Fla. Stat. 409.9201
Medicaid fraud


(1)

As used in this section, the term:“Prescription drug” means any drug, including, but not limited to, finished dosage forms or active ingredients that are subject to, defined in, or described in s. 503(b) of the Federal Food, Drug, and Cosmetic Act or in s. 465.003, s. 499.003(17), s. 499.007(13), or s. 499.82(10).“Value” means the amount billed to the Medicaid program for the property dispensed or the market value of a legend drug or goods or services at the time and place of the offense. If the market value cannot be determined, the term means the replacement cost of the legend drug or goods or services within a reasonable time after the offense.

(a)

“Prescription drug” means any drug, including, but not limited to, finished dosage forms or active ingredients that are subject to, defined in, or described in s. 503(b) of the Federal Food, Drug, and Cosmetic Act or in s. 465.003, s. 499.003(17), s. 499.007(13), or s. 499.82(10).

(b)

“Value” means the amount billed to the Medicaid program for the property dispensed or the market value of a legend drug or goods or services at the time and place of the offense. If the market value cannot be determined, the term means the replacement cost of the legend drug or goods or services within a reasonable time after the offense.

(2)

Any person who knowingly sells, who knowingly attempts or conspires to sell, or who knowingly causes any other person to sell or attempt or conspire to sell a legend drug that was paid for by the Medicaid program commits a felony.If the value of the legend drug involved is less than $20,000, the crime is a felony of the third degree, punishable as provided in s. 775.082, s. 775.083, or s. 775.084.If the value of the legend drug involved is $20,000 or more but less than $100,000, the crime is a felony of the second degree, punishable as provided in s. 775.082, s. 775.083, or s. 775.084.If the value of the legend drug involved is $100,000 or more, the crime is a felony of the first degree, punishable as provided in s. 775.082, s. 775.083, or s. 775.084.

(a)

If the value of the legend drug involved is less than $20,000, the crime is a felony of the third degree, punishable as provided in s. 775.082, s. 775.083, or s. 775.084.

(b)

If the value of the legend drug involved is $20,000 or more but less than $100,000, the crime is a felony of the second degree, punishable as provided in s. 775.082, s. 775.083, or s. 775.084.

(c)

If the value of the legend drug involved is $100,000 or more, the crime is a felony of the first degree, punishable as provided in s. 775.082, s. 775.083, or s. 775.084.

(3)

Any person who knowingly purchases, or who knowingly attempts or conspires to purchase, a legend drug that was paid for by the Medicaid program and intended for use by another person commits a felony.If the value of the legend drug is less than $20,000, the crime is a felony of the third degree, punishable as provided in s. 775.082, s. 775.083, or s. 775.084.If the value of the legend drug is $20,000 or more but less than $100,000, the crime is a felony of the second degree, punishable as provided in s. 775.082, s. 775.083, or s. 775.084.If the value of the legend drug is $100,000 or more, the crime is a felony of the first degree, punishable as provided in s. 775.082, s. 775.083, or s. 775.084.

(a)

If the value of the legend drug is less than $20,000, the crime is a felony of the third degree, punishable as provided in s. 775.082, s. 775.083, or s. 775.084.

(b)

If the value of the legend drug is $20,000 or more but less than $100,000, the crime is a felony of the second degree, punishable as provided in s. 775.082, s. 775.083, or s. 775.084.

(c)

If the value of the legend drug is $100,000 or more, the crime is a felony of the first degree, punishable as provided in s. 775.082, s. 775.083, or s. 775.084.

(4)

Any person who knowingly makes or knowingly causes to be made, or who attempts or conspires to make, any false statement or representation to any person for the purpose of obtaining goods or services from the Medicaid program commits a felony.If the value of the goods or services is less than $20,000, the crime is a felony of the third degree, punishable as provided in s. 775.082, s. 775.083, or s. 775.084.If the value of the goods or services is $20,000 or more but less than $100,000, the crime is a felony of the second degree, punishable as provided in s. 775.082, s. 775.083, or s. 775.084.If the value of the goods or services involved is $100,000 or more, the crime is a felony of the first degree, punishable as provided in s. 775.082, s. 775.083, or s. 775.084.

