Governor Ron DeSantis Announces Results of Florida’s Medicaid Integrity Initiative

WEST PALM BEACH, Fla.-Today, Governor Ron DeSantis announced results from Florida's enhanced Medicaid program integrity efforts to combat fraud, waste and abuse, protect taxpayer dollars, and ensure Medicaid resources are directed toward legitimate health care services for eligible Floridians.

In June, Governor DeSantis announced the most significant Medicaid integrity initiative in Florida history, shifting the state away from a "pay-and-chase" model toward preventing fraud before taxpayer dollars are spent. The Agency for Health Care Administration (AHCA) strengthened provider screening and oversight, expanded data analytics and claims monitoring, imposed enrollment moratoriums on certain high-risk provider categories, and launched a statewide revalidation effort for active Medicaid providers.

"Florida's Agency for Health Care Administration's Medicaid integrity initiative is delivering results," said Governor DeSantis. "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."

Since January, AHCA has conducted more than 400 provider site visits as part of its heightened program integrity efforts, with particular attention to areas where data and billing patterns have identified heightened risk, including Applied Behavior Analysis (ABA), Durable Medical Equipment, and Adult Day Care.

Florida's efforts are already producing significant results:

• Nearly $1 billion less in projected annual ABA expenditures. Medicaid spending on ABA services had been projected to reach $3.86 billion. Following Florida's transition of ABA services into managed care, utilization management efforts, and AHCA's efforts to combat fraud, waste and abuse, annual ABA expenditures are now projected at $2.88 billion in Fiscal Year 2026-27. Florida also established the Applied Behavior Analysis Task Force earlier this year to strengthen accountability within the program.
• More than 150 referrals to the Attorney General's Office over the last year based on allegations of fraud.
• More than 260 providers placed on payment restrictions or suspended from receiving payments.
• More than 220 providers terminated from Florida Medicaid for fraud, waste or abuse, accounting for more than $230 million in Medicaid billing in 2025.
  

AHCA's enhanced oversight has also identified troubling billing practices. Providers have billed Medicaid for excessive hours of service, including months of consecutive days of service through weekends and holidays. In some instances, providers billed Medicaid for more than 24 hours of services in a single day.

"Protecting Medicaid means protecting the people it was created to serve," said Agency for Health Care Administration Secretary Shevaun L. Harris. "For children, pregnant women, the disabled, and our seniors, it means making sure they have access to high-quality care while ensuring taxpayer dollars are not lost to fraud or abuse. AHCA will continue taking decisive action to strengthen program integrity, hold bad actors accountable and safeguard these critical services for Floridians."

Florida will continue using enhanced data analytics, provider screening, site visits, claims monitoring, and other program integrity tools to identify suspicious activity and bad actors. AHCA will continue taking action when appropriate, including payment restrictions, suspensions, terminations, and referrals for investigation. These efforts are focused on bad actors who exploit the Medicaid program, not legitimate providers delivering necessary care to Floridians.

As part of the initiative announced in June, AHCA:

• Launched a pilot program with SentiLink to strengthen provider screening and identify stolen identities, fake identities, hidden ownership structures, and other suspicious activity among new and existing providers;
• Strengthened oversight of high-risk Medicaid providers, including enrollment moratoriums on certain high-risk provider categories;
• Launched a statewide revalidation effort requiring active Medicaid providers to verify their credentials and identity; and
• Expanded the use of data analytics, claims monitoring, background screening, and other tools to identify bad actors and potentially fraudulent billing practices.