Florida Cuts Nearly $1 Billion From Projected Medicaid Costs as Fraud Crackdown Expands

Florida officials say an expanded effort to detect Medicaid fraud, waste, and abuse has sharply reduced projected spending on a major autism therapy program while leading to hundreds of provider actions. The state’s Agency for Health Care Administration has conducted more than 400 provider site visits since January, made more than 150 fraud referrals to the Florida Attorney General’s Office, and restricted or suspended payments to more than 260 providers. More than 220 providers have also been terminated from Florida Medicaid, with the state saying those providers accounted for more than $230 million in Medicaid billing during 2025.

Projected ABA Spending Falls by Nearly $1 Billion

One of the biggest changes involves applied behavior analysis, or ABA, a therapy commonly used by children with autism and other developmental conditions. Florida had previously projected Medicaid spending on ABA services at about $3.86 billion, but the state now projects approximately $2.88 billion in spending for fiscal year 2026-27. That represents a projected reduction of nearly $1 billion, although officials attribute the change to a combination of managed care, utilization management, and stronger efforts to prevent fraud and improper payments.

Florida Says It Is Targeting Suspicious Billing

State investigators say some of the suspicious billing they uncovered involved providers reporting unusually high numbers of service hours. In some cases, providers billed Medicaid for more than 24 hours of services in a single day, while other claims showed services being billed on consecutive days over weekends and holidays for extended periods. Officials say these patterns can signal potential fraud or abuse and are being investigated rather than automatically treated as proof of criminal wrongdoing.

More Than 220 Providers Have Been Removed

Florida says more than 220 providers have been terminated from the Medicaid program for fraud, waste, or abuse as part of the intensified oversight. Those providers collectively accounted for more than $230 million in Medicaid billing in 2025, according to the governor’s office. The state has also placed more than 260 providers under payment restrictions or suspended payments while investigations and reviews continue.

Hundreds of Site Visits Are Part of the Crackdown

The enforcement campaign goes beyond examining claims after money has already been paid. Since January, AHCA has conducted more than 400 provider site visits, focusing particularly on areas where billing data and other indicators suggest elevated risk, including ABA, durable medical equipment, and adult day care. The state says the broader strategy is intended to identify questionable providers earlier and prevent improper payments from leaving the Medicaid program in the first place.

Florida Is Changing How It Screens Providers

Florida’s initiative includes new screening and revalidation measures designed to determine whether Medicaid providers are legitimate and properly credentialed. AHCA has launched a statewide revalidation effort requiring active providers to verify their credentials and identity, while also imposing enrollment controls on certain high-risk provider categories. The agency is also expanding background screening, claims monitoring, and data analytics to identify suspicious activity.

Technology Is Being Used to Find Hidden Problems

AHCA has also begun a pilot program with SentiLink, a company that helps identify potentially suspicious identities and ownership information. State officials say the technology can help flag stolen or synthetic identities, hidden ownership structures, and other issues that may warrant closer examination. The technology is being used as one part of a broader screening system rather than as a substitute for investigations and other oversight tools.

The State Says Legitimate Patients Should Not Lose Care

The crackdown could raise concerns for families whose providers are suspended or terminated, particularly children who depend on ongoing ABA services. Florida officials say legitimate patients should continue receiving necessary care and that managed care plans can help affected families locate replacement providers when needed. The state says more than 60,000 registered behavior technicians currently serve about 40,000 children, although individual families may still face disruptions when a provider is removed.

Florida Wants to Prevent Fraud Before Payments Go Out

The new approach represents a shift from recovering questionable payments after they have been made toward trying to stop improper claims before taxpayer money is released. Florida announced the initiative in June as a comprehensive effort involving provider screening, fraud detection technology, enrollment controls, and revalidation of active providers. State officials say the goal is to direct Medicaid funding toward legitimate medical services while reducing opportunities for fraudulent or abusive billing.

A Major Savings Claim With Broader Implications

Florida’s nearly $1 billion reduction in projected annual ABA spending is one of the most significant early results officials have reported from the expanded Medicaid integrity campaign. At the same time, the savings figure is a projection rather than money already returned to the state, and officials attribute it to multiple factors including the move to managed care, utilization controls and fraud enforcement. With millions of Floridians relying on Medicaid, the challenge will be maintaining those savings while ensuring that legitimate patients continue receiving the care and services they need.