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

Enhanced Detection, Stronger Sanctions, Managed Care Fiscal Safeguards, and a Fraud and Abuse Strategic Plan Are Needed to Further Protect Medicaid Funds

Report 10-32, March 2010




Report Summary

AHCA has taken steps to better safeguard Medicaid funds but has not implemented our prior recommendations to expand its use of advanced detection methodologies, increase fines on providers that overbill for services, and ensure that managed care plans provide needed services to Medicaid beneficiaries. We continue to believe these steps are necessary to improve AHCA's ability to safeguard Medicaid funds. AHCA recently established the Fraud Steering Committee to promote an agency-wide focus on safeguarding Medicaid funds and should direct this committee to develop a strategic plan to identify areas at high risk for fraud and abuse and develop interventions to reduce these risks.


Related Reports
  1. AHCA Continues to Improve Medicaid Program Data Quality and Oversight; Additional Improvements Needed in Use of Data
    Report 20-04 January 2020
  2. AHCA Reorganized to Enhance Managed Care Program Oversight and Continues to Recoup Fee-for-Service Overpayments
    Report 16-03 January 2016
  3. Medicaid Program Integrity Recovers Overpayments in Fee-For-Service and Monitors Fraud and Abuse in Managed Care
    Report 14-05 January 2014
  4. Agency for Health Care Administration Continues Efforts to Control Medicaid Fraud and Abuse
    Report 11-22 December 2011
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.
Medicaid fraud and abuse, medicaid advanced fraud detection, provider sanctions, Medicaid program integrity, managed care fraud and abuse, fraud and abuse detection, intraagency coordination for fraud and abuse,