{"text_format":"3","workbook":"xlsx","n_sheets":7,"sheets":["Line by Line Field Definitions","Summary of Fraud and Abuse","Q1 Details","Q2 Details","Q3 Details","Q4 Details","Drop Downs"],"not_rendered":{"images":4,"macros":1,"external_links":1,"defined_names":4},"read":"whole","date_system":"1900"}

{"sheet":"Line by Line Field Definitions","index":0,"n_rows":42,"n_cols":2,"rows_kept":42}
["Field Name","Description"]
["Reporting Fiscal Year","State Fiscal Year in FY YYYY-YYYY format (ex: FY 2017-2018)"]
["Reporting Fiscal Quarter","Quarter in State Fiscal Year QQ format (ex: Q1)"]
["Medicaid Health Plan Identifier","Plan's 3 letter identifier assigned by the Agency"]
["New/Previously Reported","Quarter when complaint was first reported to MPI via the online complaint form"]
["Vendor Associated (If Applicable)","Indicate the type of vendor associated if applicable"]
["MPI Complaint ID","MPI's case tracking system complaint number"]
["Plan Internal Tracking Number","Plan's case/audit number"]
["Provider Type (Under Review)","Medicaid provider type"]
["Provider (Under Review) Tax ID","Provider's tax ID number"]
["Entity Under Review","Indicate whether a provider, recipient, health plan, or internal"]
["Provider/Entity Name","Full name of Provider or the Entity being reported (including any known \"d/b/a\")"]
["Entity Medicaid ID Number","Provider's Florida Medicaid ID number"]
["Provider NPI Number (If Applicable)","Provider's National Provider Identifier number"]
["Date Detected","Date issue was first detected by the health plan in format MM/DD/YYYY"]
["Date First Reported to MPI","Date the plan reported the issue to MPI through the online complaint form in format MM/DD/YYYY"]
["Allegation Type","Indicate whether Fraud or Abuse allegation"]
["Primary Allegation","Main type of fraud or abuse category being alleged"]
["Secondary Allegation (If Applicable)","Secondary type of fraud or abuse category being alleged"]
["Detection Tool","Indicate tool plan used to detect issue"]
["Preliminary Overpayment Identified","Total preliminary overpayment identified through plan's audit/recovery activity"]
["Updated Overpayment Amount Identified","Updated overpayment identified through plan's audit/recovery activity if different than the preliminary amount"]
["Final Overpayment Identified for Recovery","Total final overpayment identified through plan's audit/recovery activity"]
["Fines Amount (If Applicable)","Total amount of all fines plan imposed on provider"]
["Sanctions Amount (If Applicable)","Total amount of all sanctions plan imposed on provider"]
["Other Financial Penalties (If Applicable)","Total amount of all other financial penalties imposed on the provider"]
["Settlement Amount (If Applicable)","Total amount of settlement agreement between plan and provider"]
["Recoupment Amount (If Applicable)","Total recovered from provider through plan's audit/recovery activity to date"]
["Dollar Amount Lost (If Applicable)","Total lost from provider (plan's exposure that will not be recovered)"]
["Status","Select from either Open or Closed status with details of where in process open investigation/audit is, or what closed outcome is"]
["Other Entity Reported to Primary","Complete list of entities plan has reported complaint to, including MFCU, HHS/OIG, etc."]
["Other Entity Reported to Secondary","Secondary entity plan has reported complaint to (If applicable)"]
["Other Entity Reported to Tertiary","Tertiary entity plan has reported complaint to (If applicable)"]
["Other Entity Reported to Quaternary","Quaternary entity plan has reported complaint to (If applicable)"]
["Corrective Action","Type of action plan has taken against provider to address issue"]
["Number of Times Provider Reviewed  Within Last 5 Years","Number of times plan has reviewed, audited, or investigated the reported provider during the last 5 year period"]
["Detailed Update","Free-form narrative from plan that must include detailed information related to the  progression of the plan's review/investigation.  This should be updated every reporting quarter to show the plan's review is not stagnant."]
