Kelly Bennett, Chief
Office of Medicaid Program Integrity
Division of Health Quality Assurance
The Office of Medicaid Program Integrity audits and investigates providers suspected of overbilling or defrauding Florida's Medicaid program, recovers overpayments, issues administrative sanctions, and refers cases of suspected fraud for criminal investigation. Additional details about these efforts are provided in the Agency’s annual fraud report, The State’s Efforts to Control Medicaid Fraud and Abuse, several years for which can be found below.
MPI also works closely with other organizational units with the Agency. For example, MPI imposes administrative sanctions, which may include provider terminations from Medicaid participation. In partnership with the Office of the General Counsel, these action which culminate into an Agency Final Order are available to the public. The Agency’s Final Order database is available for download at the link for AHCA Sanctioned Providers.
MPI also coordinates with state and federal agencies such as the Office of the Attorney General’s Medicaid Fraud Control Unit, the Centers for Medicare and Medicaid Services Center for Program Integrity, and the Department of Health and Human Services (HHS) Office of the Inspector General. HHS is the federal agency responsible for federal exclusions. Along with the Division of Medicaid, MPI assists in ensuring that excluded individuals and entities are not participating in the Florida Medicaid program.
To report suspected Medicaid fraud complete a complaint form online. Suspected Medicaid fraud by ineligible recipients may be reported to the Florida Department of Children and Families, Office of Public Benefits Integrity.
Finally, the Agency recommends that Medicaid providers consider performing routine self-audits and has provided resources which may assist with those efforts. There are additional resources available on the HHS website as well as this pamphlet about avoiding fraud and abuse.