published in July 2005.

Copies of this report in print or alternate accessible format may be obtained by telephone (850/488-0021), by FAX (850/487-9213), in person, or by mail (OPPAGA Report Production, Claude Pepper Building, Room 312, 111 W. Madison St., Tallahassee, FL 32399-1475).
e-mail address: oppaga@oppaga.fl.gov


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