When Florida regulators found that a 71-year-old man with mental illness died from burns after he was left in a tub of scalding water at a Hialeah assisted-living facility, they could have cut off thousands in state dollars sent to the home each year.

Instead, they imposed a fine.

The next year, when inspectors discovered a caretaker at the ALF had punched a severely mentally ill man in the mouth, they could have stopped the public dollars to the home. But instead, they issued a warning.

At least four more times in the past four years, regulators turned up neglect cases at All-American ACLF — including failing to provide crucial medication to sick elders — but continued giving $1 million to the home, even as caregivers were breaking the law.

Though Florida law gives regulators the power to stop giving Medicaid money to homes caught abusing and neglecting residents, The Miami Herald found regulators routinely funnel millions every year to some of the state’s most dangerous facilities.

Since 2007, the Agency for Healthcare Administration has doled out more than $23 million to nearly 90 homes that could have been cut off from public dollars — including facilities where caretakers were caught beating and sexually abusing frail elders.

The failure of AHCA to turn more often to one of its toughest enforcement tools comes after years of neglect and abuse cases rising in ALFs across the state — with nearly one resident dying a month at the hands of caretakers. Most of the money goes to the ALFs to provide a range of support services like feeding, bathing, medication supervision and health therapies.

“As a taxpayer, I’m totally shocked. I’m outraged,” said Martha Lenderman, an expert on Florida mental health issues and member of the governor’s task force on assisted-living facilities. “That pattern is one that we can’t afford in human or financial terms. These are vulnerable [people].”

As the top regulator, AHCA says it can choose from a host of different punishments — not just cutting off state funds — to force ALFs to abide by the law. “The agency has broad authority and can impose any number of sanctions or disincentives,” said spokeswoman Shelisha Coleman.

But The Miami Herald found that fines imposed by the state were routinely decreased or dropped in the past five years against problem ALFs and homes were regularly allowed to stay open even after AHCA threatened to close them.

In those cases when the agency did sever Medicaid dollars this year, the majority of the ALFs are now closed, The Herald found.

Bentley Lipscomb, former secretary of the state’s Department of Elder Affairs, said the failure to stop the flow of public dollars is one of the main reasons troubled homes stay open.

“They know they are not at risk, that’s why they haven’t changed anything,” said Lipscomb, who pressed for the state’s first elder abuse law in 1995.

At a Pasco County home, caretakers were supposed to be watching Charlene Webb more carefully because she had been falling. But when the 82-year-old woman fell on the floor in 2009 and urinated on a power cord, the electrical surges ripping through her body, there was no one to help her. Nine times she had pressed the call button, but no one responded until it was too late: Her burns were so severe, she soon died. AHCA could have suspended public dollars to La Casa Grande, but instead ordered a $10,000 fine.