Despite vast elderly population, Florida lags other states in stopping Medicaid fraud

By Mark Stricherz
The Center Square

(The Center Square)—In Florida, a state with more elderly people than any other, state government officials lag their peers in deterring fraud in a popular taxpayer-financed program for the elderly poor and disabled, an investigation by The Center Square found.

All 50 states and three territories have a Medicaid Fraud Control Unit, a joint federal-state agency that investigates and prosecutes not only the abuse and neglect of recipients in hospitals and nursing homes but also fraud by Medicaid providers. In 2022, the latest year for which comparative data are available, Florida ranked a distant third among states at recovering Medicaid dollars, at $88.3 million, according to the National Association of Medicaid Fraud Control Units, a professional organization.

By comparison, the state of Louisiana regained $86.4 million—a figure of only $1.9 million less despite having about one-fifth of Florida’s population of 22.2 million. Texas recovered $219.9 million, the highest figure and almost two-and-a-half times more than Florida’s. Florida’s Medicaid budget was $28.3 billion.

Further, Florida’s Medicaid Fraud Control Unit reported preventing $236.2 million in fraud in 2024—$9 million less than the year before, according to a report from the state’s Attorney General. Jae Williams, press secretary for Florida Attorney General James Uthmeier, said the numbers alone don’t tell the full story. “It’s critical to keep in mind that from 2022 to 2024, there was a dip in all of the state’s recoveries of Medicaid dollars,” Williams said in an interview. “You can’t predict what a jury will award and the speed with which a case will go through the courts. A lot of that depends on the Department of Justice. They had other priorities besides fraud.” He added that in 2024, Florida’s Medicaid Fraud Control Unit recovered $76.2 million compared to Louisiana’s $63.5 million.

While Florida state officials trailed other states in fighting Medicaid, some federal counterparts in the Sunshine State lapped the field in punishing Medicare fraudsters.

Two years ago, no federal judicial district in the country sentenced more people to prison for health care fraud than the Southern District of Florida, a nine-county region that includes Miami and Fort Lauderdale. The district put 65 people behind bars, according to the U.S. Sentencing Commission, an independent federal judicial body.

That was more people than in the districts with the second-most sentences, the District of New Jersey (31), and the third-most sentences, the Southern District of New York (26), combined.

Miami was the first city, in 2007, to have a Medicare Strike Force team, an interagency unit that has prosecutors from the U.S. Justice Department, FBI agents, and investigators from the Department of Health and Human Services Office of Inspector General. The unit prosecutes fraud in Medicare, a federal health plan for seniors 65 and older.

“Florida, for sure, is a hotspot for Medicaid and Medicare fraud, not just in terms of volume but value,” Michael F. Arrigo, a medical billings expert, said in an interview with The Center Square. A history of health care fraud

Florida’s uneven record may soon face renewed scrutiny as the Trump administration seeks to crack down on scams in federal entitlement programs.On Jan. 8, Vice President J.D. Vance announced the administration had created an assistant attorney general position to root out fraud, with an initial focus on Minnesota. The state is home to a $250 million scandal in a federal food program and another involving Medicaid. Two spokespeople for Vice President Vance did not immediately return an email for comment.

Despite the focus, fraud in federal entitlement programs transcends Minnesota. As The Center Square reported last month, the U.S. Justice Department found as much as $36 billion in scams from 2020 to last year.

Florida had as much as $894.5 million in fraud, TCS found. The list of 24 alleged and actual offenders included more than providers notorious for fraud, such as telemarketers and telemedicine firms. It also included the Florida Department of Children and Families, which oversees federal entitlement programs such as Medicaid and food stamps.

In 2021, the state agency reached a $17.5 million settlement over claims that it submitted false quality-control data to the U.S. Department of Agriculture’s food-stamp program in 2011 and 2012 to receive employee performance bonuses, according to the U.S. Justice Department.

“(I)t is shocking these claims were submitted by the Florida Department of Children and Families, the state agency entrusted with assisting vulnerable and needy individuals,” Acting U.S. Attorney Joseph H. Harrington for the Eastern District of Washington said in a new release, though he commended the agency for settling the claims.

Florida state agencies have drawn fire for failing to combat healthcare fraud before.

In 2017, the U.S. Department of Health and Human Services’ Inspector General released reports regarding seven states for their compliance with a recent federal requirement aimed at cracking down on fraudulent providers. Florida was one of only two states that suspended fewer than half of the providers whose investigations had uncovered “credible fraud” allegations.

From March 2011 through 2013, HHS’ inspector general reviewed 95 cases in which Florida officials determined that fraud allegations against a provider were credible. In only 40 cases did Florida’s Agency for Health Care Administration suspend the payments. As a result, the state failed to prevent $70.2 million from going to providers credibly accused of scams.

“The state agency repeatedly failed to suspend payments when there was a credible fraud allegation because it neither updated its policies and procedures to reflect the requirements of the Act nor adhered to the memorandum of understanding…” the inspector general concluded in the report.

Florida officials admitted “we have greatly improved agency processes since these audits were initiated” and returned $228,000 to the federal government after acknowledging it had failed to document the return.

However, Florida officials denied most of the federal charges, including that it should have withheld Medicaid funding from 49 providers accused of scams. They said the charges did not rise to the level of being “credible” and noted that the providers were cleared of the allegations against them. In response, the HHS Inspector General noted that Florida officials provided no documentation to show that they had good cause to continue paying the accused providers.

At the time, Florida’s governor was Rick Scott, the former co-founder of Columbia Health Care, which, after merging with HCA Inc. in 1994, became the nation’s largest for-profit hospital chain. In 1997, the U.S. Justice Department opened a wide-ranging fraud investigation into the company’s practices, a move that prompted Scott to step down as CEO. By 2003, the company had agreed to pay $1.7 billion in civil fines and damages, a record sum. “Largest health care fraud case in U.S. history settled HCA investigation nets record total of $1.7 billion,” a Justice Department statement said.

Today, Scott is Florida’s senior U.S. senator. Spokeswoman Clare Lattanze did not immediately reply to an email for comment.Arrigo, a medical billings expert who has testified as an expert at multiple trials, said Florida officials have their work cut out for them.

“Prosecuting health care fraud is not for the faint of heart,” he said in an interview. “It’s complex. The accused doesn’t just own up to fraud. By necessity, making a case takes time, typically including an expert forensic review of a statistically valid sample of medical records and medical bills.”