["Additional Comments for Primary Allegation ","All other details for \"Other\" selection made in the primary allegation field"]
["Additional Comments for Secondary Allegation","All other details for \"Other\" selection made in the secondary allegation field"]
["Additional Comments for Detection Tool","All other details for \"Other\" selection made in the detection tool field"]
["Additional Comments for Status","All other details for any \"Other\" selection made in the status field"]
["Additional Comments for Corrective Action","All other details for \"Other\" selection made in the corrective action field"]

{"sheet":"Summary of Fraud and Abuse","index":1,"n_rows":39,"n_cols":11,"rows_kept":39,"merged":[[14,1,14,10],[16,1,16,2],[16,3,16,4],[16,5,16,6],[16,7,16,8],[16,9,16,10],[23,1,23,10],[25,1,25,2],[25,3,25,4],[25,5,25,6],[25,7,25,8],[25,9,25,10]]}
[]
[]
[]
[]
["Reporting Period"]
["Medicaid Health Plan"]
["Medicaid Health Plan Medicaid ID(s)"]
["Vendor-Dental Name:"]
["Vendor-Vision Name:"]
["Vendor-Transportation Name:"]
["Vendor-Behavioral Health Name:"]
["Vendor-Pharmacy Name:"]
[]
[]
[null,"Quarterly Fraud and Abuse Activity Report Health Plan Recovery Summary by Quarter"]
[]
[null,"Q1 Recoveries",null,"Q2 Recoveries",null,"Q3 Recoveries",null,"Q4 Recoveries",null,"YTD Recoveries"]
["Recovery Category","Identified $","Recovered $","Identified $","Recovered $","Identified $","Recovered $","Identified $","Recovered $","Identified $","Recovered $"]
["Medicaid Health Plan Initiated Audit Recoveries",null,{"$f":"(SUM('Q1 Details'!$AA$2:$AA$750)-C20)","v":{"v":0,"d":"$0.00"}},null,{"$f":"(SUM('Q2 Details'!$AA$2:$AA$750)-E20)","v":{"v":0,"d":"$0.00"}},null,{"$f":"(SUM('Q3 Details'!$AA$2:$AA$750)-G20)","v":{"v":0,"d":"$0.00"}},null,{"$f":"(SUM('Q4 Details'!$AA$2:$AA$750)-I20)","v":{"v":0,"d":"$0.00"}},{"$f":"SUM(B19,D19,F19,H19)","v":{"v":0,"d":"$0.00"}},{"$f":"SUM(C19,E19,G19,I19)","v":{"v":0,"d":"$0.00"}}]
["AHCA Referral Recoveries",null,{"$f":"(SUMIFS('Q1 Details'!$AA$2:$AA$750, 'Q1 Details'!$S$2:$S$750, \"AHCA - source of referral\") + SUMIFS('Q1 Details'!$AA$2:$AA$750, 'Q1 Details'!$S$2:$S$750, \"AHCA - MPI\"))","v":{"v":0,"d":"$0.00"}},null,{"$f":"(SUMIFS('Q2 Details'!$AA$2:$AA$750,   'Q2 Details'!$S$2:$S$750, \"AHCA - source of referral\") + SUMIFS('Q2 Details'!$AA$2:$AA$750,    'Q2 Details'!$S$2:$S$750, \"AHCA - MPI\"))","v":{"v":0,"d":"$0.00"}},null,{"$f":"(SUMIFS('Q3 Details'!$AA$2:$AA$750,  'Q3 Details'!$S$2:$S$750, \"AHCA - source of referral\") + SUMIFS('Q3 Details'!$AA$2:$AA$750,   'Q3 Details'!$E$2:$E$750, \"\", 'Q3 Details'!$S$2:$S$750, \"AHCA - MPI\"))","v":{"v":0,"d":"$0.00"}},null,{"$f":"(SUMIFS('Q4 Details'!$AA$2:$AA$750, 'Q4 Details'!$S$2:$S$750, \"AHCA - source of referral\") + SUMIFS('Q4 Details'!$AA$2:$AA$750,   'Q4 Details'!$E$2:$E$750, \"\", 'Q4 Details'!$S$2:$S$750, \"AHCA - MPI\"))","v":{"v":0,"d":"$0.00"}},{"$f":"SUM(B20,D20,F20,H20)","v":{"v":0,"d":"$0.00"}},{"v":0,"d":"$0.00"}]
