Gov. Ron DeSantis announces results of Florida Medicaid Integrity Initiative targeting fraud, waste and abuse
West Palm Beach, Florida – Florida officials say an expanded effort to fight fraud, waste and abuse in the state’s Medicaid program has led to provider terminations, payment restrictions and a major reduction in projected spending on certain services.
Gov. Ron DeSantis announced results from Florida’s Medicaid Integrity Initiative, an effort aimed at protecting taxpayer money while making sure Medicaid funding remains available for eligible Floridians who need health care.
The initiative represents a change in how the state approaches suspected Medicaid fraud.
In June, DeSantis announced what his administration described as the largest Medicaid integrity initiative in Florida history. Instead of relying primarily on a “pay-and-chase” approach, where questionable payments are pursued after money has already been spent, the state has placed greater emphasis on detecting and preventing potential fraud before payments are made.
The Agency for Health Care Administration, or AHCA, has increased provider screening and oversight as part of that strategy. The agency has also expanded its use of data analysis and claims monitoring, introduced enrollment moratoriums for certain categories considered high risk, and started a statewide effort requiring active Medicaid providers to revalidate their information.
“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 visits to provider locations.
Those inspections have focused in particular on areas where billing information and other data indicated a higher potential risk. Among the categories receiving additional attention are Applied Behavior Analysis, commonly known as ABA, Durable Medical Equipment and Adult Day Care.
One of the largest financial changes announced by the state involves projected ABA spending.
Florida Medicaid expenditures on ABA services had been expected to reach $3.86 billion annually. That projection has now fallen to $2.88 billion for the 2026-27 fiscal year, a difference of nearly $1 billion.
The state attributed the change to several factors, including moving ABA services into managed care, utilization management and AHCA’s work targeting fraud, waste and abuse.
Florida also created an Applied Behavior Analysis Task Force earlier this year as part of an effort to strengthen accountability surrounding those services.
Other results involve investigations and actions against Medicaid providers.
Over the past year, more than 150 cases involving fraud allegations have been referred to the Florida Attorney General’s Office, according to the state.
More than 260 providers have either been placed under payment restrictions or suspended from receiving Medicaid payments.
Another 220-plus providers have been terminated from the Florida Medicaid program for fraud, waste or abuse. Those providers accounted for more than $230 million in Medicaid billing during 2025.
The increased scrutiny has also uncovered billing practices that state officials described as troubling.
Some providers billed Medicaid for what authorities considered excessive numbers of service hours. Records included months in which services were billed on consecutive days, including weekends and holidays.
In some cases, providers submitted claims for more than 24 hours of services during 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.”
State officials said the enhanced enforcement is intended to focus on providers who exploit Medicaid rather than legitimate health care providers offering necessary services.
AHCA plans to continue using a combination of provider screening, site inspections, claims monitoring and data analytics to look for unusual or suspicious activity.
When the agency determines that action is necessary, options can include restricting payments, suspending providers, removing them from the Medicaid program or referring cases for additional investigation.
Several new tools were included when the broader initiative was announced in June.
Among them is a pilot program with SentiLink intended to strengthen provider screening. The system is being used to help identify potentially stolen or fabricated identities, concealed ownership arrangements and other suspicious activity involving both new and existing Medicaid providers.
Florida has also increased oversight of provider categories considered particularly vulnerable to fraud or abuse. That includes placing enrollment moratoriums on certain high-risk categories.
At the same time, the state launched its statewide provider revalidation effort.
Active Medicaid providers are required to verify their identities and credentials, providing another layer of screening for organizations and individuals already participating in the program.
Technology and data are playing a larger role as well.
AHCA has expanded its use of claims analysis, background screening and other tools designed to identify billing patterns that may warrant closer examination. The goal is to find questionable activity earlier rather than attempting to recover taxpayer funds after potentially improper payments have already been made.
The results announced by DeSantis provide an early look at how that approach is affecting Florida’s Medicaid system.
Hundreds of providers have faced payment restrictions, suspensions or termination, while more than 150 fraud-related referrals have been sent to the Attorney General’s Office. Meanwhile, projected annual spending for ABA services has declined by nearly $1 billion compared with earlier estimates.
Florida officials said the work will continue.
AHCA plans to maintain heightened monitoring while conducting additional site visits and reviewing provider information and billing activity. Providers suspected of exploiting Medicaid may face further administrative action or investigation.
The administration says the broader objective is to protect a program serving some of Florida’s most vulnerable residents while ensuring that public money pays for legitimate health care.
Under the state’s current strategy, that means placing more emphasis on identifying potential problems before payments are made — and taking action when billing data, provider information or on-site inspections indicate possible fraud, waste or abuse.
