Florida Attorney General Reports On $100 Million In Medicaid Overpayments Prevented

TALLAHASSEE, FL – LAWFUEL – Legal Newswire – Attorney General Bill McCollum and Agency for Health Care Administration (AHCA) Secretary Andrew Agwunobi today released
the state’s annual Medicaid fraud report, highlighting the importance of
increased vigilance against Medicaid fraud. The report, jointly released
by the two agencies each fiscal year, notes that combined efforts have
prevented more than $100 million in Medicaid overpayments over the past
three years.

“Medicaid fraud diverts valuable health care resources away from
those who truly need the assistance and we will not permit that to go
unnoticed and unaddressed,” said Attorney General McCollum. “Our resources
are best utilized when we cooperatively combat this issue, and I look
forward to continued progress made on this front.”

The Attorney General’s Medicaid Fraud Control Unit (MFCU) and AHCA
continue to work together on joint investigative projects, Medicaid
program issues, enhancement of processes and development of protocols for
improved coordination. AHCA and the Medicaid Fraud Control Unit have also
committed to improving the referral process for allegations of fraud and
abuse. For the second consecutive year, the number of referrals made to
MFCU exceeded 200. Between August 2006 and March 2007, MFCU made at least
eight arrests that were a result of referrals made by AHCA’s Medicaid
Program Integrity initiative and these arrests alone involved more than
$4.3 million in fraudulent overpayments by the Florida Medicaid program.

“Every dollar recovered from Medicaid fraud and abuse is another
dollar going to the Medicaid population we serve,” said Dr. Agwunobi.
“Practices of fraud and abuse throughout Florida will not be tolerated.
The combined efforts of our two agencies ensure that the Medicaid program
retains its integrity and continues to efficiently serve our state’s
vulnerable population.”

One specific area receiving increased attention has been Medicaid
fraud related to durable medical equipment (DME). The Medicaid Fraud
Control Unit has continued to increase enforcement activity in this area
and the number of complaint referrals from the Agency for Health Care
Administration has continued to trend upwards, with the majority of
referrals occurring in the South Florida area. In addition to the upward
trend in referrals, this fiscal year has seen a significant surge of
arrests related to DME providers, principally the result of a multi-agency
strike force comprised of state, local and federal law enforcement
agencies working the South Florida area.

The AHCA Inspector General’s Bureau of Medicaid Program Integrity
(MPI) is responsible for minimizing fraud and abuse losses in the Medicaid
program. MPI carries out fraud and abuse preventive activities, performs
detection analyses, conducts audits, imposes sanctions as appropriate and
refers certain providers to the Medicaid Fraud Control Unit and to other
regulatory and investigative agencies. The Medicaid Fraud Control Unit is
responsible for policing the Medicaid Program, as well as investigating
allegations of corruption and fraud in the administration of the program.

The Medicaid Fraud Control Unit also investigates the abuse, neglect
and exploitation of the elderly, as well as ill and disabled residents of
long-term care facilities, such as nursing homes, facilities for the
mentally and physically disabled and assisted care living facilities. One
of the ways this is accomplished is by conducting random spot-check visits
to these types of facilities. Each month, random visits are made to a few
of the above mentioned facilities. The visits help determine whether
Medicaid policy and procedures are being followed. Other entities that
attend these visits include the Agency for Persons with Disabilities,
Department of Health, Ombudsmen, Building Code Compliance officials, local
fire inspectors and the Health Quality Assurance Division of the Agency
for Health Care Administration, which licenses and regulates this

The Attorney General’s Medicaid Fraud Control Unit has undergone
substantial growth and development since January 2007, including a
reorganization of regional responsibilities, new training initiatives and
new procedures for case management. In addition to the recent
developments, the unit has created a new bureau tasked with investigating
and litigating multi-state false claims cases involving false claims to
the Florida Medicaid program. The Complex Civil Enforcement Bureau (CCEB)
will work primarily with “Qui Tam” or whistleblower actions brought
pursuant to the Federal False Claims Act. Plaintiffs include the Relator,
the United States, and the various states whose Medicaid programs have
paid false claims pursuant to the alleged scheme to defraud. An executive
summary of the unit’s accomplishments is available online at:

Working to improve access to affordable, quality health care for all
Floridians, AHCA administers Florida’s $16.6 billion Medicaid program,
licenses and regulates more than 32,000 health care facilities and 37
health maintenance organizations, and publishes health care data and
statistics. More information is available online at:

A copy of the annual report for the 2006-2007 fiscal year is
available online at:

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