DeSantis fraud crackdown drives nearly $1B spending plunge after providers billed impossible hours
Florida's sweeping Medicaid fraud crackdown has helped drive a nearly $1 billion reduction in projected annual spending on behavioral therapy services alone, according to state officials, after investigators uncovered suspicious...
By Fox News · Fox News
Florida's sweeping Medicaid fraud crackdown has helped drive a nearly $1 billion reduction in projected annual spending on behavioral therapy services alone, according to state officials, after investigators uncovered suspicious billing practices. Tallahassee’s internal crackdown — which included discoveries of providers billing Medicaid for more hours than there are in a day — comes amid heightened federal scrutiny of Medicaid fraud, including investigations and payment reviews involving Minnesota. The DeSantis administration said its approach aims to stop suspicious Medicaid claims before taxpayer dollars are paid out rather than trying to recover improper payments afterward. The strategy mirrors a call from HHS Secretary Robert F. Kennedy Jr. to move away from traditional "pay-and-chase" models. "This year, we announced the most significant Medicaid integrity initiative in the history of our state, and today, I was proud to announce some of the results from these efforts," Gov. Ron DeSantis said in a news release. VANCE TURNS UP HEAT ON STATES WITH FEDERAL CASH THREAT OVER MEDICAID FRAUD CRACKDOWN More than 220 Medicaid providers have been terminated for fraud, waste or abuse, while more than 260 have faced payment restrictions or suspensions. The state has also referred more than 150 suspected fraud cases to the attorney general's office over the past year. Annual Medicaid spending on Applied Behavior Analysis (ABA), a therapy commonly used for children with autism, had been projected to reach $3.86 billion but is now expected to total $2.88 billion in fiscal year 2026-27, according to the governor's office. Officials attributed the nearly $980 million reduction to a combination of fraud enforcement, managed care and utilization management efforts. Florida's Agency for Health Care Administration (AHCA) told Fox News Digital that its expanded monitoring uncovered providers billing Medicaid for services through every weekend and holiday for months, including inst…