["Settlement Dollars ",{"$f":"SUMIFS('Q1 Details'!$AA$2:$AA$750,    'Q1 Details'!$Z$2:$Z$750, \">0\",  'Q1 Details'!$D$2:$D$750, \"New\")","v":{"v":0,"d":"$0.00"}},{"$f":"SUMIFS('Q1 Details'!$AA$2:$AA$750,   'Q1 Details'!$E$2:$E$750, \"\", 'Q1 Details'!$Z$2:$Z$750, \">0\")","v":{"v":0,"d":"$0.00"}},{"$f":"SUMIFS('Q2 Details'!$AA$2:$AA$750,   'Q2 Details'!$Z$2:$Z$750, \">0\",  'Q2 Details'!$D$2:$D$750, \"New\")","v":{"v":0,"d":"$0.00"}},{"$f":"SUMIFS('Q2 Details'!$AA$2:$AA$750, 'Q2 Details'!$Z$2:$Z$750, \">0\")","v":{"v":0,"d":"$0.00"}},{"$f":"SUMIFS('Q3 Details'!$AA$2:$AA$750,  'Q3 Details'!$Z$2:$Z$750, \">0\",  'Q3 Details'!$D$2:$D$750, \"New\")","v":{"v":0,"d":"$0.00"}},{"$f":"SUMIFS('Q3 Details'!$AA$2:$AA$750,  'Q3 Details'!$Z$2:$Z$750, \">0\")","v":{"v":0,"d":"$0.00"}},{"$f":"SUMIFS('Q4 Details'!$AA$2:$AA$750, 'Q4 Details'!$Z$2:$Z$750, \">0\",  'Q4 Details'!$D$2:$D$750, \"New\")","v":{"v":0,"d":"$0.00"}},{"$f":"SUMIFS('Q4 Details'!$AA$2:$AA$750,  'Q4 Details'!$Z$2:$Z$750, \">0\")","v":{"v":0,"d":"$0.00"}},{"$f":"SUM(B21,D21,F21,H21)","v":{"v":0,"d":"$0.00"}},{"v":0,"d":"$0.00"}]
["Grand Total",{"$f":"SUM(B19:B21)","v":{"v":0,"d":"$0.00"}},{"v":0,"d":"$0.00"},{"v":0,"d":"$0.00"},{"v":0,"d":"$0.00"},{"v":0,"d":"$0.00"},{"v":0,"d":"$0.00"},{"v":0,"d":"$0.00"},{"v":0,"d":"$0.00"},{"$f":"SUM(B22,D22,F22,H22)","v":{"v":0,"d":"$0.00"}},{"v":0,"d":"$0.00"}]
[]
[null,"Quarterly Fraud and Abuse Activity Report  Health Plan Sanctions and Fines Summary by Quarter"]
[]
[null,"Q1 Sanctions/Fines",null,"Q2 Sanctions/Fines",null,"Q3 Sanctions/Fines",null,"Q4 Sanctions/Fines",null,"YTD Sanctions/Fines"]
["Recovery Category","Imposed $","Received $","Imposed $","Received $","Imposed $","Received $","Imposed $","Received $","Imposed $","Received $"]
["Sanctions (Not Vendor Associated)",{"$f":"SUMIFS('Q1 Details'!$W$2:$W$750, 'Q1 Details'!$E$2:$E$750,  \"\", 'Q1 Details'!$D$2:$D$750, \"New\")","v":{"v":0,"d":"$0.00"}},{"$f":"(SUMIFS('Q1 Details'!$AA$2:$AA$749, 'Q1 Details'!$E$2:$E$749, \"\", 'Q1 Details'!$W$2:$W$749, \">0\")  )","v":{"v":0,"d":"$0.00"}},{"$f":"SUMIFS('Q2 Details'!$W$2:$W$750, 'Q2 Details'!$E$2:$E$750,  \"\", 'Q2 Details'!$D$2:$D$750, \"New\")","v":{"v":0,"d":"$0.00"}},{"$f":"(SUMIFS('Q2 Details'!$AA$2:$AA$749, 'Q2 Details'!$E$2:$E$749, \"\", 'Q2 Details'!$W$2:$W$749, \">0\")  )","v":{"v":0,"d":"$0.00"}},{"$f":"SUMIFS('Q3 Details'!$W$2:$W$750, 'Q3 Details'!$E$2:$E$750,  \"\", 'Q3 Details'!$D$2:$D$750, \"New\")","v":{"v":0,"d":"$0.00"}},{"$f":"(SUMIFS('Q3 Details'!$AA$2:$AA$749, 'Q3 Details'!$E$2:$E$749, \"\", 'Q3 Details'!$W$2:$W$749, \">0\")  )","v":{"v":0,"d":"$0.00"}},{"$f":"SUMIFS('Q4 Details'!$W$2:$W$750, 'Q4 Details'!$E$2:$E$750,  \"\", 'Q4 Details'!$D$2:$D$750, \"New\")","v":{"v":0,"d":"$0.00"}},{"$f":"(SUMIFS('Q4 Details'!$AA$2:$AA$749, 'Q4 Details'!$E$2:$E$749, \"\", 'Q4 Details'!$W$2:$W$749, \">0\")  )","v":{"v":0,"d":"$0.00"}},{"$f":"SUM(B28,D28,F28,H28)","v":{"v":0,"d":"$0.00"}},{"$f":"SUM(C28,E28,G28,I28)","v":{"v":0,"d":"$0.00"}}]
["Fines (Not Vendor Associated)",{"$f":"SUMIFS('Q1 Details'!$X$2:$X$750, 'Q1 Details'!$E$2:$E$750,  \"\", 'Q1 Details'!$D$2:$D$750, \"New\")","v":{"v":0,"d":"$0.00"}},{"$f":"(SUMIFS('Q1 Details'!$AA$2:$AA$749, 'Q1 Details'!$E$2:$E$749, \"\", 'Q1 Details'!$X$2:$X$749, \">0\")  )","v":{"v":0,"d":"$0.00"}},{"$f":"SUMIFS('Q2 Details'!$X$2:$X$750, 'Q2 Details'!$E$2:$E$750,  \"\", 'Q2 Details'!$D$2:$D$750, \"New\")","v":{"v":0,"d":"$0.00"}},{"$f":"(SUMIFS('Q2 Details'!$AA$2:$AA$749, 'Q2 Details'!$E$2:$E$749, \"\", 'Q2 Details'!$X$2:$X$749, \">0\")  )","v":{"v":0,"d":"$0.00"}},{"$f":"SUMIFS('Q3 Details'!$X$2:$X$750, 'Q3 Details'!$E$2:$E$750,  \"\", 'Q3 Details'!$D$2:$D$750, \"New\")","v":{"v":0,"d":"$0.00"}},{"$f":"(SUMIFS('Q3 Details'!$AA$2:$AA$749, 'Q3 Details'!$E$2:$E$749, \"\", 'Q3 Details'!$X$2:$X$749, \">0\")  )","v":{"v":0,"d":"$0.00"}},{"$f":"SUMIFS('Q4 Details'!$X$2:$X$750, 'Q4 Details'!$E$2:$E$750,  \"\", 'Q4 Details'!$D$2:$D$750, \"New\")","v":{"v":0,"d":"$0.00"}},{"$f":"(SUMIFS('Q4 Details'!$AA$2:$AA$749, 'Q4 Details'!$E$2:$E$749, \"\", 'Q4 Details'!$X$2:$X$749, \">0\")  )","v":{"v":0,"d":"$0.00"}},{"v":0,"d":"$0.00"},{"v":0,"d":"$0.00"}]
