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State claims $40-million cut in Medicaid fraud

Stepped-up efforts to fight Medicaid fraud saved the state nearly $40-million last year, state health care regulators said Monday.

More reviews of claims before making payments and a big increase in the number of health care providers who were kicked out of the Medicaid program resulted in the savings, which were 57 percent higher than the year before, the Agency for Health Care Administration said in its annual report on Medicaid abuse.

In the fiscal year that ended in July 2005, the agency required prior review of payments submitted by 285 providers, nearly triple as many as were checked in advance the year before.

The agency requests more documentation from those providers before approving claims because their billing in the past has been suspicious in some way.

The agency has been under pressure for years to curb spending on Medicaid, which pays care costs for more than 2-million poor, disabled, and nursing homebound Floridians.

"This has been one of my biggest priorities," said AHCA Secretary Alan Levine. He said efforts to chase fraud after it has been committed are inefficient, because it can cost nearly as much to track it down as will be recovered.

"So the biggest focus for us is to try and prevent it," Levine said.

He said the agency has been moving much more swiftly than in the past to terminate contracts with providers suspected of fraud. Last year, 224 providers were kicked out of the program, up from just 28 two years earlier.

AHCA conducted more than 1,500 audits of Medicaid providers in the fiscal year that ended last July, officials said.

In all, the agency avoided paying $38.8-million in fraudulent claims by catching them in advance, the report said.

The report said another reason for better fraud protection was an increase in recovering money from third parties that may have been liable for someone's medical expenses, such as an insurance company or Medicare.