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Office of Program Policy Analysis and Government Accountability

AHCA Making Progress But Stronger Detection, Sanctions, and Managed Care Oversight Needed, Report No. 08-08, February 2008
 
Full report in PDF format


Since our 2006 review, AHCA has taken steps we recommended to improve performance reporting and to strengthen its ability to safeguard the state against provider waste, abuse, and fraud in the Medicaid program. However, AHCA has not implemented our recommendations to develop a sustainable advanced detection system using artificial intelligence and to strengthen its sanctioning process by establishing fines that represent a minimum percentage of identified overpayments. While AHCA has strengthened its oversight of Medicaid managed care organizations, more steps are needed to deter and detect corporate level abusive and fraudulent practices.

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. 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. 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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