|January 3, 2013
Contact: Whitney Ray
Phone: (850) 245-0150
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TALLAHASSEE – Florida Agency for Health Care Administration (Agency) Secretary Liz Dudek and Florida Attorney General Pam Bondi jointly released the annual Medicaid Fraud and Abuse Report. Florida’s Medicaid program is the fourth largest in the nation serving more than 3.3 million recipients. A few of the report highlights include:
• Return on Investment: For FY 2011-12, the Agency’s return on investment for recovery efforts is 7.9:1 and 5.3:1 for prevention efforts, totaling a 6.8:1 overall. This means that for every $1.00 spent to prevent fraud and abuse or to recover Medicaid funds due to fraud and abuse, the State of Florida gains $6.80.
• Terminated providers: In 2011, the Agency’s Bureau of Medicaid Program Integrity (MPI) embarked on a new process to terminate the prescribing rights of non-Medicaid providers who were prescribing pill mill type drugs in suspicious amounts. MPI has terminated the Medicaid prescribing rights of 437 non-Medicaid providers who were prescribing pill mill type drugs during FY 2011-12.
• Total dollars recouped: During this fiscal year, total collections, net of adjustments and refunds approached $49.7 million. The collections were: $44.2 million in overpayments, $200,000 in investigation costs, $5 million in fines/sanctions and $300,000 in interest. Additionally, MFCU collected $74.2 million in federal Medicaid overpayments and the Agency’s Third Party Liability Unit recovered $148.1 million.
“This report shows both agencies commitment to work together and safeguard this program from major fraud and abuse,” said Secretary Liz Dudek. “The Agency continues to be forward thinking and is working toward increased use of technology and stakeholder collaboration to aid in fraud fighting efforts.”
The Agency and MFCU are involved with external partners, stakeholders and internal offices to advance the coordination of prevention of fraud and abuse of the Medicaid program through workgroups, adoption of Medicaid policy changes to safeguard the Medicaid program and by continuous analysis of the cost of Medicaid services. In addition, the Agency continues to produce provider training opportunities about Medicaid fraud that are now available on the Florida Medicaid Provider Training e-Library.
“Our collaborative efforts with the Agency for Health Care Administration have resulted in tremendous financial recoveries on behalf of taxpayers,” said Attorney General Pam Bondi. “We will continue to work steadfastly toward the shared goal of ensuring that Medicaid dollars go to helping the needy rather than to those who defraud the system.”
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. Anyone can report fraud online by visiting the Agency’s Web site at www.ahca.myflorida.com and clicking the “Report Fraud” button.
Click here to view the 2011-12 Florida Medicaid Fraud and Abuse Annual Report, which is also available on the Agency’s homepage at www.AHCA.MyFlorida.com.