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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 No. 10-32, March 2010
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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.

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. 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).
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