Ohio Governor Mike DeWine on Wednesday announced several new initiatives aimed at strengthening Ohio’s efforts to prevent Medicaid fraud, waste, and abuse.
“Ohio has long been a national leader in fighting Medicaid fraud. Ohio has one of the best Medicaid Fraud Control units in the country, and, in 2018, Ohio became the first state to implement Electronic Visit Verification in home health care,” said Mike DeWine. “Today, we are ready to begin several new initiatives long in development that will enhance this nation-leading work and further protect taxpayer funds from those trying to defraud the State. I thank the Trump Administration for their partnership and collaboration that is allowing us to proceed with these reforms much faster than previously possible.”
Among the new measures announced is a request by the Ohio Department of Medicaid to the Centers for Medicare and Medicaid Services for a six-month moratorium on new home healthcare and hospice providers enrolling in Medicaid.
State officials say the pause would allow Ohio to review existing providers and identify those considered high-risk for fraud.
Ohio Medicaid is also implementing an immediate payment suspension policy for providers whose billing practices show potential signs of fraud.
State officials said new data analytics tools introduced earlier this year have already identified 87 providers for additional review and possible suspension.
Governor DeWine also plans to issue an executive order allowing emergency rules requiring more frequent revalidation of providers identified as high-risk.
The administration says the effort follows a May 1 letter sent to federal officials committing Ohio to stricter fraud prevention standards.
Additional changes include requiring GPS tracking for all providers using Electronic Visit Verification, or EVV, during home healthcare visits.
Ohio Medicaid officials say the rule change addresses concerns raised in audits conducted by Ohio Auditor Keith Faber.
The state will also begin the rulemaking process to require live-in caregivers and family caregivers to use EVV as a condition for Medicaid payment.
Those caregivers are currently exempt from the requirement.
According to the state, Ohio has secured 444 Medicaid fraud indictments, 481 convictions, and 146 civil settlements or judgments since the beginning of 2023, recovering more than $78 million in taxpayer funds.
Ohio officials also emphasized the importance of legitimate home healthcare programs, noting that in-home care is often safer for patients and significantly less expensive than nursing facility placement.
The DeWine Administration says Ohio saved more than $600 million in 2024 by utilizing home and community-based care programs instead of higher-cost institutional care.
State officials said Ohio Medicaid has also increased prior authorization requirements for certain high-risk services and expanded the use of artificial intelligence and advanced data analytics to identify suspicious billing patterns and improve fraud detection efforts.
