Florida Statutes
Part III - Medicaid (Ss. 409.901-409.9205)
409.9201 - Medicaid fraud.


(1) As used in this section, the term:
(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.
(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.
(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.
(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.


The value of individual items of the legend drugs or goods or services involved in distinct transactions committed during a single scheme or course of conduct, whether involving a single person or several persons, may be aggregated when determining the punishment for the offense.

History.—s. 9, ch. 2004-344; s. 38, ch. 2008-207; s. 37, ch. 2010-161; s. 32, ch. 2014-89; s. 12, ch. 2016-145; s. 18, ch. 2016-212; s. 26, ch. 2017-3; s. 13, ch. 2022-35.

Structure Florida Statutes

Florida Statutes

Title XXX - Social Welfare

Chapter 409 - Social and Economic Assistance

Part III - Medicaid (Ss. 409.901-409.9205)

409.901 - Definitions; ss. 409.901-409.920.

409.902 - Designated single state agency; payment requirements; program title; release of medical records.

409.90201 - Recipient address update process.

409.9021 - Forfeiture of eligibility agreement.

409.9025 - Eligibility while an inmate.

409.903 - Mandatory payments for eligible persons.

409.904 - Optional payments for eligible persons.

409.905 - Mandatory Medicaid services.

409.906 - Optional Medicaid services.

409.9062 - Lung transplant services for Medicaid recipients.

409.9066 - Medicare prescription discount program.

409.907 - Medicaid provider agreements.

409.9071 - Medicaid provider agreements for school districts certifying state match.

409.9072 - Medicaid provider agreements for charter schools and private schools.

409.908 - Reimbursement of Medicaid providers.

409.9081 - Copayments.

409.9082 - Quality assessment on nursing home facility providers; exemptions; purpose; federal approval required; remedies.

409.9083 - Quality assessment on privately operated intermediate care facilities for the developmentally disabled; exemptions; purpose; federal approval required; remedies.

409.909 - Statewide Medicaid Residency Program.

409.910 - Responsibility for payments on behalf of Medicaid-eligible persons when other parties are liable.

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.

409.911 - Disproportionate share program.

409.9113 - Disproportionate share program for teaching hospitals.

409.9115 - Disproportionate share program for mental health hospitals.

409.91151 - Expenditure of funds generated through mental health disproportionate share program.

409.9116 - Disproportionate share/financial assistance program for rural hospitals.

409.9118 - Disproportionate share program for specialty hospitals.

409.91188 - Specialty prepaid health plans for Medicaid recipients with HIV or AIDS.

409.9119 - Disproportionate share program for specialty hospitals for children.

409.91195 - Medicaid Pharmaceutical and Therapeutics Committee.

409.91196 - Supplemental rebate agreements; public records and public meetings exemption.

409.912 - Cost-effective purchasing of health care.

409.91206 - Alternatives for health and long-term care reforms.

409.9121 - Legislative findings and intent.

409.91212 - Medicaid managed care fraud.

409.9122 - Medicaid managed care enrollment; HIV/AIDS patients; procedures; data collection; accounting; information system; medical loss ratio.

409.9123 - Quality-of-care reporting.

409.91255 - Federally qualified health center access program.

409.9126 - Children with special health care needs.

409.9127 - Preauthorization and concurrent utilization review; conflict-of-interest standards.

409.9128 - Requirements for providing emergency services and care.

409.913 - Oversight of the integrity of the Medicaid program.

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.

409.914 - 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.

409.9201 - Medicaid fraud.

409.9203 - Rewards for reporting Medicaid fraud.

409.9205 - Medicaid Fraud Control Unit.