UMVA has learned that a staggering wave of sophisticated fraud and abuse is plaguing Medicaid and other government programs in Ohio, a crisis that threatens to undermine the very fabric of the healthcare system.
The alarming reality is that wherever big government programs meet big government spending, unscrupulous individuals will inevitably find ways to exploit loopholes and lax controls to line their own pockets, leaving vulnerable residents to bear the brunt of the consequences.
As the Auditor of State in Ohio, I've been sounding the alarm about Medicaid fraud, waste, and abuse since 2019, and I'm heartened to see more people taking notice and voicing a commitment to addressing the egregious misuse of taxpayer dollars.
The Ohio Department of Medicaid is a behemoth, accounting for a whopping $40 billion annually in the state general fund and federal funding, directed towards healthcare and related programming for nearly 2.9 million lower-income residents, older adults, individuals with disabilities, and others.
Yet, year after year, my office has pointed out glaring issues in the Medicaid system, with error rates that are likely leading to hundreds of millions or even billions of dollars in potential fraud, waste, and abuse, a crisis that demands immediate attention and action.
In the most recent State Single audit, a staggering 15.6% error rate was revealed for payments made for services for residents who had died or were otherwise ineligible for Medicaid programming, translating to potential unallowable costs of $800 million to $4.4 billion, a sum that is nothing short of breathtaking.
But the problems run far deeper, with dozens of Medicaid provider audits conducted by my office uncovering more than $20 million in improper payments over the past seven years, a disturbing pattern that suggests a systemic failure to enforce the law and protect the integrity of the program.
One glaring example of this failure involves Medicaid-funded home healthcare, where federal law requires states to use Electronic Visit Verification (EVV) systems to confirm that in-home services actually occurred before payments are processed, yet in 2024, we found that roughly half of Ohio's Medicaid-reimbursed home healthcare services skipped this required verification entirely.
This lack of agency enforcement leaves the backdoor wide open for unscrupulous providers to engage in improper billing for services that may never have occurred, a betrayal of the public trust that must be addressed with urgency and resolve.
Recent reporting has also raised questions about unusual provider concentrations and billing patterns within Ohio's home healthcare sector, particularly within a small geographic area of Franklin County, anomalies that my office is independently evaluating to expose any bad actors involved.
Make no mistake, ignoring repeated warning signs is irresponsible, and every dollar lost to outside exploitation is a dollar unavailable to Ohioans who genuinely rely on these services, a harsh reality that demands leadership, accountability, and a commitment to restoring program integrity.
The problems are entirely fixable, but success requires state agency administrators to match the commitment to accountability with tangible action, including stronger eligibility verification, better cross-state coordination, and ruthless enforcement of EVV requirements.
My office will continue to independently audit state programs and report findings transparently, because Ohio taxpayers deserve competent stewardship of public dollars, and vulnerable residents deserve confidence that the resources intended for their care are rigorously protected from abuse.
