Toll-free Hotline to Report Medicaid Fraud: 1-866-966-7226
- Attorney General Bondi’s Office Arrests Brevard County Resident for Medicaid Fraud
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- Attorney General Pam Bondi Reaches Landmark $181 Million Multistate Settlement with Janssen Pharmaceuticals, Inc.
- Attorney General’s Office Arrests Okaloosa County Resident for $270,000 in Medicaid Fraud
- Attorney General Bondi Announces that McKesson Corporation Must Pay States More Than $151 Million in Medicaid Fraud Case
The Florida Attorney General’s Office has been investigating and prosecuting Medicaid fraud since the unit became part of the Attorney General’s Office in July 1994. The Florida Medicaid Fraud Control Unit (MFCU) investigates and prosecutes fraud involving providers that intentionally defraud the state’s Medicaid program.
The most common schemes involve doctors, dentists, clinics and other health care providers billing for services never performed, over billing for services provided, or billing for tests, services and products that are medically unnecessary. MFCU investigations involve a wide range of misconduct originating primarily from fraudulent billing schemes.
Examples include phantom billing, where the medical provider bills for services not rendered, and up-coding, where a medical provider bills for providing a costly medical service when only a less expensive procedure was performed.
In addition to investigating fraud committed by health care providers, MFCU also investigates the abuse, neglect and exploitation of the elderly, ill and disabled residents of long-term care facilities such as nursing homes, facilities for the mentally and physically disabled and assisted care living facilities. The investigation of corruption in the administration of the Medicaid program is another important responsibility of MFCU.
Prescription drug diversion is another form of abuse that defrauds the Medicaid system. Prescription drug diversion includes:
- illicit prescribing by physicians
- a nurse ordering medication for patients without a doctor’s approval
- a pharmacist forging documents to filled counterfeit scripts for medication
- a health care worker stealing a patient’s medication, selling it, or keeping it for him/herself
- a patient doctor shopping
In March 2011, Governor Rick Scott and Attorney General Pam Bondi created the Regional Drug Enforcement Strike Forces to reduce the supply of diverted prescription drugs through intelligence driven, multi-jurisdictional operations against the whole spectrum of the prescription drug abuse phenomenon: corrupt wholesalers, unscrupulous “physicians”, rogue pharmacies and the “doctor-shopping” “patients” supporting their addiction. Each of the seven Strike Forces is co-led by a Sheriff and a Police Chief. MFCU supports the Regional Drug Enforcement Strike Forces by working with local law enforcement and state health regulators when the nexus of Medicaid fraud and prescription drug diversion exists.
Medicaid fraud drives up the cost of health care for all Floridians. We each have an important role to play in reporting fraud, waste and abuse within the Medicaid system. The Attorney General’s Office welcomes the assistance of citizens in fighting health care fraud. Under Florida’s False Claims Act, people who blow the whistle on Medicaid Fraud are entitled to share in any funds recovered by the state.
"In these tough fiscal times, we need to ensure that every dollar spent on Medicaid goes to Floridians in need – not to criminals who exploit the system."
The unit has its administrative headquarters in Tallahassee and has field offices located in eight cities across Florida. To report fraud or abuse, individuals may use the statewide hotline number or contact the Medicaid Fraud Control Unit nearest them:
The hearing impaired may now report Medicaid Provider Fraud Monday through Friday, 7:30 a.m. to 4:30 p.m., by contacting the Medicaid Fraud Control Unit at (850) 414-3935 (voice/TTY) or through the Florida Relay at 1-800-955-8771 (TTY)