So apparently most states have decided that the best way to deal with Medicaid fraud is to just nuke everybody's payments from orbit and call it a day. Nebraska chopped autism therapy reimbursements by as much as 80%. Indiana floated payment caps. Colorado and New York are mulling budget cuts that would rip care away from kids who legitimately need it. That's not fighting fraud, folks. That's balancing your checkbook on the backs of disabled children and hoping nobody notices.
Meanwhile, as USA Journal reported, Governor Ron DeSantis decided Florida would try something wild and crazy called "actually catching the criminals." Revolutionary stuff, I know.
Last month DeSantis rolled out a statewide Medicaid Integrity Initiative with a pretty straightforward concept. Screen out the scammers BEFORE they get enrolled, instead of waiting years until prosecutors finally knock on their door. Florida's Agency for Health Care Administration teamed up with identity verification company SentiLink to spot stolen identities, fake identities, and shady ownership structures right at the enrollment gate. Every active Medicaid provider has to revalidate their credentials or get booted. High risk provider categories face enrollment freezes. Honest providers keep every penny they've earned.
And guess what? It's actually working. Over the past two years, Florida has terminated or denied enrollment to over 3,200 providers and clawed back more than $72 million in bogus payments. Not by slashing therapy hours, but by nabbing people who were billing for sessions that literally never happened.
The national numbers here are absolutely bonkers. Senator John Kennedy documented that Medicaid spending on autism therapy skyrocketed 403% nationally between 2019 and 2024. Minnesota's spending went from $670,000 to $342.8 million in that window, which is a 50,988% increase. Let that number marinate in your brain for a second. Meanwhile, federal prosecutors were charging clinic operators with billing $46.6 million for phantom therapy sessions. An HHS inspector general audit uncovered at least $600 million in sketchy billing across just four states.
Private equity is pouring gasoline on this dumpster fire. More than 500 autism centers got scooped up by PE firms over the past decade, with four out of five of those deals happening in just the last four years. When the same company profits from both diagnosing kids and billing for their treatment, shocking absolutely no one, diagnoses go up. Children on Medicaid are now 2.5 times more likely to receive an autism diagnosis than kids on private insurance. Nobody with a functioning brain thinks that gap is purely medical.
Now, there is one fair knock on the Florida approach. Some families in Palm Beach County lost coverage suddenly when their provider got dropped, and they deserve a clear explanation and a quick path back to services if their provider was legitimately clean. Good fraud enforcement shouldn't leave innocent families scrambling.
But the overall framework is solid. Go after the thieves. Leave the honest providers alone. Protect the kids who actually need help. It's almost like common sense still exists somewhere in American governance. Other states might want to take notes instead of just carpet bombing their Medicaid budgets and calling it reform.
Read more conservative news commentary at: USA Journal News
