Annual Report Recaps Florida’s Lucrative War on Medicaid Fraud

Florida Agency for Health Care Administration and the Florida Attorney General just released the State’s annual Medicaid Fraud and Abuse Report, which reveals a solid return on investment for recovery efforts. Medicaid is a big issue in Florida – the fourth largest Medicaid program in the country, serving more than 3.3 million people.

Fighting Medicaid fraud makes good financial sense in the State. According to the report, for every $1 spent in fiscal year 2011- ’12 to prevent fraud and abuse or to recover Medicaid funds due to fraud and abuse, Florida gained $6.80.

While Medicaid’s process to terminate prescribing rights of providers who were prescribing suspicious amounts of pill-mill type drugs is going strong. The State recouped nearly $49.7 million, including $44.2 million in overpayments and $5 million in fines and sanctions. In addition, the Agency’s Bureau of Medicaid Program Integrity collected $74.2 million in Medicaid overpayments and the government’s Third Party Liability Unit recovered $148.1 million.

Recouping money from Medicaid fraud and abuse is clearly an important and much-needed money-making initiative for Florida as well as other states. With the strength of the qui tam provisions of the False Claims Act, the amount recovered should increase each year.

According to the report, citizens made the majority of Medicaid fraud complaints in FY 2011-’12, followed by Medicaid recipient and qui tam complaints.

More information for whistleblowers is located at the Nolan Auerbach website.