["Other (Not Vendor Associated)",{"$f":"SUMIFS('Q1 Details'!$Y$2:$Y$750, 'Q1 Details'!$E$2:$E$750,  \"\", 'Q1 Details'!$D$2:$D$750, \"New\")","v":{"v":0,"d":"$0.00"}},{"$f":"(SUMIFS('Q1 Details'!$AA$2:$AA$749, 'Q1 Details'!$E$2:$E$749, \"\", 'Q1 Details'!$Y$2:$Y$749, \">0\")  )","v":{"v":0,"d":"$0.00"}},{"$f":"SUMIFS('Q2 Details'!$Y$2:$Y$750, 'Q2 Details'!$E$2:$E$750,  \"\", 'Q2 Details'!$D$2:$D$750, \"New\")","v":{"v":0,"d":"$0.00"}},{"$f":"(SUMIFS('Q2 Details'!$AA$2:$AA$749, 'Q2 Details'!$E$2:$E$749, \"\", 'Q2 Details'!$Y$2:$Y$749, \">0\")  )","v":{"v":0,"d":"$0.00"}},{"$f":"SUMIFS('Q3 Details'!$Y$2:$Y$750, 'Q3 Details'!$E$2:$E$750,  \"\", 'Q3 Details'!$D$2:$D$750, \"New\")","v":{"v":0,"d":"$0.00"}},{"$f":"(SUMIFS('Q3 Details'!$AA$2:$AA$749, 'Q3 Details'!$E$2:$E$749, \"\", 'Q3 Details'!$Y$2:$Y$749, \">0\")  )","v":{"v":0,"d":"$0.00"}},{"$f":"SUMIFS('Q4 Details'!$Y$2:$Y$750, 'Q4 Details'!$E$2:$E$750,  \"\", 'Q4 Details'!$D$2:$D$750, \"New\")","v":{"v":0,"d":"$0.00"}},{"$f":"(SUMIFS('Q4 Details'!$AA$2:$AA$749, 'Q4 Details'!$E$2:$E$749, \"\", 'Q4 Details'!$Y$2:$Y$749, \">0\")  )","v":{"v":0,"d":"$0.00"}},{"v":0,"d":"$0.00"},{"v":0,"d":"$0.00"}]
["Total",{"$f":"SUM(B28:B30)","v":{"v":0,"d":"$0.00"}},{"$f":"SUM(C28:C30)","v":{"v":0,"d":"$0.00"}},{"v":0,"d":"$0.00"},{"v":0,"d":"$0.00"},{"v":0,"d":"$0.00"},{"v":0,"d":"$0.00"},{"v":0,"d":"$0.00"},{"v":0,"d":"$0.00"},{"v":0,"d":"$0.00"},{"v":0,"d":"$0.00"}]
["Vendor-Dental",{"$f":"(SUMIFS('Q1 Details'!$W$2:$W$750, 'Q1 Details'!$E$2:$E$750,  \"Dental\", 'Q1 Details'!$D$2:$D$750, \"New\") + SUMIFS('Q1 Details'!$X$2:$X$750, 'Q1 Details'!$E$2:$E$750,  \"Dental\", 'Q1 Details'!$D$2:$D$750, \"New\")  + SUMIFS('Q1 Details'!$Y$2:$Y$750, 'Q1 Details'!$E$2:$E$750,  \"Dental\", 'Q1 Details'!$D$2:$D$750, \"New\")  )","v":{"v":0,"d":"$0.00"}},{"$f":"(SUMIFS('Q1 Details'!$AA$2:$AA$749, 'Q1 Details'!$E$2:$E$749, \"Dental\", 'Q1 Details'!$W$2:$W$749, \">0\") +   SUMIFS('Q1 Details'!$AA$2:$AA$749, 'Q1 Details'!$E$2:$E$749, \"Dental\", 'Q1 Details'!$X$2:$X$749, \">0\") + SUMIFS('Q1 Details'!$AA$2:$AA$749, 'Q1 Details'!$E$2:$E$749, \"Dental\", 'Q1 Details'!$Y$2:$Y$749, \">0\") )","v":{"v":0,"d":"$0.00"}},{"$f":"(SUMIFS('Q2 Details'!$W$2:$W$750, 'Q2 Details'!$E$2:$E$750,  \"Dental\", 'Q2 Details'!$D$2:$D$750, \"New\") + SUMIFS('Q2 Details'!$X$2:$X$750, 'Q2 Details'!$E$2:$E$750,  \"Dental\", 'Q2 Details'!$D$2:$D$750, \"New\")  + SUMIFS('Q2 Details'!$Y$2:$Y$750, 'Q2 Details'!$E$2:$E$750,  \"Dental\", 'Q2 Details'!$D$2:$D$750, \"New\")  )","v":{"v":0,"d":"$0.00"}},{"$f":"(SUMIFS('Q2 Details'!$AA$2:$AA$749, 'Q2 Details'!$E$2:$E$749, \"Dental\", 'Q2 Details'!$W$2:$W$749, \">0\") +   SUMIFS('Q2 Details'!$AA$2:$AA$749, 'Q2 Details'!$E$2:$E$749, \"Dental\", 'Q2 Details'!$X$2:$X$749, \">0\") + SUMIFS('Q2 Details'!$AA$2:$AA$749, 'Q2 Details'!$E$2:$E$749, \"Dental\", 'Q2 Details'!$Y$2:$Y$749, \">0\") )","v":{"v":0,"d":"$0.00"}},{"$f":"(SUMIFS('Q3 Details'!$W$2:$W$750, 'Q3 Details'!$E$2:$E$750,  \"Dental\", 'Q3 Details'!$D$2:$D$750, \"New\") + SUMIFS('Q3 Details'!$X$2:$X$750, 'Q3 Details'!$E$2:$E$750,  \"Dental\", 'Q3 Details'!$D$2:$D$750, \"New\")  + SUMIFS('Q3 Details'!$Y$2:$Y$750, 'Q3 Details'!$E$2:$E$750,  \"Dental\", 'Q3 Details'!