FLORIDA MEDICAID
A Division of the Agency for Health Care Administration

Florida Medicaid Health Care Alert
July 2015

Provider Self Audit Resources are Now Available on the Agency’s Website

Medicaid providers are encouraged to voluntarily conduct self-audits and remedy any issues of non-compliance that are identified, including either voiding/adjusting improper claims or submitting to the Agency’s Bureau of Medicaid Program Integrity (MPI), the self-audit findings and repayment of the improper claims.

MPI recommended that providers review claims with dates of service as old as five years to the present.  MPI also encourages providers to engage in routine self-audits of more current claims (most recent twelve months).  This allows providers to have the opportunity to remedy the claims before an Agency-initiated audit.  When the Agency conducts an audit, it is entitled to recover the costs of the audit and is required to assess sanctions for the non-compliance.  A provider who conducts a self-audit, submits the results, and remits payment, may avoid sanctions for their voluntary disclosure and repayment of overpayments so long as the Agency determines that the disclosure is valid and so long as it is not discovered to be an attempt to alleviate liability for fraudulent practices.

Information about conducting self-audits is available on the Agency’s website, on the MPI landing page.  Please see the below screen-shot which demonstrates how to navigate from the Agency’s home page to the MPI landing page.

Medicaid providers are encouraged to voluntarily conduct self-audits and remedy any issues of non-compliance that are identified, including either voiding/adjusting improper claims or submitting to the Agency’s Bureau of Medicaid Program Integrity (MPI), the self-audit findings and repayment of the improper claims.

Questions regarding conducting a self-audit may be directed to Pam Fante via email at Pam.Fante@ahca.myflorida.com and please include the question in the email.