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Audit faults state agency over Medicaid fraud

It could do more to curb fraud and recover money, it says. An official disagrees.


© St. Petersburg Times, published September 15, 2001

It could do more to curb fraud and recover money, it says. An official disagrees.

TALLAHASSEE -- Florida's Agency for Health Care Administration could do more to curb Medicaid fraud and recover those dollars, legislative auditors said this week.

In fact, AHCA may have lost between $445-million and $890-million last year on Medicaid fraud alone. Not only has that contributed to budget woes, AHCA has done too little to recover that money, auditors wrote.

Medicaid is the joint federal-state program to provide health care coverage to the poor.

"The agency rarely sanctions providers by applying disincentives such as fines, comprehensive followup reviews and prepayment review of claims," the audit said.

"For the most part, providers need only repay money they should not have received in the first place."

Bob Sharpe runs the state's Medicaid program. He disagreed with the numbers Medicaid used to estimate the fraud levels and said the agency has produced its own detailed reports showing how much money it has recovered.

"I think the report used estimates of fraud and abuse inappropriately," Sharpe said. He added that the state demonstrated during a grand jury investigation into fraud several years ago that the estimates auditors used don't apply to Florida's Medicaid program.

The legislative audit further said that from 1995 to 2001 AHCA recovered $96-million from providers that had overbilled the Medicaid program. But during the same period, estimates of losses from fraud and abuse ranged from just over $2-billion to more than $4-billion, between 5 and 10 percent of Medicaid expenditures.

The audit recommends that AHCA develop standards to evaluate Medicaid fraud, impose more sanctions against those who commit fraud and report its findings to the Legislature.

-- Information from the Associated Press was used in this report.

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