$D$2:$D$750, \"New\")  )","v":{"v":0,"d":"$0.00"}},{"$f":"(SUMIFS('Q3 Details'!$AA$2:$AA$749, 'Q3 Details'!$E$2:$E$749, \"Dental\", 'Q3 Details'!$W$2:$W$749, \">0\") +   SUMIFS('Q3 Details'!$AA$2:$AA$749, 'Q3 Details'!$E$2:$E$749, \"Dental\", 'Q3 Details'!$X$2:$X$749, \">0\") + SUMIFS('Q3 Details'!$AA$2:$AA$749, 'Q3 Details'!$E$2:$E$749, \"Dental\", 'Q3 Details'!$Y$2:$Y$749, \">0\") )","v":{"v":0,"d":"$0.00"}},{"$f":"(SUMIFS('Q4 Details'!$W$2:$W$750, 'Q4 Details'!$E$2:$E$750,  \"Dental\", 'Q4 Details'!$D$2:$D$750, \"New\") + SUMIFS('Q4 Details'!$X$2:$X$750, 'Q4 Details'!$E$2:$E$750,  \"Dental\", 'Q4 Details'!$D$2:$D$750, \"New\")  + SUMIFS('Q4 Details'!$Y$2:$Y$750, 'Q4 Details'!$E$2:$E$750,  \"Dental\", 'Q4 Details'!$D$2:$D$750, \"New\")  )","v":{"v":0,"d":"$0.00"}},{"$f":"(SUMIFS('Q4 Details'!$AA$2:$AA$749, 'Q4 Details'!$E$2:$E$749, \"Dental\", 'Q4 Details'!$W$2:$W$749, \">0\") +   SUMIFS('Q4 Details'!$AA$2:$AA$749, 'Q4 Details'!$E$2:$E$749, \"Dental\", 'Q4 Details'!$X$2:$X$749, \">0\") + SUMIFS('Q4 Details'!$AA$2:$AA$749, 'Q4 Details'!$E$2:$E$749, \"Dental\", 'Q4 Details'!$Y$2:$Y$749, \">0\") )","v":{"v":0,"d":"$0.00"}},{"v":0,"d":"$0.00"},{"v":0,"d":"$0.00"}]
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[]
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["Reporting Fiscal Year","Reporting Fiscal Quarter","Medicaid Health Plan Identifier","New/Previously Reported","Vendor Associated (If Applicable)","MPI Complaint ID","Plan Internal Tracking Number","Provider Type (Under Review)","Provider (Under Review) Tax ID","Entity Under Review","Provider/Entity Name","Entity Medicaid ID Number","Provider NPI Number (If Applicable)","Date Detected","Date First Reported to MPI","Allegation Type","Primary Allegation","Secondary Allegation (If Applicable)","Detection Tool","Preliminary Overpayment Identified","Updated Overpayment Amount Identified","Final Overpayment Identified for Recovery","Fines Amount (If Applicable)","Sanctions Amount (If Applicable)","Other Financial Penalties (If Applicable)","Settlement Amount (If Applicable)","Recoupment Amount (If Applicable)","Dollar Amount Lost (If Applicable)","Status","Other Entity Reported To Primary","Other Entity Reported To Secondary","Other Entity Reported To Tertiary","Other Entity Reported To Quaternary","Corrective Action","Times Provider Reviewed Within Last 5 Years","Detailed Update","Additional Comments for Primary Allegation ","Additional Comments for Secondary Allegation","Additional Comments for Detection Tool","Additional Comments for Status","Additional Comments for Corrective Action"]
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["Reporting Fiscal Year","Reporting Fiscal Quarter","Medicaid Health Plan Identifier","New/Previously Reported","Vendor Associated (If Applicable)","MPI Complaint ID","Plan Internal Tracking Number","Provider Type (Under Review)","Provider (Under Review) Tax ID","Entity Under Review","Provider/Entity Name","Entity Medicaid ID Number","Provider NPI Number (If Applicable)","Date Detected","Date First Reported to MPI","Allegation Type","Primary Allegation","Secondary Allegation (If Applicable)","Detection Tool","Preliminary Overpayment Identified","Updated Overpayment Amount Identified","Final Overpayment Identified for Recovery","Fines Amount (If Applicable)","Sanctions Amount (If Applicable)","Other Financial Penalties (If Applicable)","Settlement Amount (If Applicable)","Recoupment Amount (If Applicable)","Dollar Amount Lost (If Applicable)","Status","Other Entity Reported To Primary","Other Entity Reported To Secondary","Other Entity Reported To Tertiary","Other Entity Reported To Quaternary","Corrective Action","Times Provider Reviewed Within Last 5 Years","Detailed Update","Additional Comments for Primary Allegation ","Additional Comments for Secondary Allegation","Additional Comments for Detection Tool","Additional Comments for Status","Additional Comments for Corrective Action"]
