July 10, 2010 - TALLAHASSEE, FL - Attorney General Bill McCollum and Secretary Tom Arnold of the Florida Agency for Health Care Administration today announced they have submitted a formal request for a waiver from the federal government which, if granted, would launch a Florida pilot program for enhanced Medicaid fraud enforcement. The waiver would permit the Attorney General's Medicaid Fraud Control Unit increased authority to access data from the Florida Medicaid program so the unit can generate its own leads for investigations.
"This waiver program has been one of my top priorities for over a year because for the first time, our Medicaid Fraud Control Unit would be able to routinely analyze Medicaid claims data to detect fraud," said Attorney General McCollum. "If this waiver is granted, Florida will become the first in the nation to have a program granting a state attorney general authority to routinely review this data."
The Attorney General has written several letters to the federal government requesting a waiver of the federal regulation and has worked on this initiative with the Agency for Health Care Administration for over a year. Today's request is the result of over 14 months of cooperative effort that will ultimately benefit the Florida taxpayers.
Currently, state Medicaid Fraud Control Units are prohibited by Federal Code from proactively reviewing data to determine whether fraud is taking place. The waiver would make the process for reviewing this data more efficient, allowing McCollum's Medicaid Fraud Control Unit to mine data on Medicaid's fee-for-services program and identify any outliers, anomalies, or other indicators of fraud.
"Our Agency and the Attorney General's Medicaid Fraud Control Unit have a long history of cooperating to fight Medicaid fraud," said Secretary Arnold. "I look forward to strengthening our collaboration, increasing the effectiveness of investigations and preventing Medicaid fraud through this demonstration project."
Going forward, the Medicaid Fraud Control Unit would be able to review the billing practices of Medicaid providers such as doctors, pharmacies and hospitals. For example, the unit would be able to proactively obtain data from hospitals that are Medicaid providers to ensure that the Florida Medicaid program is not being over billed or is submitting reimbursements for services that were never provided.
A copy of the formal request and an outline of the plan for the waiver is online at:
http://myfloridalegal.com/webfiles.nsf/WF/MRAY-875JCC/$file/AHCALetter.pdf