Ochratoxin A (OTA) can occur in a large variety of commodities (cereals, beans, groundnuts, spices, dried fruits, coffee, beer, wine) and, because of a carry-over effect, in milk, pig blood, liver, and kidney, and poultry meat from animals fed with contaminated feed. Because of the persistence of OTA in the food chain, exposure to the compound is a potential human health hazard. This has prompted adoption of regulatory limits in several countries which, in turn, implies the development of suitable validated and official analytical methods and rapid screening tests for cost-effective food control on a large scale. Liquid chromatography with fluorescence detection (LC-FLD), coupled with immunoaffinity column (IAC) clean-up, is the most widely employed analytical technique. LC coupled with electrospray-ionization mass spectrometry (MS) has detection limits comparable with those of LC-FLD and the selectivity of IAC can be achieved by tandem (MS-MS) or sequential (MS(n)) detection. Synthetic counterparts to natural antibodies in the form of molecularly imprinted polymers seem a promising alternative to IAC for sample preparation. New analytical approaches to rapid, low-cost screening methods, for example those based on biosensors and dip-stick-like kits, are a direction in which innovation can be expected. Analytical methods for evaluation of the occurrence of OTA in foods, human exposure, and risk assessment are critically reviewed.