ORANGE COUNTY, Fla. \u2014 The state of Florida says it is cracking down on Medicaid fraud, especially among providers serving children with special needs.<\/p>\n
The Florida Agency for Health Care Administration said it recovered more than $72 million in fraudulent Medicaid payments over the last year alone. <\/p>\n
The agency\u2019s annual fraud and abuse report says investigators with the Medicaid Program Integrity unit had nearly 3,000 active cases in Fiscal Year 2024-2025. <\/p>\n
According to the state, that unit \u201caudits and investigates providers suspected of overbilling or defrauding Florida\u2019s Medicaid program, recovers overpayments, issues administrative sanctions, and refers cases of suspected fraud for criminal investigation.\u201d <\/p>\n
Officials are now warning about fraud involving behavior analysis services, which are commonly used to help children diagnosed with autism or developmental disorders.<\/p>\n
\u201cWe are seeing some very concerning practices,\u201d said Shevaun Harris, secretary of the Florida Agency for Health Care Administration.<\/p>\n
Behavior analysts provide intervention services aimed at correcting behaviors such as aggression, helping with communication, and teaching day-to-day self-care skills, including eating and using the toilet.<\/p>\n
\u201cThis is a service covered under Florida Medicaid and is an essential service for so many children diagnosed with autism or a developmental disorder,\u201d said Harris.<\/p>\n
According to the agency, some providers have falsified records, fraudulently billed for services never rendered and offered kickbacks to parents in exchange for Medicaid identification numbers used to bill the state.<\/p>\n
\u201cIf you are a parent, be aware of providers offering you cash, gift cards, or other forms of Compensation to sign your child up for this service,\u201d Harris said.<\/p>\n
According to the annual state report, Medicaid fraud spans multiple medical professions, including physicians, nurses and therapists. More than 1,400 providers were prevented from enrolling or reenrolling in the Medicaid program as a result of documented medicaid fraud, the report says. <\/p>\n
More than half of those providers were behavior analysts, with 893 analysts denied in FY 2024-2025.<\/p>\n
\u201cEvery dollar spent unnecessarily because of fraud, waste, or abuse is a lost opportunity to provide care for a child waiting to receive services,\u201d Harris said.<\/p>\n
The report also highlights coordination between state and federal agencies investigating Medicaid fraud.<\/p>\n
According to the report, the Florida Attorney General\u2019s Office opened 190 Medicaid fraud investigations last year. While some cases remain ongoing, at least 39 criminal cases moved forward. That year, 38 warrants for arrests were issued related to Medicaid Fraud. <\/p>\n
State officials warned that unless changes are made, behavior analysts could soon face additional scrutiny and administrative requirements. Officials also warned that Medicaid fraud is a crime and both providers and parents could face prosecution.<\/p>\n
\u201cThese are crimes under Florida law and we must work collectively to root out this kind of behavior in the Medicaid program,\u201d said Harris. <\/p>\n
Harris asked parents and providers to stay vigilant and join in the fight against fraud.<\/p>\n
Anyone who sees suspicious activity, is being asked to report it to the Office or Medicaid Program Integrity at 888-419-3456.<\/p>\n
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