All Providers
A Note from the Inspector General
– Linda Keen, R.N., J.D., M.S.W., Inspector General, AHCA
Section 20.055 (2), F.S., establishes the Office of the Inspector General (oig) in each state agency to promote accountability, integrity and efficiency in government. Each ig is appointed, supervised and removed by their respective agency head. The major responsibilities of the oig include investigations, audits and reviews of state agency programs and activities.
The OIG at the Agency for Health Care Administration (AHCA) has oversight of the Bureau of Medicaid Program Integrity (MPI). Title 42 CFR, Part 455, establishes the requirements for a state fraud detection and investigation program, and for disclosure of information on ownership and control. Under the authority of sections 1902(a) (4), 1903(i)(2) and 1909 of the Social Security Act, Subpart A provides state plan requirements for the identification, investigation, and referral of suspected fraud and abuse cases.
MPI is responsible for overseeing the activities of Medicaid beneficiaries, and Medicaid providers and their representatives, to ensure that fraudulent and abusive behavior and neglect of beneficiaries occur to the minimum extent possible, and for recovering overpayments and imposing sanctions as appropriate. This is done by conducting audits and investigations using MPI staff as well as outside contractors. Investigations may employ statistical sampling, computer-based analyses or focused audits using selective samples of areas deemed to be of higher risk.
Providers are encouraged to be compliant with Medicaid policy. At the time of enrollment, an applicant completes a provider agreement, which states in part, that the provider agrees to comply with laws, rules and Medicaid handbooks. As a provider, you should be familiar with your Medicaid provider agreement, Section 409.913, F. S., the applicable Medicaid handbook(s) and any applicable licensure laws.
Florida Statutes and Florida Administrative Code are available on the Internet. Medicaid handbooks are located on the fiscal agent website. Additional information about the Florida Medicaid program is on the AHCA website. We encourage you to follow Medicaid policies and procedures. If you suspect any type of fraud or abuse within Medicaid, please call 1-888-419-3456 or go to http://ahcaxnet.fdhc.state.fl.us/InspectorGeneral/fraud_complaintform.aspx.