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OPPAGA text logo with graphic of FL historic capitol

Agency for Health Care Administration Continues Efforts to Control Medicaid Fraud and Abuse

Report 11-22, December 2011

Report Summary

  • The Agency for Health Care Administration continues to coordinate efforts to prevent and detect fraud and abuse in its Medicaid fee-for-service and managed care programs. It oversees fraud and abuse prevention and detection in Medicaid managed care by requiring plans to perform specific fraud and abuse activities and by monitoring to ensure that plans comply with these requirements. For fee-for-service, the agency follows a systematic process to identify and investigate providers who are suspected of overbilling.
  • The agency has reduced the time it takes to recover overpayments from providers and has increased the fines and penalties imposed for provider overbilling.

Related Reports
  1. AHCA Continues to Improve Medicaid Program Data Quality and Oversight; Additional Improvements Needed in Use of Data
    Report 20-04 January 2020
  2. AHCA Continues to Expand Medicaid Program Integrity Efforts; Establishing Performance Criteria Would Be Beneficial
    Report 18-03 January 2018
  3. AHCA Reorganized to Enhance Managed Care Program Oversight and Continues to Recoup Fee-for-Service Overpayments
    Report 16-03 January 2016
  4. Medicaid Program Integrity Recovers Overpayments in Fee-For-Service and Monitors Fraud and Abuse in Managed Care
    Report 14-05 January 2014
Copies of this report in print or alternate accessible format may be obtained by email OPPAGA@oppaga.fl.gov, telephone (850) 488-0021, or mail 111 W. Madison St., Room 312 Tallahassee, FL 32399-1475.
fraud and abuse, Medicaid program integrity, Medicaid managed care, Medicaid overpayments, Medicaid inter- and intra-agency coordination, combat fraud and abuse, Health Care Administration, Control Medicaid Fraud and Abuse