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Office of Program Policy Analysis and Government Accountability

Agency for Health Care Administration Continues Efforts to Control Medicaid Fraud and Abuse, Report No. 11-22, December 2011
 
Full report in PDF format


  • The Agency for Health Care Administration continues to coordinate efforts to prevent and detect fraud and abuse in its Medicaid fee-for-service and managed care programs. It oversees fraud and abuse prevention and detection in Medicaid managed care by requiring plans to perform specific fraud and abuse activities and by monitoring to ensure that plans comply with these requirements. For fee-for-service, the agency follows a systematic process to identify and investigate providers who are suspected of overbilling.
  • The agency has reduced the time it takes to recover overpayments from providers and has increased the fines and penalties imposed for provider overbilling.

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. 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. 04-77 Progress Report: AHCA Takes Steps to Improve Medicaid Program Integrity, But Further Actions Are Needed, November 2004,published in November 2004.
  • Report No. 01-39 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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