Oct 21, 2011

Persons who report Medicaid fraud may be entitled to a reward for their information up to 25 percent of the amount recovered,

Not all providers commit fraud but all Floridians can help by identifying those who do. Persons who report Medicaid fraud may be entitled to a reward for their information up to 25 percent of the amount recovered, or a maximum of $500,000 per case, if the case results in a fine, penalty or a forfeiture of property. Tips about suspected fraud can be reported by calling the Attorney General’s Fraud Hotline at 1-866-966-7226 or the Agency’s Consumer Call Center at 1-888-419-3456. Communication initiatives are in progress, including a mailing to Medicaid recipients, to heighten awareness and encourage recipients to report fraud. Citizens may also report fraud online by visiting our Web site, http://click.icptrack.com/icp/relay.php?r=12353917&msgid=218447&act=52BP&c=227375&admin=0&destination=http%3A%2F%2Fwww.ahca.myflorida.com%2F and clicking the “Report Fraud” button. We hope you’ll use these brochures and posters to help us promote this effort.
Agency Highlights
The Florida Medicaid program is fortunate that a vast majority of its providers are honest and provide high-quality care. Unfortunately, the few bad players create a need for bold efforts. We are committed to working with our partners to fight those who cheat Florida taxpayers and hope you will join us in this effort.
The number one priority in our state Medicaid program is to ensure our limited resources are spent on health care services for our state’s most vulnerable citizens who need care. Now more than ever, a team effort is vital to success in combating health care fraud statewide and stopping providers and others who cheat taxpayers. Both the Medicare and Medicaid programs are working hard to find and eliminate waste, fraud and abuse and to ensure scarce health care resources are spent appropriately. While the Medicare program is administered and funded by the federal government’s Centers for Medicare and Medicaid Services, Florida’s Medicaid program is operated by the state Agency for Health Care Administration (Agency) and funded with state and federal dollars. By working together, we are taking strong steps to curb health care fraud in Florida.
For example, after identifying alarming numbers of claims for home health aide services in the Miami-Dade area in 2008, our Florida Medicaid Program Integrity staff embarked on an effort to find those home health agencies billing for services never delivered to Medicaid patients. In March and October 2009, we formed teams with investigators and trained medical personnel from the Agency, the state Department of Health and the federal Centers for Medicare and Medicaid Services, and we conducted major sweeps of Miami-Dade County home health agencies. Together, we interviewed hundreds of recipients and prescribing physicians and found some home health agencies billed for services not delivered or not medically necessary. As a result of these field investigations and audits over the past two years, Medicaid home health services claims dropped by over $10 million in state fiscal year 2008-09.
We are strengthening this important effort with the 2009 passage of Senate Bill 1986. This new law increases standards home health agencies must meet before receiving Medicaid payments, adds penalties and provides new authority to impose sanctions and to suspend or revoke licenses of those who cheat the system. When the Agency suspects a provider has committed fraud, referrals go to the Florida Attorney General’s Medicaid Fraud Control Unit and the Florida Department of Law Enforcement to pursue criminal and/or civil actions if the allegations are found to be true. Actions regarding licensure are handled by related licensing entities in our Agency and at the Department of Health.
In 2010, Florida Medicaid staff will begin new outreach efforts to verify Medicaid patients do, in fact, have a condition requiring home health services. The Agency is on track to inspect all of the approximately 360 home health agencies that provide services to Medicaid recipients in Miami-Dade County and randomly selected agencies statewide. And, by June 2010, a new technology pilot program will be introduced allowing the Medicaid program to verify that home health services were actually delivered to the patient. At the same time, our Medicaid Program Integrity staff will continue to carefully scrutinize the data available to us to identify unusual trends and opportunities to stop the bad players in Florida’s Medicaid system throughout the state.