Background Regarding Medicaid Fraud Activities in Miami-Dade and Broward Counties in FL

Prior to our 8/22/2018 Ethics of Medicaid Fraud Webinar with Dr. Jon Bailey, PhD, BCBA-D, we invited the Agency for Healthcare Administration (AHCA), the agency that oversees Medicaid in FL, to attend as a panelist to share additional information surrounding Medicaid fraud activities in Miami-Dade and Brower counties in FL.. Our objective was to obtain additional insights directly from AHCA regarding egregious Medicaid fraud perpetuated by 4 behavioral care agencies that led to sanctions, as well as other behavioral agencies currently under investigation. Our goal was (and continues to be) to bring transparency and insight regarding healthcare fraud, not just in FL but throughout the U.S., to discourage activities such as this from happening in the fugure and also to encourage BCBAs (et al.) and RBTs to report these egregious activities to the BACB so that they can take proactive action against these individuals whose actions affect the field of behavior analysis.

Obviously, since this was an Ethics webinar, we also planned (and did so) to engage in a discussion as to why BCBAs who knew of these activities did not report actions of individual violating the ethics code to Behavior Analyst Certification Board (BACB).

to curtail similar actions

agregious healthcare fraud issues perpetuated by few agencies

few to avoid situations such as this in the future. Unfortunately, Beth Kidder, Deputy Secretary for Medicaid was not able to attend due to a scheduling conflict but agreed to participate in our efforts to curtail these activities in the field of behavior analysis.

For those BCBA et al. outside FL, here's the back story.

On August 21, 2018, one day prior to our Ethics of Medicaid Fraud Webinar with Dr. Jon Bailey, PhD, BCBA-D webinar, AHCA provided Special Learning with an official statement regarding the temporary moritorium on enrolling new behavioral care providers for 6 months due to rampant Medicaid fraud in Miami-Dade and Brower counties. Shortly thereafter, they sent out a press release announcing sanctions imposed on 4 behavioral care agencies for actions which include the following:

• Terminations from Medicaid
• Medicaid Overpayments
• Suspensions from Medicaid

According to Oxford dictionary, a definition of sanction is A threatened penalty for disobeying a law or rule…*