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State reports hike in Medicaid fraud

Published December 31, 2006


TALLAHASSEE - Investigators helped recover more than $74-million in taxpayer money involving Medicaid fraud in Florida this past fiscal year, an increase of more than 75 percent from the previous year, a state report showed.

The report released Friday also said the state terminated 194 providers from participating in Medicaid in fiscal 2005-2006, up from 28 during fiscal 2004-05.

Both the Florida Agency for Health Care Administration and the state Attorney General's Office have units investigating fraud in Florida's $15-billion Medicaid system.

The teams investigate fraud involving doctors, nursing homes, pharmacies, medical equipment companies and other providers.

Some of the crimes include overbilling or billing the government for services not provided.

Since 2003, the state fraud units made more than 200 arrests, resulting in 123 convictions, the report showed.

Local state attorneys prosecute those arrested, and civil suits also are pursued.

This past fiscal year, the state's investigations led to the recovery of $74,872,888 in taxpayer funds, up from $41,872,801 in fiscal year 2004-2005, the report showed.

Also, the fraud teams prevented $37-million in overpayments, the report showed. Prevention techniques include a prepayment review system, denied payments and recommendations for termination when providers are suspected of misuse of the system.

The report also showed that the 194 providers barred from participating in Medicaid included 80 doctors and 30 home and community-care entities.

[Last modified December 31, 2006, 01:02:34]

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