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Massive Medicaid fraud leads to moratorium in Miami, Broward

A state-wide program that funds costly treatment for low-income children who suffer from autism was dealt a blow this month when regulators put a hold on enrollment of new behavioral analysis therapists. Regulators blamed the moratorium on widespread fraud and overbilling by individuals and agencies who were supposed to be delivering this effective type of therapy to needy autistic children in Miami-Dade and Broward counties, and across Florida.

Medicaid and Medicare fraud has become increasingly widespread in the Sunshine State and elsewhere in the United States. Several therapy providers, pharmacies and home health care agencies in South Florida have run afoul of regulators and law enforcement in recent months. A single case easily represents millions of dollars in fraudulent claims, overbilling or charges for services never rendered.

In announcing the behavior analysis moratorium, the Florida Agency for Health Care Administration, which oversees the state’s Medicaid program, announced that it had pending investigations of more than 100 group providers and 700 individual providers. The AHCA believed that these providers may have enrolled using deception in order to bill for the costly behavior analysis therapy.

According to AHCA, it particularly zeroed in on Miami-Dade as a high-risk area for fraudulent enrollment and billing practices. Some of the fraudulent activities identified included billing for more than 24 hours in a day and more than 31 days in a month; falsified qualifications, which put children at risk; and more than a dozen referrals of larger provider groups for suspected fraudulent activity. The AHCA says that during the moratorium, no recipients will go without the services they need.

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