(a)

If the value of the goods or services is less than $20,000, the crime is a felony of the third degree, punishable as provided in s. 775.082, s. 775.083, or s. 775.084.

(b)

If the value of the goods or services is $20,000 or more but less than $100,000, the crime is a felony of the second degree, punishable as provided in s. 775.082, s. 775.083, or s. 775.084.

(c)

If the value of the goods or services involved is $100,000 or more, the crime is a felony of the first degree, punishable as provided in s. 775.082, s. 775.083, or s. 775.084.

Source: Section 409.9201 — Medicaid fraud, https://www.­flsenate.­gov/Laws/Statutes/2024/0409.­9201 (accessed Aug. 7, 2025).

409.901
Definitions
409.902
Designated single state agency
409.903
Mandatory payments for eligible persons
409.904
Optional payments for eligible persons
409.905
Mandatory Medicaid services
409.906
Optional Medicaid services
409.907
Medicaid provider agreements
409.908
Reimbursement of Medicaid providers
409.909
Statewide Medicaid Residency Program
409.910
Responsibility for payments on behalf of Medicaid-eligible persons when other parties are liable
409.911
Disproportionate share program
409.912
Cost-effective purchasing of health care
409.913
Oversight of the integrity of the Medicaid program
409.914
Assistance for the uninsured
409.915
County contributions to Medicaid
409.916
Grants and Donations Trust Fund
409.918
Public Medical Assistance Trust Fund
409.919
Rules
409.920
Medicaid provider fraud
409.9021
Forfeiture of eligibility agreement
409.9025
Eligibility while an inmate
409.9062
Lung transplant services for Medicaid recipients
409.9063
Coverage of continuous glucose monitors for Medicaid recipients
409.9066
Medicare prescription discount program
409.9071
Medicaid provider agreements for school districts certifying state match
409.9072
Medicaid provider agreements for charter schools and private schools
409.9081
Copayments
409.9082
Quality assessment on nursing home facility providers
409.9083
Quality assessment on privately operated intermediate care facilities for the developmentally disabled
409.9101
Recovery for payments made on behalf of Medicaid-eligible persons
409.9102
A qualified state Long-Term Care Insurance Partnership Program in Florida
409.9113
Disproportionate share program for teaching hospitals
409.9115
Disproportionate share program for mental health hospitals
409.9116
Disproportionate share/financial assistance program for rural hospitals
409.9118
Disproportionate share program for specialty hospitals
409.9119
Disproportionate share program for specialty hospitals for children
409.9121
Legislative findings and intent
409.9122
Medicaid managed care enrollment
409.9123
Quality-of-care reporting
409.9126
Children with special health care needs
409.9127
Preauthorization and concurrent utilization review
409.9128
Requirements for providing emergency services and care
409.9131
Special provisions relating to integrity of the Medicaid program
409.9132
Pilot project to monitor home health services
409.9133
Pilot project for home health care management
409.9134
Agency to distinguish certain services as to skilled home health services
409.9201
Medicaid fraud
409.9203
Rewards for reporting Medicaid fraud
409.9205
Medicaid Fraud Control Unit
409.90201
Recipient address update process
409.90637
Agency to seek federal approval for coverage and reimbursement authority for mobile crisis response services
409.90638
Agency to seek federal approval to implement acute hospital care at home program in state Medicaid program
409.91151
Expenditure of funds generated through mental health disproportionate share program
409.91188
Specialty prepaid health plans for Medicaid recipients with HIV or AIDS
409.91195
Medicaid Pharmaceutical and Therapeutics Committee
409.91196
Supplemental rebate agreements
409.91206
Alternatives for health and long-term care reforms
409.91212
Medicaid managed care fraud
409.91235
Agency review and report on medications, treatments, and services for sickle cell disease
409.91255
Federally qualified health center access program
409.91256
Training, Education, and Clinicals in Health (TEACH) Funding Program

Current through Fall 2025

§ 409.9201. Medicaid fraud's source at flsenate​.gov