TALLAHASSEE — With Medicaid costs climbing nationwide and prosecutors opening cases over questionable autism-therapy billing, Florida is betting on a different play: stop suspect providers before they enroll, rather than slash payments that would hit legitimate clinics and the families who rely on them.
Gov. Ron DeSantis’ administration is building that strategy around the Agency for Health Care Administration and identity-verification firm SentiLink. The partnership is designed to flag stolen identities, synthetic IDs and concealed ownership structures during enrollment — and to keep watching providers after they are in the program. Existing providers must revalidate credentials. High-risk categories, including durable medical equipment suppliers and adult day-care operators, face temporary enrollment freezes while screening is tightened.
“For far too long, we’ve relied on a pay-and-chase model where fraudulent claims are paid first and investigated years later,” DeSantis said when the Medicaid Integrity Initiative was announced. AHCA Secretary Shevaun Harris said SentiLink’s platform can surface in minutes what used to take days of manual review.
State officials say the approach is already producing results. Over two years, Florida has denied or terminated enrollment for more than 3,200 providers and recovered or prevented more than $136 million in improper payments. Supporters argue that aggressive screening can protect taxpayers without cutting therapy for children with autism and other disabilities.
The push comes as autism-related Medicaid spending draws national attention. Sen. John Kennedy has pointed to a 403 percent increase in Medicaid spending on autism therapy from 2019 to 2024. Minnesota’s jump is the most striking: reimbursements for early autism services rose from roughly $670,000 to about $343 million in that period. Federal prosecutors have charged providers accused of billing for sessions that never happened, and HHS audits have flagged questionable billing in several states.
Spending growth alone is not proof of fraud. Broader diagnosis, expanded coverage and more available treatment can all drive higher costs. That distinction matters because Medicaid is often the only realistic source of care for many families.
Florida’s bet is to separate legitimate practices from those gaming the system, instead of imposing across-the-board rate cuts. The strategy has costs of its own. Families in Palm Beach County and elsewhere have lost trusted providers when clinics were dropped, sometimes with little notice and long waiting lists for replacements. Officials say communication and transition help have to be part of enforcement if the crackdown is going to work.
Private-equity investment in autism centers is another flashpoint. Hundreds of clinics have been acquired in recent years. Critics warn that financial incentives can distort diagnosis and treatment; investors say capital is what allows providers to expand and reach more children.
For state and federal policymakers, the test is whether fraud can be squeezed without making families pay the price. Florida is offering one model: verify identities earlier, revalidate everyone already in the program, recover improper payments, and leave reimbursement rates for real care intact.
Whether that holds as caseloads and budgets keep rising will be watched closely. The question hanging over Medicaid programs nationwide is no longer abstract: Can states go after fraud hard enough to protect the treasury without stranding children who actually need the services? Florida is wagering that tighter gates — not blanket cuts — is the better answer.
