IMPOSSIBLE HOURS
There are 24 hours in a day. Some Florida Medicaid providers billed more than that anyway.
Ron DeSantis went to West Palm Beach this week to announce results from what he called the most significant Medicaid integrity initiative in state history. The headline number, from the governor’s office and Fox News: projected annual Applied Behavior Analysis spending falling from $3.86 billion to $2.88 billion in Fiscal Year 2026-27 — nearly $1 billion, or about $980 million, less.
ABA is the therapy families use for children with autism. It is also, Florida says, where the billing got creative.
The clock that does not exist
AHCA’s monitoring found providers billing for consecutive days through weekends and holidays for months, and in some cases billing for more than 24 hours of services in a single day, per the governor’s release, Fox, and News4Jax.
DeSantis’s reaction, per News4Jax: “How does that happen? This is unacceptable. Medicaid dollars must go to healthcare for eligible Floridians, not to people who are gaming the system.”
AHCA Secretary Shevaun Harris put the mechanics in one line: “Claims do not submit themselves.” It takes keystrokes. “Therefore, it’s inconceivable how you could not know,” she said, per News4Jax.
Shevaun Harris, secretary of Florida’s Agency for Health Care Administration. “Claims do not submit themselves,” she said of impossible-hour billing. Credit: Florida AHCA, public domain via Wikimedia Commons.
When the defense of a claim requires a 25-hour day, you do not have a documentation problem. You have a theft problem with a CPT code.
The body count, provider edition
Since January, per the governor’s office and Fox:
- More than 400 provider site visits, with focus on ABA, durable medical equipment, and adult day care.
- More than 220 providers terminated for fraud, waste, or abuse, tied to more than $230 million in Medicaid billing in 2025.
- More than 260 providers placed on payment restrictions or suspended.
- More than 150 referrals to the attorney general’s office over the last year.
- ABA moved into managed care; an Applied Behavior Analysis Task Force stood up; enrollment moratoriums on some high-risk categories; a statewide revalidation push; a SentiLink pilot to flag stolen or fake identities and hidden ownership.
- Fox adds: more than 1,000 adverse decisions on provider enrollment or re-enrollment since January 2026.
Harris told Fox the agency is building a model: “prevent fraud at the front door, verify every provider, and follow the data.” Florida is trying to kill “pay-and-chase” — pay first, hunt later — the same shift HHS Secretary Robert F. Kennedy Jr. has pushed nationally, Fox notes.
Robert F. Kennedy Jr., official HHS portrait, 2025. Fox ties Florida’s front-door integrity model to his national push away from pay-and-chase. Credit: U.S. Department of Health and Human Services, public domain.
News4Jax also reports Harris saying Florida Medicaid paid about $6.57 billion for ABA between 2023 and 2025 — nearly four times more than any other state Medicaid program — and had been projecting 30% year-over-year growth. “To say that we’re an outlier is an understatement,” she said.
Officials say care coordination exists so kids are not stranded when a bad actor is cut off. Harris cited roughly 60,000 registered behavior technicians and about 40,000 kids in services, per News4Jax, and told predators: “In my opinion, you’re a predator and we’re going to treat you as such.”
Integrity that protects autistic kids by firing the people inventing hours is not an attack on autism care. It is the minimum.
Harris told News4Jax today is “not a victory lap yet.” DeSantis said AHCA will keep using data analytics, site visits, and claims monitoring. Good. Publish the provider names when the cases clear. Taxpayers funded the impossible hours. They deserve the roster.
The red costume: fraud for thee
If you came up on “drain the swamp” and “waste, fraud, and abuse,” enjoy the Florida numbers. Then look in the mirror.
Republicans love an integrity press conference when the villain is an ABA mill in someone else’s county. They get quieter when the fraud pipeline runs through allied industries, PPP-era leftovers, nursing-home chains, or donor-adjacent providers who know which fundraiser to buy a table at. The same movement that built a national brand on hunting noncitizen voter fraud — we covered that hunt’s thin arrest math in Cheat Like Hell — somehow discovers due process and “don’t disrupt care” the minute a red-state hospital lobby calls.
