Florida combats Medicaid fraud by targeting bad actors at enrollment instead of cutting legitimate provider rates, offering a model for US states.
Every other state dealing with Medicaid fraud is doing it the lazy way: across-the-board rate cuts that punish legitimate providers along with the fraudsters. Nebraska slashed autism therapy payments by up to 80%. Indiana floated payment caps. Colorado and New York are considering budget cuts that would gut access for kids who genuinely need care. That’s not fraud enforcement. That’s budget balancing dressed up as reform — and the families paying the price have every right to be furious.
Florida is doing it differently. And the rest of the country needs to pay attention
Last month, Governor DeSantis launched a statewide Medicaid Integrity Initiative built around one core principle: catch the fraudsters before they enroll, not years later after prosecutors show up with an indictment. Florida’s Agency for Health Care Administration is partnering with identity-verification firm SentiLink to detect stolen identities, synthetic identities, and hidden ownership structures at the enrollment stage. Every active Medicaid provider in the state has to revalidate credentials or get dropped. High-risk provider categories face enrollment moratoriums. No legitimate provider loses a dime for doing their job honestly. The results justify the approach. Over the past two years, Florida has terminated or denied enrollment to more than 3,200 providers and recovered more than $72 million in improper payments. That money didn’t come from cutting therapy hours. It came from catching people who were billing for therapy that never happened.