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Governor announces new preventative measures against Medicaid fraud in Ohio

By John Tisdell, WHIO.com
Medicaid Payments FILE - The U.S. Department of Health and Human Services building is seen, April 5, 2009, in Washington. (AP Photo/Alex Brandon, File) (Alex Brandon/AP)
By John Tisdell, WHIO.com

COLUMBUS — Governor Mike DeWine announced new measures to help crack down on Medicaid fraud in Ohio.

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These new measures are designed to fight fraud, waste, and abuse in the Ohio Medicaid system, according to the governor’s spokesperson.

“Today I announced several new fraud prevention initiatives to strengthen and build upon long-standing efforts to fight fraud, waste, and abuse in the Ohio Medicaid System,” he said on social media. “We are ready to begin these initiatives long in development that will enhance Ohio’s nation-leading work and further protect taxpayer funds from those trying to defraud the State.”

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DeWine said that he has directed the Ohio Department of Medicaid to implement these measures:

  • Statewide New Provider Moratorium. The Ohio Department of Medicaid will ask the Center for Medicare and Medicaid Services (CMS) so that Ohio may implement a six-month moratorium on new home-healthcare and hospice businesses being able to become Medicaid providers.
  • Immediate Payment Suspension to High-Risk Providers. Ohio Medicaid will begin a policy of immediately removing and suspending payment to providers whose billing practices show “red flags” that indicate a high probability of fraud.
  • Executive Order for Emergency Rules. This will allow the Ohio Department of Medicaid to implement emergency rules to require more frequent revalidation of providers being identified as higher-risk for committing fraud.
  • Mandatory GPS Requirement for Electronic Visit Verification. Ohio Medicaid will file rules to require GPS for all providers using Electronic Visit Verification (EVV). Since March 2025, Ohio Medicaid has begun phasing in EVV as a mandatory requirement for home healthcare provider payment. Ohio Medicaid is now ready to make this rule change to implement the requirement.
  • Mandatory EVV for Live-In Caregivers. Ohio Medicaid will begin the rulemaking process to require live-in caregivers to use EVV during home healthcare and as a requirement for payment.

The governor added that Ohio’s home and community-based care programs have been a core component of Medicaid services for decades. They are grounded in data that shows legitimate in-home care is safer for individuals and more affordable for taxpayers, the spokesperson said.

“In 2024, Ohio saved more than $600 million in taxpayer funds that would have been expended had patients receiving home healthcare been diverted to skilled nursing or other residential care services, saving several billion dollars over the course of the DeWine Administration,” the spokesperson stated. “On average, home health care costs half as much as placement in a nursing facility.”

Ohio Medicaid and the Ohio Attorney General’s Medicaid Fraud Control said they have secured over 400 Medicaid fraud indictments and almost 500 convictions since 2023.

They have also recovered over $78 million in taxpayer funds.

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