The Agency for Health Care Administration (Agency) is now accepting nominations for the 2017 Fraud Fighter Achievement Award. This award recognizes an individual, team or entity whose efforts to reduce or deter fraud increased integrity in health care while supporting the Agency’s mission of providing better health care for all Floridians.
A nominee of this award may be a Medicaid recipient or provider, government official or entity, or a private citizen who demonstrates the Agency’s values of accountability, fairness, responsiveness, and teamwork in efforts that helped to detect, prosecute, or prevent fraudulent activity in health care.
Nominations will be accepted through November 3, 2017 and award winners will be recognized during Fraud Awareness Week (November 12-18, 2017). The nomination form and a list of past winners are available on the Agency’s website.
The Agency uses many techniques to deter fraud or abuse in the Medicaid program including, but not limited to:
- Field initiatives that incorporate teams of investigators focusing on a single provider type making unannounced visits and specific checks regarding Medicaid billing, necessary medical services rendered, proper licenses, and certifications;
- Third-party billing verification to ensure that Medicaid is the payer of last resort;
- In-house data-mining and analytical efforts that allow the Agency to perform random audits of providers’ billing activities and run targeted audits of providers that bill outside the average for their provider type; and
- Educational programs for providers to help them understand the Medicaid billing process, the laws, rules and regulations that apply to them as providers.
In addition, the Agency, in collaboration with the Office of the Attorney General, annually releases a comprehensive report highlighting efforts to reduce and deter fraud and abuse. Click here to view the 2015-16 Florida Medicaid Fraud and Abuse Annual Report.