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Office of Program Policy Analysis and Government Accountability

Enhanced Detection and Stronger Use of Sanctions Could Improve AHCA’s Ability to Detect and Deter Overpayments to Providers, Report No. 06-23, March 2006
 
Full report in PDF format


Since our 2004 review, the Agency for Health Care Administration (AHCA) has worked to implement legislative actions to safeguard the state against waste, abuse, and fraud in the Medicaid program. Although these actions are beneficial, AHCA has not yet fully implemented all prior OPPAGA recommendations related to performance measures and detection efforts. In addition, AHCA should consider strengthening its sanctioning process to ensure that it deters providers from repeating abusive billing patterns, and expand oversight of Medicaid managed care to prevent and reduce waste, abuse, and fraud in managed care plans

Which Government Program Summaries contain related information?

Medicaid Health Care Services

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. 04-77 Progress Report: AHCA Takes Steps to Improve Medicaid Program Integrity, But Further Actions Are Needed, published in November 2004.
  • Report No. 01-39 Justification Review: Medicaid Program Integrity Efforts Recover Minimal Dollars, Sanctions Rarely Imposed, Stronger Accountability Needed, published in September 2001.

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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