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["Reporting Fiscal Year","Reporting Fiscal Quarter","Medicaid Health Plan Identifier","New/Previously Reported","Vendor Associated (If Applicable)","MPI Complaint ID","Plan Internal Tracking Number","Provider Type (Under Review)","Provider (Under Review) Tax ID","Entity Under Review","Provider/Entity Name","Entity Medicaid ID Number","Provider NPI Number (If Applicable)","Date Detected","Date First Reported to MPI","Allegation Type","Primary Allegation","Secondary Allegation (If Applicable)","Detection Tool","Preliminary Overpayment Identified","Updated Overpayment Amount Identified","Final Overpayment Identified for Recovery","Fines Amount (If Applicable)","Sanctions Amount (If Applicable)","Other Financial Penalties (If Applicable)","Settlement Amount (If Applicable)","Recoupment Amount (If Applicable)","Dollar Amount Lost (If Applicable)","Status","Other Entity Reported To Primary","Other Entity Reported To Secondary","Other Entity Reported To Tertiary","Other Entity Reported To Quaternary","Corrective Action","Times Provider Reviewed Within Last 5 Years","Detailed Update","Additional Comments for Primary Allegation ","Additional Comments for Secondary Allegation","Additional Comments for Detection Tool","Additional Comments for Status","Additional Comments for Corrective Action"]
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{"sheet":"Drop Downs","index":6,"n_rows":62,"n_cols":7,"rows_kept":62,"hidden":true}
[null,null,"Reporting Fiscal Quarter",null,"Provider Type",null,"Entity Under Review"]
[null,null,"Q1",null,"01 - GENERAL HOSPITAL                                  ",null,"Provider"]
[null,null,"Q2",null,"05 - COMMUNITY BEHAVORIAL HEALTH SERVICES              ",null,"Recipient"]
[null,null,"Q3",null,"06 - AMBULATORY SURGERY CENTER                         ",null,"Internal"]
[null,null,"Q4",null,"07 - SPECIALIZED MENTAL HEALTH PRACTITIONER            ",null,"Health Plan"]
[{"$nulls":4},"08 - SCHOOL DISTRICT                                   "]
[{"$nulls":4},"09 - SKILLED NURSING UNIT HOSPITAL BASED               ",null,"Corrective Action"]
["Primary Allegation",null,"Secondary Allegation",null,"10 - SKILLED NURSING FACILITY                          ",null,"Education"]
["Kickbacks",null,"Kickbacks",null,"13 - SWING BED FACILITY                                ",null,"Fines/Sanctions"]
["Other - (describe in narrative field)",null,"Other - (describe in narrative field)",null,"14 - ASSISTIVE CARE SERVICES                           ",null,"Recoupment"]
["Provider - Altering, falsifying, or destroying clinical record documentation",null,"Provider - Altering, falsifying, or destroying clinical record documentation",null,"15 - HOSPICE                                           ",null,"Settlement"]
["Provider - Billing excessive services",null,"Provider - Billing excessive services",null,"16 - RESIDENTIAL AND FREESTANDING PSYCH                ",null,"Termination - Voluntary"]
