Medicaid Fraud
Andrade: DeSantis Medicaid Initiative Is Cover, Not Cure
The state lawmaker who knows Medicaid better than anyone in the Florida House calls the governor’s new anti-fraud push a legacy cleanup act. He says the real damage runs into the billions.
Gov. Ron DeSantis announced a sweeping Medicaid integrity initiative last week, promising enhanced provider screening, advanced fraud detection technology, and a statewide revalidation of all active Medicaid providers. But the legislator who has spent two years chairing the Florida House Health Care Budget Subcommittee isn’t buying it.
State Rep. Alex Andrade (R-District 2) joined Rick’s Blog Live this week to offer a blunt assessment: the announcement is more about protecting the governor’s legacy than protecting taxpayers.
“I think this is more about trying to provide cover for future legacy reviews than anything else. Once you pull up the hood on the car that was the DeSantis administration, there’s been fraud in SNAP and Medicaid into the billions of dollars for the past several years.”
— Rep. Alex Andrade
Behavioral Analysis: A Case Study in Mismanagement
Andrade walked through one of the most damaging examples: the transfer of behavioral analysis services—care for people with autism, mental health conditions, and other disabilities—into Florida’s managed care system in February 2025.
The fraud trajectory heading into the transition was already alarming:
- $1.0 billion in behavioral analysis costs in 2020
- $1.5 billion in 2022
- $1.7 billion in 2023
The move to managed care was supposed to bring those numbers down. Instead, Andrade says, AHCA actively blocked the managed care companies from doing their jobs.
- “AHCA essentially said, ‘Do not do any work at all. Just let it happen,'” Andrade told Rick Outzen. “And then unfortunately we had this circumstance where the AHCA secretary was up for confirmation by the Florida Senate.”
The result? Andrade says he’s been told that managed care plans were told to avoid generating any complaints to legislators until Secretary Shevaun Harris was confirmed, creating an extended period in which fraud went unchecked by design.
Behavioral analysis costs are now estimated at $2.3 billion—an increase of roughly $600 million from the year before managed care took over.
“Solely due to the management decisions of Governor DeSantis’ administration.”
— Rep. Alex Andrade
SNAP: Florida Is Near the Bottom of the Country
The managed care debacle is not an isolated case. Andrade pointed to Florida’s SNAP program—commonly known as food stamps—as another measure of executive neglect.
Florida receives roughly $6 billion annually in federal SNAP funds. The state’s only financial obligation is administering the program. But under DeSantis, Florida’s error rate—the percentage of payments going to ineligible recipients—has ballooned.
- Under Gov. Rick Scott: roughly 4–5% error rate
- Under Gov. DeSantis: now hovering around 15%
- Florida ranks as the worst or second-worst state in the country for SNAP fraud, waste, and abuse—a status that began around 2022
The timing is not lost on Andrade. “I think there is somewhat of a correlation between when Governor DeSantis started thinking of himself as a national figure and stopped caring about doing the day-to-day job of being governor.”
And there’s a price tag coming. Under the Trump administration’s reconciliation legislation, states with error rates above 10 percent will be required to cover more than 15 percent of their own SNAP costs.
“We as a state could have to come up with a billion dollars next year in general revenue for the first time ever just to pay out the existing SNAP benefits that people are already receiving.”
— Rep. Alex Andrade
Hope Florida: The Facts Are Established
No conversation about Medicaid fraud in Florida is complete without discussing the Hope Florida Foundation, and Andrade was direct about what he believes happened.
Andrade on Hope Florida: “James Uthmeyer stole $10 million in Medicaid funds from Florida taxpayers and funneled them to his own PAC and then funneled them from his own PAC to Evan Power at RPOF. I can say definitively that the Hope Florida Foundation still has not filed their 990 to tell the IRS what they did with that $10 million of Medicaid money.”
He also noted that the state admitted the funds were Medicaid dollars by paying $6 million back to the federal Centers for Medicare & Medicaid Services.
The grand jury report on Hope Florida has been withheld. Attorney General James Uthmeyer—who Andrade says is at the center of the diversion—is now running for re-election.
What Would Actually Help?
Andrade is terming out of the legislature and won’t be in the chair when the next administration takes over. But he offered a prescription for what meaningful Medicaid oversight actually requires.
- Engaged executive leadership. Andrade says the core of the problem is a governor who checked out. “If we have a governor that cares about just doing a good job as an executive, we won’t have these same problems.”
- Legislators willing to do the hard work. He estimates only about six Florida lawmakers know what a social services estimating conference is, much less how to analyze its data.
- Institutional humility. “You need legislators that are humble enough and willing to do the work and care enough about the taxpayer dollar and the public trust.”
As a point of contrast, Andrade repeatedly invoked Rick Scott. “We did not have this problem when Rick Scott was governor, love him or hate him. He was an incredible executive.”
Rick Scott isn’t the best example of someone who kept fraud under control. I worked at HCA and had the feds go through my desk when he was CEO and committed the largest MCR fraud in history at the time.