SouthernWorldwide.com – As Ohio’s state auditor, I’m testifying on Capitol Hill to address a critical issue: my home state is not immune to the sophisticated fraud and abuse that is plaguing Medicaid and other government programs nationwide.
Whenever large government programs involve substantial spending, there will always be individuals who seek to exploit loopholes and weak controls for personal gain.
When state bureaucracies fail to address these weaknesses, they become vulnerable to external manipulation, eroding public trust. The impact is even more severe when these crimes target the most vulnerable members of society, diverting resources meant for those truly in need.
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I have been raising the alarm about Medicaid fraud, waste, and abuse since I became Ohio’s Auditor of State in 2019. I am grateful that more attention is being paid to this issue, and that there is a growing commitment to addressing the misuse of taxpayer dollars.
The Ohio Department of Medicaid constitutes the largest portion of the state’s biennial budget, with approximately $40 billion annually allocated from the state general fund and federal funding. These funds are directed towards healthcare and related programs for about 2.9 million residents, including low-income individuals, older adults, people with disabilities, pregnant women, infants, and children.
This is a vast and complex program, often administered inconsistently with confusing rules and susceptible to both system and human errors. Year after year, my office has identified issues within the Medicaid system and reported error rates that likely result in hundreds of millions, if not billions, of dollars in potential fraud, waste, and abuse.
Consider these figures:
Most recently, the annual State Single Audit revealed an error rate of 15.6% for payments made for services rendered to residents who had passed away or were otherwise ineligible for Medicaid. This translates to potential unallowable costs ranging from $800 million to $4.4 billion. This figure does not even include the numerous other Medicaid provider audits we have conducted, which have identified over $20 million in improper payments in the last seven years.
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The list of concerning findings is extensive.
These are not minor accounting discrepancies. They are a direct consequence of an administrative reluctance to strictly enforce the boundaries of the law.
One particularly striking example involves Medicaid-funded home healthcare services. Federal law mandates that states implement Electronic Visit Verification (EVV) systems to confirm that in-home services were indeed provided before processing payments.
In 2024, we discovered that approximately half of Ohio’s Medicaid-reimbursed home healthcare services completely bypassed this mandatory verification process, despite a $146 million investment in implementing the EVV system. This lack of enforcement by the relevant agency leaves the system vulnerable to unscrupulous providers who may engage in improper billing for services that were never rendered.
Furthermore, recent reports have brought to light concerns regarding unusual concentrations of providers and billing patterns within Ohio’s home healthcare sector. These anomalies are particularly noticeable within a small geographic area of Franklin County.
My office is conducting an independent evaluation of these unusual patterns to identify any bad actors involved. However, it is crucial to differentiate between identifying risk and making criminal allegations. Audits are designed to expose failures in internal controls; it is the role of investigators and prosecutors to determine if specific actions constitute fraud.
Nevertheless, ignoring repeated warning signs is an unacceptable dereliction of duty. Every dollar lost to external exploitation is a dollar that cannot be used to support Ohioans who genuinely depend on these services.
These problems are entirely preventable and fixable. While leadership is committed to accountability, success hinges on state agency administrators matching that commitment. Implementing stronger eligibility verification processes, improving cross-state coordination, and rigorously enforcing EVV requirements are essential steps to restore the integrity of the program.
My office will continue its independent audits of state programs and transparently report its findings. Ohio taxpayers deserve responsible stewardship of public funds, and vulnerable residents deserve the assurance that the resources allocated for their care are rigorously protected from abuse.