["Provider - Billing for services not rendered",null,"Provider - Billing for services not rendered",null,"20 - PHARMACY                                          ",null,"Termination - Involuntary"]
["Provider - Billing for services that are medically unnecessary",null,"Provider - Billing for services that are medically unnecessary",null,"23 - MEDICAL FOSTER CARE/ PERSONAL CARE PROVIDER       ",null,"Other (describe in narrative field)"]
["Provider - Charging enrollees for covered services",null,"Provider - Charging enrollees for covered services",null,"24 - PRESCRIBED MEDICAL REHAB SERVICES (PPEC)          "]
["Provider - Disenrollment issues",null,"Provider - Disenrollment issues",null,"25 - PHYSICIAN (M.D.)                                  "]
["Provider - Failing to render medically necessary services",null,"Provider - Failing to render medically necessary services",null,"26 - PHYSICIAN (D.O.)                                  ",null,"Detection Tools"]
["Provider - False statements related to credentials",null,"Provider - False statements related to credentials",null,"27 - PODIATRIST                                        ",null,"AHCA - source of referral"]
["Provider - Federally Excluded Provider",null,"Provider - Federally Excluded Provider",null,"28 - CHIROPRACTOR                                      ",null,"AHCA - MPI"]
["Provider - Marketing violations",null,"Provider - Marketing violations",null,"29 - PHYSICIAN ASSISTANT                               ",null,"Claims Edits"]
["Provider - Misrepresenting medical info to justify referral",null,"Provider - Misrepresenting medical info to justify referral",null,"30 - NURSE PRACTITIONER (ARNP)                         ",null,"Data Analysis"]
["Provider - Other, not operating within Medicaid guidelines",null,"Provider - Other, not operating within Medicaid guidelines",null,"31 - REGISTERED NURSE/REGISTERED NURSE FIRST ASSISTANT ",null,"Data Matching/Mining"]
["Provider - Overcharging for services that are provided",null,"Provider - Overcharging for services that are provided",null,"32 - SOCIAL WORKER/CASE MANAGER                        ",null,"Direct contact with or by an informant"]
["Provider - Pattern of falsified encounter or service reports",null,"Provider - Pattern of falsified encounter or service reports",null,"34 - LICENSED MIDWIFE                                  ",null,"Employee Identification of red flags or fraud indicators"]
["Provider - Pattern of overstated reports (upcoding)",null,"Provider - Pattern of overstated reports (upcoding)",null,"35 - DENTIST                                           ",null,"Enrollee Recipient - source of referral"]
["Provider - Pattern of unbundling services",null,"Provider - Pattern of unbundling services",null,"40 - AMBULANCE                                         ",null,"External Audit (Vendor)"]
["Provider - Prior Auth - Provider billing for non-covered/ unauthorized services",null,"Provider - Prior Auth - Provider billing for non-covered/ unauthorized services",null,"41 - NON-EMERGENCY TRANSPORT                           ",null,"Federal Agency – source of referral (specify in narrative)"]
["Provider - Underutilization",null,"Provider - Underutilization",null,"42 - AIR AMBULANCE                                     ",null,"Hotline - Health Plan's Internal Confidential Hotline"]
[{"$nulls":4},"50 - INDEPENDENT LABORATORY                            ",null,"Hotline - Health Plan's Third Party Vendor Hotline"]