DeSantis deserves credit for moving from pay-and-chase to front-door screening. Credit is not a lifetime exemption. If Medicaid integrity is a principle, it applies when the provider’s lawyer is a bundler, not only when the billing software invents a 26th hour.
Florida moved ABA into managed care and stood up a task force. That is process. Process only matters if the next press conference includes convictions, recoveries, and a public scoreboard — not just projected savings that can quietly rebound when the cameras leave.
The blue costume: every audit is a hate crime
Democrats, before you write the thread.
Fox places Florida’s announcement amid heightened federal scrutiny of Medicaid fraud, including investigations and payment reviews involving Minnesota, plus federal payment fights involving California and Minnesota that Fox summarizes as an HHS freeze dispute in which Gavin Newsom calls the pressure “pure politics.” Tim Walz‘s Minnesota sits in that federal glare. The blue reflex, when the glare hits, is to treat oversight as an attack on immigrants, kids, and the programs themselves — anything but a billing problem.
Tim Walz, official portrait. Fox places Florida’s crackdown amid federal Medicaid scrutiny that includes Minnesota payment reviews. Credit: U.S. Congress, public domain.
The blue reflex is predictable: any serious integrity push gets reframed as an attack on autistic children, disabled adults, or the poor — as if the fraudsters were the therapy. Harris’s own message undercuts that. Protecting Medicaid, she said, means protecting the people it was created to serve: children, pregnant women, the disabled, seniors. If your coalition’s first move is to defend impossible hours, you are not defending care. You are defending a business model.
Democrats ran CMS and state Medicaid agencies for years under the old pay-and-chase religion. They expanded enrollment faster than they expanded auditors. Then they act shocked when a red state shows what happens when you actually visit the office and ask who worked the 25th hour.
Both costumes
Florida also told Fox it welcomes partnership with CMS and other states, because “a fraudulent provider stopped in Florida is a scheme that does not move on to the next state.” That is the right national posture — if other governors actually want it. Pay-and-chase made fraud a relocation business. Front-door screening makes it a dead end.
Fair is fair. Not every ABA provider is a crook. Florida says the campaign targets bad actors, not legitimate clinicians. Families should not lose real therapy because a neighbor’s clinic invented Christmas Day overtime. DeSantis and Harris say the state will help re-place kids. Hold them to it.
But the hypocrisy is bipartisan. The red costume wraps itself in taxpayer virtue while soft-pedaling fraud when it wears a donor badge. The blue costume wraps itself in disability rights while treating every eligibility check like a book burning. Florida’s nearly $1 billion ABA plunge is what it looks like when someone finally reads the claim file.
You do not need a costume for this one. You need a timesheet that fits inside a clock. Call your governor and ask how many providers in your state billed more hours than God put in the day — and whether anyone is counting.
Receipts
- Executive Office of Governor Ron DeSantis, October 2026. ABA $3.86B to $2.88B projection, 400+ site visits, 150+ AG referrals, 260+ restrictions/suspensions, 220+ terminations, $230M+ billing, Task Force, managed care shift, SentiLink pilot, Harris quote on protecting Medicaid populations.
- Fox News, October 8, 2026. Nearly $1B / ~$980M plunge, impossible-hour billing, 1,000+ adverse enrollment decisions, RFK Jr. pay-and-chase parallel, Minnesota scrutiny context, AHCA “front door” model quotes.
- News4Jax, October 6, 2026. “Claims do not submit themselves,” DeSantis “How does that happen,” $6.57B ABA 2023–2025, 30% growth projection, ~60,000 RBTs / ~40,000 kids, “predator” line, care-coordination assurances.
- Hypocrisy Democracy, Cheat Like Hell. Prior coverage of selective “integrity” hunts.
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Originally published on Substack.