I'm Ohio's state auditor — Medicaid fraud is not just a Washington problem

When I attest connected Capitol Hill, I’ll beryllium addressing the information that my location authorities of Ohio is not immune to the blase fraud and maltreatment plaguing Medicaid and different authorities programs nationally.

Wherever determination are large authorities programs backed by large authorities spending, determination volition beryllium radical who find ways to exploit loopholes and lax controls to capable their ain pocketbooks.

Left unaddressed by the authorities bureaucracies, these weaknesses invitation extracurricular manipulation and erode nationalist trust. The crimes are adjacent worse erstwhile they impact the astir susceptible among us, taking resources for programs that service genuinely needy residents.

VANCE-LED TASK FORCE CUTS OFF $1.4B FROM HOME HEALTH, HOSPICE PROVIDERS SUSPECTED OF FRAUD

I’ve been sounding the alarm astir Medicaid fraud, discarded and maltreatment since becoming Ohio’s Auditor of State successful 2019. I’m thankful much radical are taking announcement and voicing a committedness to addressing the misuse of taxation dollars.

The Ohio Department of Medicaid makes up the biggest portion of the state’s biennial budget, with astir $40 cardinal annually successful the authorities wide money and national backing directed to wellness attraction and related programming for astir 2.9 cardinal lower-income residents, older adults, individuals with disabilities, large women, infants and children, and others. It’s a large, analyzable programme administered (often inconsistently) with confusing rules and ample strategy and quality error.

Year aft year, my bureau has pointed retired issues successful the Medicaid strategy and mistake rates that are apt starring to hundreds of millions oregon billions of dollars successful imaginable fraud, discarded and abuse.

 Consider:

• In 2020, we identified much than $455 cardinal successful Medicaid benefits paid to ineligible recipients owed to flawed oversight.
• In 2022, we recovered that authorities bureau administrators failed to retrieve $118.5 cardinal successful duplicate oregon improper payments tied to situation inmates and dormant people.
• In 2022, we besides noted agency-level failures to enactment connected multi-state enrollment eligibility alerts that outgo taxpayers up to $24.5 million.
• In 2024, an audit identified much than 124,000 radical enrolled successful Medicaid programs crossed aggregate states, with Ohio paying managed-care organizations much than $1 cardinal for imaginable duplicate services.

Most recently, the yearly State Single Audit reported an mistake complaint of 15.6% for payments made for services for residents who had died oregon were different ineligible for Medicaid programming, meaning imaginable unallowable costs of $800 cardinal to $4.4 billion. That’s not including the dozens of different Medicaid supplier audits we’ve conducted that person included much than $20 cardinal successful improper payments successful the past 7 years.

The database goes connected and on.

These are not insignificant bookkeeping errors. They are the nonstop effect of an administrative unwillingness to enforce the strict boundaries of the law.

One glaring illustration involves Medicaid-funded location healthcare. Federal instrumentality requires states to usage Electronic Visit Verification (EVV) systems to corroborate that in-home services really occurred earlier payments are processed.

In 2024, we recovered that astir fractional of Ohio's Medicaid-reimbursed location healthcare services skipped this required verification entirely, contempt a $146 cardinal concern to instrumentality the system. This deficiency of bureau enforcement leaves the backdoor wide unfastened for unscrupulous providers to prosecute successful improper billing for services that whitethorn ne'er person occurred.

Furthermore, caller reporting has raised questions astir antithetic supplier concentrations and billing patterns wrong Ohio’s location healthcare sector, peculiarly wrong a tiny geographic country of Franklin County.

My bureau is independently evaluating these anomalies to exposure immoderate atrocious actors involved. That said, we indispensable separate betwixt identifying hazard and making transgression allegations. Audits exposure interior power failures; investigators and prosecutors indispensable find if circumstantial behaviour constitutes fraud.

Still, ignoring repeated informing signs is irresponsible. Every dollar mislaid to extracurricular exploitation is simply a dollar unavailable to Ohioans who genuinely trust connected these services.

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These problems are wholly fixable. Leadership is committed to accountability, but occurrence requires authorities bureau administrators to lucifer that commitment. Stronger eligibility verification, amended cross-state coordination, and ruthless enforcement of EVV requirements volition reconstruct programme integrity.

My bureau volition proceed independently auditing authorities programs and reporting findings transparently. Ohio taxpayers merit competent stewardship of nationalist dollars, and susceptible residents merit assurance that the resources intended for their attraction are rigorously protected from abuse.