Florida Healthcare Exclusion
Under the State of Florida’s Agency for Health Care Administration (AHCA) is the Office of the Inspector General, spearheaded by Chief Kelly Bennett. As an integral part of the AHCA, the Office of the Inspector General “provides a central point for coordination of and responsibility for activities that promote accountability, integrity, and efficiency,” and functions in keen pursuant to Section 20.055 of the Florida Statutes.
The Office of the Inspector General actively fosters its core mission: “To assist the Secretary and other Agency management in championing accessible, affordable, quality healthcare for all Floridians by assessing the efficiency and effectiveness of health care administration resource management.”
This mission is carried out through an array of functions, including:
- Independent examination and evaluation of Agency programs, activities, and resources.
- Internal investigations of alleged violations of Agency policies, procedures, rules or laws.
- Investigation of suspected fraud and/or abuse of the state’s Medicaid program.
The Office of the Inspector General supervises four units: Internal Audit, Investigations, HIPAA Compliance Office, and Medicaid Program Integrity.
The Medicaid Program Integrity office exists pursuant to Section 409.913, Florida Statutes. Its main objective is the investigation of providers suspected of fraud or abuse of the state’s Medicaid program. Other functions of this office include:
- Recovery of overpayments
- Issuance of administrative sanctions
- Referral of fraud-related cases to the Office of the Attorney General for criminal investigation
Through the sustained efforts of the Medicaid Program Integrity under Florida’s Office of the Inspector General, $905 million recoveries have been made from 2008 to 2015. In FY 2014-15, a total of $34,234,735.00 was made in both civil and criminal cases.
For reports of suspected fraud, contact the MPI’s hotline at 1-888-419-3456 or Complete a complaint form online.
Some Florida OIG Exclusion Stats:
- A total of 6,347 individuals and/or entities from Florida have been listed on the List of Excluded Individuals/Entities since 1978.
- This includes 734 total number of businesses on the LEIE.
- 1,939 listed on the LEIE from Florida for the years 2010-2015 which is about 7% decrease from the previous period of 2,070.
- Exclusions include among others:
- Entities controlled by a family or household member of an excluded individual and where there has been a transfer of ownership/ control.
- Default on health education loan or scholarship obligations.
- License revocation or suspension.
- Felony conviction relating to health care fraud.
- Specialties with OIG exclusions among others are:
- Billing Dept.
- Home care
- Plastic Surgery