[{"$nulls":4},"51 - PORTABLE X-RAY COMPANY                            ",null,"Internal Audit (Health Plan)"]
["Referral to…",null,"Vendor",null,"60 - AUDIOLOGIST                                       ",null,"Internal Controls"]
["AHCA – Division of Medicaid ",null,"Dental",null,"61 - HEARING AID SPECIALIST                            ",null,"News Articles/Internet"]
["AHCA – Health Quality Assurance",null,"Vision",null,"62 - OPTOMETRIST                                       ",null,"Notified by Police or Law Enforcement (includes MFCU)"]
["AHCA – Medicaid Program Integrity",null,"Transportation",null,"63 - OPTICIAN                                          ",null,"Other (describe in narrative field)"]
["AHCA – Other ",null,"Behavioral Health",null,"65 - HOME HEALTH AGENCY                                ",null,"Prepayment Review"]
["APD – Agency for Persons with Disabilities ",null,"Pharmacy ",null,"66 - RURAL HEALTH CLINIC                               ",null,"Provider - source of referral"]
["APS - Adult Protective Services ",{"$nulls":3},"67 - HOME AND COMMUNITY BASED SERVICES WAIVER          ",null,"Provider Credentialing"]
["Consumer Protection Agency ",null,"Status",null,"68 - FEDERALLY QUALIFIED HEALTH CENTER                 ",null,"Provider Self Audit"]
["Contractor for CMS ",null,"New",null,"81 - PROFESSIONAL EARLY INTERVENTION SERVICES          ",null,"Site Visit"]
["Department of Children and Families ",null,"Reported - Q1 FY2017-2018",null,"83 - THERAPIST (PT, OT, ST, RT)                        "]
["Department of Health ",null,"Reported - Q2 FY2017-2018",null,"89 - DIALYSIS CENTER                                   ",null,"Number of Previous Reviews"]
["FBI – Federal Bureau of Investigation ",null,"Reported - Q3 FY2017-2018",null,"90 - DURABLE MED EQUIPT/ MEDICAL SUPPLIES              ",null,0]
["Florida Department of Law Enforcement ",null,"Reported - Q4 FY2017-2018",null,"91 - CASE MANAGEMENT AGENCY                            ",null,1]
["HHS – OIG Health & Human Services Inspector",null,"Reported - Q1 FY2018-2019",{"$nulls":3},2]
["Law Enforcement Agency ",null,"Reported - Q2 FY2018-2019",null,"Status",null,3]
["MFCU ",null,"Reported - Q3 FY2018-2019",null,"Open: Active Litigation – External (by regulatory authority)",null,4]
["State Agency – Other ",null,"Reported - Q4 FY2018-2019",null,"Open: Active Litigation – Internal (by health plan)",null,5]
["Federal Agencies – Other",null,"Reported - Q1 FY2019-2020",null,"Open: Investigation in progress",null,6]
["Other - Please specify",null,"Reported - Q2 FY2019-2020",null,"Open: Overpayment partially recovered",null,7]
[null,null,"Reported - Q3 FY2019-2020",null,"Open: Overpayment recovery pending",null,"8 or more"]
["Allegation Type",null,"Reported - Q4 FY2019-2020",null,"Open: Other (describe in narrative field)"]
["Fraud",null,"Reported - Q1 FY2020-2021",null,"Closed: Final overpayment  recovered"]
["Abuse",null,"Reported - Q2 FY2020-2021",null,"Closed: Allegation determined as unsubstantiated"]
[null,null,"Reported - Q3 FY2020-2021",null,"Closed: Other (describe in narrative field)"]
["Reporting Fiscal Year",null,"Reported - Q4 FY2020-2021"]
["FY 2018-2019",null,"Reported - Q1 FY2021-2022"]
["FY 2019-2020",null,"Reported - Q2 FY2022-2023"]
["FY 2020-2021",null,"Reported - Q3 FY2023-2024"]
["FY 2021-2022",null,"Reported - Q4 FY2024-2025"]
["FY 2022-2023"]
["FY 2023-2024"]
["FY 2024-2025"]