Florida's Medicare Fraud Epidemic
56 AI-Flagged Providers Billing $52M — America's Medicare Fraud Capital
⚠️ Important Disclaimer: The providers identified in this analysis are flagged based on statistical patterns, not evidence of wrongdoing. A high fraud probability score means a provider's billing patterns are mathematically similar to those of convicted fraudsters. There may be entirely legitimate explanations. No provider named here has been accused or charged with any crime unless otherwise noted.
Florida has 56 AI-flagged Medicare providers — tied with California for the most of any state. These providers collectively billed Medicare over $52 million. South Florida remains what it has been for decades: the undisputed capital of Medicare fraud in the United States.
The South Florida Problem
There's a reason the DOJ established its Medicare Fraud Strike Force in Miami in 2007. South Florida — specifically the Miami-Dade, Broward, and Palm Beach county triangle — has been the #1 Medicare fraud hotspot in the United States for over two decades. The numbers are staggering: the Strike Force has charged over 2,000 defendants and recovered over $6 billion since its inception.
Why South Florida? The factors are well-documented:
- Massive elderly population: Florida has the second-highest proportion of residents over 65 in the country, creating an enormous Medicare billing base
- Transient population: High population turnover makes it easier for fraudulent providers to operate without community scrutiny
- Established networks: Decades of fraud have created sophisticated networks for patient recruitment, shell companies, and money laundering
- Jurisdictional complexity: The tri-county area spans multiple judicial districts, complicating enforcement
- Cultural factors: Large immigrant communities where language barriers can be exploited
The Strike Force Effect
The Medicare Fraud Strike Force, headquartered in Miami, has been the DOJ's primary weapon against healthcare fraud since 2007. It has expanded to 15 cities, but Miami remains its operational center. Major South Florida takedowns include:
- Operation Pharm Scam (2020): $174M in fraudulent HIV drug billing schemes centered in Miami-Dade
- Hialeah Home Health Sweep (2016): Dozens of home health agencies in Hialeah charged with billing for phantom visits
- South Beach Clinic Ring (2019): A network of clinics billing Medicare for unnecessary genetic tests and durable medical equipment
- Operation Brace Yourself (2019): Major Florida component of the nationwide DME fraud crackdown
Despite these enforcement actions, our model found 56 active Florida providers whose billing patterns still match those of convicted fraudsters. The fraud persists even in the most heavily policed Medicare market in the country.
Internal Medicine + Family Practice
Unlike California, where Internal Medicine dominates almost exclusively, Florida's flagged providers show a mix of Internal Medicine and Family Practice. This is significant because it suggests a broader base of fraud schemes — not just the office visit upcoding that characterizes IM fraud, but also the preventive care billing and chronic care management fraud more common in Family Practice.
The specialty mix also reflects Florida's healthcare market structure. The state has a higher proportion of Family Practice providers serving Medicare patients compared to California, and fraudulent billing patterns have adapted accordingly.
Top 5 Flagged Florida Providers
These five providers have the highest fraud probability scores among Florida's 56 flagged providers.
Highest fraud probability among all Florida providers. Miami-based internist with billing volume and patterns that closely match convicted South Florida fraudsters.
Miami — historically the single most fraudulent city in Medicare history per DOJ records. Over $1.2M in Medicare billings.
Hialeah — the small city that consistently appears in DOJ takedown press releases. Family Practice adds diversity to FL's fraud profile.
Broward County presence — South Florida fraud extends well beyond Miami-Dade into neighboring counties.
Another Miami-area provider flagged. The mix of Internal Medicine and Family Practice distinguishes Florida from California's IM-dominated flags.
The Bigger Picture
Florida's 56 flagged providers represent 11.2% of all 500 flags nationwide — identical to California's share. Together, these two states account for 22.4% of all AI-identified suspicious billing. The Sunshine State's fraud problem is deeply structural: high elderly population, established criminal networks, and a healthcare market that has been shaped by decades of fraud.
The Medicare Fraud Strike Force has made significant inroads, but as our model shows, the underlying billing patterns persist. For every provider convicted and excluded, others continue to bill in ways that are statistically indistinguishable from fraud.
Florida Medicare Fraud — Key Numbers
Data Sources
- • CMS Medicare Provider Utilization and Payment Data (2014–2023)
- • HHS Office of Inspector General — List of Excluded Individuals/Entities (LEIE)
- • DOJ Medicare Fraud Strike Force — South Florida Operations (2007–2025)
- • OpenMedicare ML Model v2.0 (Random Forest, AUC 0.83)
- • U.S. Census Bureau — Florida Population Estimates (65+ demographics)
Note: All data is from publicly available Medicare records. OpenMedicare is an independent journalism project not affiliated with CMS.
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