
佛罗里达州官员表示,在该州对医疗补助计划(Medicaid)欺诈行为展开大规模打击行动后,仅行为治疗服务的年度预计支出就减少了近10亿美元。此前,调查人员发现了可疑的收费行为。
Florida's sweeping Medicaid fraud crackdown has helped drive a nearly $1 billion reduction in projected annual spending on behavioral therapy services alone, according to state officials, after investigators uncovered suspicious billing practices.
塔拉哈西市政府的内部打击行动中发现,一些服务提供者向医疗补助计划申报的时长甚至超过了实际的一天时长。此次行动正值联邦政府加强对医疗补助计划欺诈行为的审查之际,相关调查和支付审核也涉及明尼苏达州。
Tallahassee’s internal crackdown — which included discoveries of providers billing Medicaid for more hours than there are in a day — comes amid heightened federal scrutiny of Medicaid fraud, including investigations and payment reviews involving Minnesota.
德桑蒂斯政府表示,其方法旨在在纳税人资金支付前就阻止可疑的医疗补助申请,而不是事后试图追回不当支付。这一策略呼应了美国卫生与公众服务部(HHS)部长罗伯特·F·肯尼迪小杰提出的呼吁,即逐步摒弃传统的“先支付、后追讨”模式。
The DeSantis administration said its approach aims to stop suspicious Medicaid claims before taxpayer dollars are paid out rather than trying to recover improper payments afterward. The strategy mirrors a call from HHS Secretary Robert F. Kennedy Jr. to move away from traditional "pay-and-chase" models.
州长罗恩·德桑蒂斯在一份新闻稿中表示:“今年,我们宣布了本州历史上最重大的医疗补助计划诚信计划,今天,我很自豪地宣布这些努力取得的部分成果。”
"This year, we announced the most significant Medicaid integrity initiative in the history of our state, and today, I was proud to announce some of the results from these efforts," Gov. Ron DeSantis said in a news release.
VANCE 因医疗补助欺诈打击问题以联邦资金威胁各州,施压升级已有超过220家医疗补助计划服务提供者因欺诈、浪费或滥用行为被终止合作,另有超过260家面临支付限制或暂停。在过去一年中,该州还将超过150起涉嫌欺诈的案件移交至总检察长办公室。
VANCE TURNS UP HEAT ON STATES WITH FEDERAL CASH THREAT OVER MEDICAID FRAUD CRACKDOWN More than 220 Medicaid providers have been terminated for fraud, waste or abuse, while more than 260 have faced payment restrictions or suspensions. The state has also referred more than 150 suspected fraud cases to the attorney general's office over the past year.
据州长办公室称,应用于自闭症儿童的一种常见疗法——应用行为分析(ABA)——的年度医疗补助支出原预计达到38.6亿美元,但如今预计将在2026-27财年降至28.8亿美元。官员们将这一近9.8亿美元的削减归因于欺诈执法、医疗管理和使用管理等多方面的努力。
Annual Medicaid spending on Applied Behavior Analysis (ABA), a therapy commonly used for children with autism, had been projected to reach $3.86 billion but is now expected to total $2.88 billion in fiscal year 2026-27, according to the governor's office. Officials attributed the nearly $980 million reduction to a combination of fraud enforcement, managed care and utilization management efforts.
佛罗里达州医疗保健管理局(AHCA)告诉《福克斯新闻数字》平台,其扩大后的监控发现,提供者在数月内于每个周末和假期为 Medicaid 计费,包括有些提供者在同一天计费超过 24 小时的服务。
Florida's Agency for Health Care Administration (AHCA) told Fox News Digital that its expanded monitoring uncovered providers billing Medicaid for services through every weekend and holiday for months, including instances in which providers billed for more than 24 hours of services in a single day.
“保护 Medicaid 就是保护它所服务的对象,”AHCA 秘书 Shevaun Harris 在声明中说。
"Protecting Medicaid means protecting the people it was created to serve," AHCA Secretary Shevaun Harris said in a statement.
“对于儿童、孕妇、残障人士和我们的老年人来说,这意味着确保他们能够获得高质量的护理,同时确保纳税人的钱不会因欺诈或滥用而流失。AHCA 将继续采取果断行动,加强项目完整性,追究不法行为者的责任,保障佛罗里达居民的这些关键服务,”她说。
FRAUD EXPERT EXPOSES HOW HIDDEN NETWORKS DROVE MINNESOTA FRAUD, OTHER MAJOR SCAMS: 'CRIMINAL ENTERPRISE' "For children, pregnant women, the disabled, and our seniors, it means making sure they have access to high-quality care while ensuring taxpayer dollars are not lost to fraud or abuse. AHCA will continue taking decisive action to strengthen program integrity, hold bad actors accountable and safeguard these critical services for Floridians," she said.

Harris 所属机构向《福克斯新闻数字》提供了其打击行动的更多细节,包括其新欺诈防护机制的运作方式。
Harris’ agency provided additional details on its crackdown to Fox News Digital, including how its new fraud-protection mechanisms work.
通过与身份验证公司 SentiLink 的试点项目,佛罗里达正在对 Medicaid 提供者进行被盗或虚假身份以及隐藏所有权结构的筛查。此外,州政府已对某些高风险提供者类别实施了入网暂停。
Through a pilot program with identity-verification firm SentiLink, Florida is screening for stolen or fake identities and hidden ownership structures among Medicaid providers. Separately, the state has imposed enrollment moratoriums on certain high-risk provider categories.
AHCA 还告诉《福克斯新闻数字》,自 2026 年 1 月以来,已对 Medicaid 提供者的入网或重新入网作出超过 1,000 项不利决定,这是防止可疑提供者进入或继续留在项目中的一部分努力。
AHCA also told Fox News Digital that it has issued more than 1,000 adverse decisions involving Medicaid provider enrollment or re-enrollment since January 2026, part of its effort to prevent suspicious providers from entering or remaining in the program.
自今年 1 月以来,机构已对提供者进行 400 次现场检查,涵盖了行为分析、医疗设备和成人日间护理等高风险类别的提供者。
The agency has conducted 400 site visits to providers since January, including providers in high-risk categories such as applied behavior analysis, medical equipment and adult day care.
“Medicaid 欺诈是全国性问题,并且在各地变得日益复杂,”AHCA 对《福克斯新闻数字》表示。
"Medicaid fraud is a national problem, and it is growing more sophisticated everywhere," AHCA told Fox News Digital.
佛罗里达州不会坐等指示。我们正在构建一套模式:在源头预防欺诈,核实每一位服务提供商,并依据数据采取行动。我们欢迎与CMS及其他州合作,因为一个在佛罗里达州被阻止的欺诈性服务提供商,就意味着一个骗局无法蔓延到下一个州。
"Florida is not waiting to be told what to do. We are building the model: prevent fraud at the front door, verify every provider, and follow the data. We welcome partnership with CMS and other states, because a fraudulent provider stopped in Florida is a scheme that does not move on to the next state."