Florida announced the expulsion of over 220 Medicaid providers as part of a crackdown on fraud, waste, and abuse in the public health program. Authorities also detected cases of billing for more than 24 hours of services in a single day, an anomaly that has raised alarms about the use of funds intended for healthcare.
The results were presented on Tuesday October 6, 2026 by Governor Ron DeSantis and the Agency for Health Care Administration of Florida (AHCA), during an appearance in West Palm Beach. According to the official statement from the Government of Florida, over 260 providers have also been subjected to payment restrictions or payment suspensions.
The announcement raises an important question for thousands of residents, including Cuban Medicaid beneficiaries: what happens if the doctor, clinic, or therapy center that treats them stops providing services to the program?
More than 220 suppliers expelled and invoices totaling 230 million dollars
The AHCA reported that the providers excluded from the program had collectively submitted more than 230 million dollars in invoices to Medicaid during 2025. This amount reflects their billing volume, not a sum of fraud proven in court or money that the state has recovered.
During the last year, the agency referred more than 150 cases to the Florida Attorney General's Office due to suspected irregularities. It also announced payment restrictions or suspensions for over 260 providers. These categories may overlap, and the statement does not provide a count of unique providers affected; therefore, they should not be added together as if they were independent cases.
Since January, the inspection teams of the AHCA have conducted more than 400 visits to providers, primarily in areas considered to be of higher risk: applied behavior analysis (ABA) therapies, durable medical equipment, and adult day care centers.
Among the identified practices are invoices for hours that are incompatible with the duration of a day and records of uninterrupted care over long periods, including weekends and holidays. The agency presents these findings as reasons to strengthen investigations and controls, although an administrative investigation does not, by itself, equate to a criminal conviction.
The government projects nearly 980 million less for ABA therapies
Another noteworthy fact is the revision of spending projections for ABA therapies, used especially by minors with autism and other developmental needs. Florida had estimated that these services would reach an annual spending of 3.86 billion dollars; it now projects 2.88 billion for the fiscal year 2026-2027.
The difference is approximately $980 million. However, this is not money recovered from investigated suppliers. According to the report, the reduction in the projection is due to several factors, including the transfer of ABA therapies to managed care plans, new utilization reviews, and program integrity measures.
That change in the provision of therapies, initiated in 2025, has generated criticism. An investigation by Florida Phoenix reports that families and professionals have raised concerns about interruptions in treatments because some providers stopped being part of the networks of the plans or decided not to continue treating Medicaid patients.
The problems associated with the transition of the care model should not be automatically confused with the more than 220 announced expulsions. The secretary of the AHCA, Shevaun Harris, stated that the plans contracted by the state are helping the affected families find other providers to ensure continuity of service.
Can patients lose their Medicaid coverage?
The expulsion of a provider does not automatically cancel the Medicaid of their patients. This measure affects the participation of companies and professionals in the program, but it does not itself constitute a general change to the requirements for receiving coverage.
However, it can affect access to care when an office, clinic, or therapist stops accepting Medicaid. In those cases, the beneficiary should check with their plan to find out which providers are still available and seek assistance to prevent disruptions, especially if it involves treatments that require continuity.
The offensive against irregular billing is different from the new Medicaid eligibility restrictions for certain categories of immigrants, which have been in effect since October 1, as reported by CiberCuba.
What to do if your doctor or therapist stops accepting Medicaid
The AHCA indicates that those enrolled in a managed care plan must first contact their insurer. The plan number is usually found on the member's card. It is advisable to inquire about alternative providers within the network, necessary authorizations, and mechanisms to continue a treatment that has already begun.
If the issue is not resolved, the beneficiary may call the Florida Medicaid Help Line, 1-877-254-1055, which is available Monday to Friday, from 8:00 a.m. to 5:00 p.m. Eastern Time. They can also file a complaint with the AHCA regarding access to medical services, treatments, or providers.
On the other hand, Florida has kept open until November 30, 2026, the enrollment period to change plans within Medicaid Managed Care, which is a different process from billing investigations.
More controls, but also concern about access to care
The offensive, initially announced in June, includes a review of vendor credentials, analysis of billing patterns, and a pilot identity verification program with the company SentiLink, aimed at detecting potential fictitious business structures or compromised identities.
The Florida government asserts 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 that the safeguards against abuses are enforced without hindering timely access to doctors, therapies, and other necessary care.
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