In a sweeping move against fraud, waste, and abuse in the public health sector, Florida has ousted more than 220 Medicaid providers. Authorities uncovered instances of billing for over 24 hours of services in a single day, raising serious concerns about the misuse of funds intended for healthcare.
The findings were revealed on October 6, 2026, by Governor Ron DeSantis and the Florida Agency for Health Care Administration (AHCA) in West Palm Beach. According to the official statement from the Florida government, over 260 providers have faced payment restrictions or suspensions.
This announcement raises pressing questions for thousands of residents, including Cuban Medicaid beneficiaries: what happens if their doctor, clinic, or therapy center no longer participates in the program?
Significant Financial Implications of Provider Expulsions
The AHCA reported that the providers removed from the program collectively billed Medicaid over $230 million in 2025. This figure represents their billing volume, not proven fraud or funds recovered by the state.
In the past year, more than 150 cases were sent to the Florida Attorney General due to suspected irregularities. Additionally, over 260 providers faced payment restrictions or suspensions. These categories might overlap, and the statement does not provide a unique count of affected providers, so they should not be considered independent cases.
Since January, AHCA inspection teams conducted more than 400 visits to providers, primarily in high-risk areas such as applied behavior analysis (ABA) therapies, durable medical equipment, and adult day care centers.
Some identified practices included billing for hours exceeding a day's duration and records of uninterrupted care over extended periods, including weekends and holidays. The agency uses these findings to justify increased investigations and controls, although an administrative investigation does not equate to a criminal conviction.
Budget Adjustments for ABA Therapies
Another key point is the revision of projected spending on ABA therapies, primarily used for children with autism and other developmental needs. Florida initially estimated an annual expenditure of $3.86 billion on these services; however, it now projects $2.88 billion for the 2026-2027 fiscal year.
The nearly $980 million difference is not due to funds recovered from investigated providers. The state attributes the reduction to several factors, including the shift of ABA therapies to managed care plans, new utilization reviews, and program integrity measures.
This transition, started in 2025, has sparked criticism. According to an investigation by Florida Phoenix, families and professionals have reported treatment interruptions as some providers left the networks or chose not to continue serving Medicaid patients.
Problems related to this transition should not be automatically associated with the over 220 announced expulsions. AHCA Secretary Shevaun Harris stated that state-contracted plans are assisting affected families in finding alternative providers to ensure service continuity.
Impact on Medicaid Coverage for Patients
The removal of a provider does not automatically terminate Medicaid coverage for patients. The action affects the participation of businesses and professionals in the program but does not constitute a general change in eligibility requirements.
However, it can disrupt care if a practice, clinic, or therapist stops accepting Medicaid. In such cases, beneficiaries should consult their plan to identify available providers and seek assistance to prevent interruptions, particularly for treatments requiring continuity.
The crackdown on irregular billing is separate from new Medicaid eligibility restrictions for certain immigrant categories, effective October 1, as previously reported by CiberCuba.
Guidance for Patients Facing Provider Changes
The AHCA advises those enrolled in a managed care plan to first contact their insurer. The plan number is usually found on the member's card. It's advisable to inquire about alternative in-network providers, necessary authorizations, and mechanisms to continue ongoing treatments.
If unresolved, beneficiaries can call the Florida Medicaid help line at 1-877-254-1055, available Monday through Friday, 8:00 a.m. to 5:00 p.m. Eastern Time. Complaints about access to medical services, treatments, or providers can also be filed with the AHCA.
Florida's open enrollment period for changing plans within Medicaid Managed Care remains available until November 30, 2026, a process distinct from billing investigations.
Increased Oversight Sparks Concern Over Healthcare Access
The initiative, initially announced in June, encompasses provider credential reviews, billing pattern analyses, and a pilot identity verification program with SentiLink to detect potential phantom businesses or compromised identities.
The Florida government maintains that these measures aim to protect public resources and ensure they are allocated to legitimate services. For patients and their families, the challenge will be ensuring that anti-abuse measures do not hinder timely access to doctors, therapies, and other necessary care.
Understanding Florida's Medicaid Provider Expulsions
What led to the expulsion of over 220 Medicaid providers in Florida?
The expulsion resulted from a state crackdown on fraud, waste, and abuse within the Medicaid program. Authorities found cases of overbilling, including claims for more than 24 hours of service in a single day.
How does the removal of a provider affect Medicaid patients?
While the removal of a provider doesn't cancel a patient's Medicaid coverage, it can disrupt care if the provider stops accepting Medicaid. Patients should contact their plan to find alternative providers and ensure continuity of care.
What actions should patients take if their provider stops accepting Medicaid?
Patients should first contact their managed care plan to explore alternative providers within the network. If the issue remains unresolved, they can call the Florida Medicaid help line for assistance.