AG Moody Fights Medicaid Fraud as Enrollment Increases

TALLAHASSEE, Fla.—Attorney General Ashley Moody continues to fight price gouging, scams and fraud related to the COVID-19 pandemic. As the pandemic and resulting economic crises deepen, enrollment in Florida’s Medicaid Program is increasing. More than four million Floridians now rely on Medicaid for health coverage, creating more opportunities for criminals to exploit the government benefit to steal taxpayer money. Attorney General Moody’s Medicaid Fraud Control Unit is committed to identifying, investigating and stopping fraud in the government health care program. Since Attorney General Moody took office in January 2019, MFCU has secured more than $54 million in settlements and judgments as a direct result of actions brought by the office. MFCU also conducted investigations leading to the arrests of nearly 90 individuals charged with Medicaid fraud.

Attorney General Ashley Moody said, “With thousands more Floridians now depending on Medicaid as a result of COVID-19, there is more opportunity than ever before for fraudsters to take advantage of this program. Rest assured that we will not tolerate it. My Medicaid Fraud Control Unit will continue to aggressively pursue fraudsters and seek to recover taxpayer funds. Our analysts, attorneys, auditors and investigators are dedicated to protecting the integrity of the Medicaid program by bringing to justice anyone who would leverage this health care crisis to exploit the hardworking taxpayers of this state.”

Attorney General Moody recently issued a Consumer Alert warning Floridians about long-term care facilities seizing the stimulus payments of residents in the Medicaid program. To view the alert, click here. Additionally, health care providers must remember to not seek payment from Medicaid recipients for co-payments, co-insurance, deductibles, or other cost-sharing during the declared state of emergency. On March 16, Florida Medicaid waived co-payment requirements for all services. Florida Medicaid also indicated it will pay for medically necessary services provided to Medicaid recipients diagnosed with COVID-19, regardless of whether the provider is located in-state or out-of-state.

The potential for identity theft to increase, along with the growing Medicaid enrollment, is a real possibility. To guard against identity theft, Medicaid recipients should:

• Never share personal identifying information or protected health information over the phone;
• Beware of solicitation from telemarketing organizations or telemedicine companies asking for Medicaid recipient PII or PHI;
• Avoid phone calls or text messages offering free COVID-19 tests, or other communications claiming to be acting on behalf of government entities; and
• Remember that free tests are never sent to the Medicaid recipient.

These are just a few examples of government benefit fraud schemes and trends that have emerged since the pandemic struck Florida. Attorney General Moody’s MFCU continues to work with local, state and federal agencies to stay ahead of trends and identify emerging COVID-19 related fraud schemes.

MFCU investigates and prosecutes fraud involving providers that intentionally defraud the state's Medicaid program through fraudulent billing practices. MFCU investigates a wide range of misconduct originating primarily from fraudulent billing schemes. The most common schemes involve clinics, dentists, doctors and other health care providers billing for services never performed, overbilling for services provided, or billing for products, services and tests that are medically unnecessary.

MFCU also investigates allegations of patient abuse, exploitation and neglect in facilities receiving payments under the Medicaid program, such as nursing homes, facilities for the mentally and physically disabled, and assisted living facilities.

If you suspect Medicaid fraud, please report it to the Florida Attorney General’s Office by calling 1(866) 9NO-SCAM or visiting MyFloridaLegal.com.

The Florida Attorney General’s Medicaid Fraud Control Unit investigates and prosecutes providers that intentionally defraud the state’s Medicaid program through fraudulent billing practices. Medicaid fraud essentially steals from Florida’s taxpayers. From Jan. 2019 to the present, Attorney General Moody’s MFCU has obtained more than $54 million in settlements and judgments. Additionally, the MFCU investigates allegations of patient abuse, neglect and exploitation in facilities receiving payments under the Medicaid program.