The annual Medicaid Fraud and Abuse Report has been released by the Florida Agency for Health Care Administration and Florida Attorney General. The report shows that cuts to the budget of the Florida Medicaid Fraud Control Unit (“MFCU”) have caused the state to lose $1.89 million of federal funds.
Florida’s Medicaid program is the fourth largest in the country with more than 3.3 million recipients. As such, the chances of Medicaid fraud are great.
MFCU is responsible for investigating and prosecuting individuals and companies that intentionally defraud the state’s Medicaid program. The most common schemes involve billing by health care providers for services not performed; billing for a costly procedure when a less expensive procedure was actually performed; and billing for services and medical equipment that is medically unnecessary.
According to the report, of the MFCU’s annual $16.7 million budget, $12.5 million is provided by the federal government. The amount of federal funding is tied to matching state funds. When Florida reduced the MFCU’s general revenue budget by $631,290, it lost out on approximately $1.89 million of federal monies. In addition, the budget reduction has resulted in 23 unfilled employee positions in MFCU.
Some other highlights of the Medicaid annual report show that
• of every $1.00 spent by the State of Florida in its efforts to prevent fraud and abuse or to recover Medicaid funds due to fraud and abuse, the state gained $6.80.
• 9% decline in the number of cases opened compared to the previous year
• 23% decline in arrest warrants issued
• $162 million was recovered, with the majority of that from civil settlements, including those tied to whistleblower cases.
The full report is available by clicking here.