Florida says it has cut nearly $1 billion out of a single Medicaid line item — not by spending more on oversight, but by refusing to pay suspicious claims in the first place. The reason the state gives is almost hard to believe: investigators found providers billing Medicaid for more hours than there are in a day.
Annual Medicaid spending on Applied Behavior Analysis, the therapy most commonly used for children with autism, had been projected to hit $3.86 billion in Florida. It is now expected to total $2.88 billion in fiscal year 2026-27, Fox News Digital reported, citing the governor’s office. That is a reduction of roughly $980 million, which officials credited to a combination of fraud enforcement, managed care and utilization management.
“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,” Gov. Ron DeSantis said in a news release.
The numbers behind that line are what Washington should be reading. More than 220 Medicaid providers have been terminated for fraud, waste or abuse. More than 260 have been hit with payment restrictions or suspensions. More than 150 suspected fraud cases have been referred to the attorney general’s office in the past year.
Florida’s Agency for Health Care Administration told Fox News Digital that its expanded monitoring turned up providers billing Medicaid for services through every weekend and holiday for months at a stretch, including instances in which a provider billed for more than 24 hours of services in a single day.
“Protecting Medicaid means protecting the people it was created to serve,” AHCA Secretary Shevaun Harris said in a statement. “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.”
The design matters more than the dollar figure. The DeSantis administration says its approach is built to stop suspicious claims before taxpayer money goes out the door, rather than chasing improper payments afterward — the same break from the traditional “pay-and-chase” model that HHS Secretary Robert F. Kennedy Jr. has been pushing on the states. Florida is also screening providers for stolen or fake identities and hidden ownership structures, and has frozen enrollment in high-risk provider categories.
Since January the agency says it has issued more than 1,000 adverse decisions on provider enrollment or re-enrollment and conducted 400 site visits, concentrated in high-risk categories like applied behavior analysis, medical equipment and adult day care.
“Medicaid fraud is a national problem, and it is growing more sophisticated everywhere,” AHCA told Fox News Digital. “Florida is not waiting to be told what to do. We are building the model: prevent fraud at the front door, verify every provider, and follow the data.”
Note what is absent from this story: no new program, no emergency appropriation, no task force with a four-year timeline. A state agency verified who it was paying, and a billion dollars in projected spending evaporated. So what are the other 49 states paying for, and why has every fix proposed in Washington started with more money rather than a working verification system?
Source: foxnews.com
