Governor Ron DeSantis and Agency for Health Care Administration (AHCA) Secretary Shevaun Harris announced a sweeping Medicaid integrity initiative on June 12 aimed at strengthening oversight, preventing fraud before it occurs, and ensuring Medicaid dollars are used to serve eligible Floridians.

The initiative represents one of the most significant anti-fraud efforts undertaken by the state and reflects a broader shift away from the traditional “pay and chase” model — where fraudulent payments are identified and recovered after the fact — and toward proactive prevention and real-time oversight.

According to the Governor’s Office, the reforms are intended to strengthen provider accountability, enhance fraud detection capabilities, and protect taxpayer resources while ensuring Medicaid funding remains available for vulnerable populations who rely on the program.

“Today, we announced major actions to strengthen the integrity of Florida’s Medicaid program and crack down on fraud,” Governor DeSantis said. “In Florida, we work to ensure that taxpayer dollars are spent responsibly and that public programs serve the people they are intended to serve.”

Growing Focus on Medicaid Program Integrity

Governor DeSantis noted that Medicaid fraud has become a growing national concern, citing major investigations in other states and recent federal efforts to strengthen program integrity. He said the Trump Administration and the Centers for Medicare & Medicaid Services (CMS) have directed states to enhance provider screening, increase oversight, and remove fraudulent actors from Medicaid programs.

The initiative also builds upon Florida’s broader efforts to strengthen program integrity. In April, Attorney General James Uthmeier launched the Task Force on Public Assistance Fraud, a multi-agency initiative involving AHCA, the Florida Department of Law Enforcement (FDLE), and other state partners. The Task Force was established to improve coordination among investigators and prosecutors, accelerate enforcement actions, and strengthen the state’s ability to pursue increasingly sophisticated Medicaid and public assistance fraud schemes.

Together, the Task Force and AHCA’s newly announced reforms signal a coordinated statewide approach focused on preventing fraud before it occurs, improving enforcement capabilities, and safeguarding public resources.

Florida’s Medicaid program currently serves nearly four million recipients, including children, pregnant women, seniors, and individuals with disabilities.

“The Medicaid program exists to meet the health care needs of pregnant women, children, seniors, and some of our most vulnerable populations,” Secretary Harris said. “Every dollar stolen through fraudulent schemes is one less dollar available to meet the needs of those who rely on the program most. That’s why we are working harder than ever to make sure the right people get the care they need, and everyone trying to exploit this program will be stopped.”

Four-Part Medicaid Integrity Initiative

The initiative consists of four primary components designed to prevent fraud, identify suspicious activity earlier, and strengthen enforcement efforts.

1. Enhanced Provider Screening Through SentiLink Partnership

AHCA will launch a pilot program with SentiLink, a fraud prevention and identity verification company, to strengthen provider screening and identify sophisticated fraud schemes before providers enter or exploit the Medicaid program.

According to the agency, the technology is designed to detect:

• Stolen identities
• Synthetic identities
• Hidden ownership structures
• Other complex fraud schemes designed to evade traditional screening processes

The tools will be used both during provider enrollment and for ongoing monitoring of existing Medicaid providers.

2. Enrollment Moratoriums for High-Risk Provider Categories

As part of its fraud prevention strategy, AHCA has implemented enrollment moratoriums on select high-risk provider categories, including durable medical equipment (DME) suppliers statewide and adult day care providers in Miami-Dade County, allowing the agency to enhance screening procedures and strengthen program oversight.

According to state officials, the moratoriums will remain in place while AHCA deploys additional analytics tools and enhanced provider screening measures.

3. Statewide Medicaid Provider Revalidation

One of the most significant aspects of the initiative is a comprehensive statewide revalidation effort affecting all active Florida Medicaid providers.

Under the initiative, providers will be required to revalidate their:

• Enrollment information
• Professional credentials
• Ownership information
• Identity documentation
• Program eligibility requirements

Providers who fail to complete the process or who do not meet program requirements will be removed from the Medicaid program.

AHCA indicated that the statewide revalidation effort is expected to occur over the next 12 to 24 months and will incorporate enhanced background screening, third-party data verification, real-time monitoring tools, and artificial intelligence-driven identity analytics.

4. Expanded Claims Monitoring and Enforcement

AHCA will also deploy additional tools and analytics to identify potentially fraudulent billing activity and support investigations and enforcement actions.

The initiative includes enhanced collaboration with state and federal partners responsible for:

• Fraud investigations
• Provider oversight
• Enforcement actions
• Victim protection efforts
• Recovery of improperly paid Medicaid funds

Recent Enforcement Results

During the announcement, Secretary Harris highlighted AHCA’s ongoing efforts to strengthen Medicaid program integrity and combat fraud.

According to the agency, over the past two years AHCA has:

• More than doubled Medicaid overpayment recoveries
• Denied or terminated enrollment for more than 3,200 providers
• Generated approximately $136.45 million in recoveries and prevented losses through program integrity initiatives

Secretary Harris also referenced a recent enforcement action in Palm Beach County involving more than a dozen entities posing as Medicaid providers. According to the agency, the entities allegedly operated through shell ownership structures, shared addresses, and without evidence of providing legitimate patient care.

In addition, Harris noted the significant volume of fraud-related complaints received by the Attorney General’s Medicaid Fraud Control Unit (MFCU) and highlighted efforts that have prevented hundreds of providers from enrolling or re-enrolling in the Medicaid program due to prior fraud, abuse, or other program integrity concerns.

What Medicaid Providers Should Expect

While the enrollment moratoriums currently apply only to certain provider categories, all Florida Medicaid providers should anticipate increased scrutiny as AHCA rolls out its enhanced oversight efforts.

Providers should ensure enrollment records, ownership information, licensure documentation, and credentialing information remain current and accurate in preparation for future revalidation requests. Providers should also expect continued emphasis on documentation accuracy, billing integrity, medical necessity requirements, and robust internal compliance programs as state and federal agencies intensify their focus on Medicaid program integrity.

HCAF will continue monitoring implementation of these initiatives and provide members with updates as AHCA releases additional guidance regarding provider revalidation, enrollment requirements, and program integrity expectations.