Ohio Governor Mike DeWine has taken decisive action to address potential Medicaid fraud by signing an executive order that mandates more frequent revalidation of certain Medicaid providers. This move comes as a response to a federal investigation initiated by the U.S. House Committee on Oversight and Government Reform, which is scrutinizing the Ohio Department of Medicaid.

Federal Oversight and State Response

The investigation, spearheaded by the newly formed Task Force on Defending Constitutional Rights and Exposing Institutional Abuses, is focusing on fraud within Ohio’s Medicaid personal care services authorized by Home and Community-Based Services (HCBS) waivers. The task force, led by Rep. Brandon Gill, R-Texas, is examining reports of significant fraud, including improper billing practices by providers.

Governor DeWine’s executive order is part of a broader effort to tighten oversight and prevent misuse of Medicaid funds. The order includes a six-month moratorium on new provider enrollments for certain high-risk categories, such as hospice and home health agencies, and mandates more frequent revalidation for providers deemed high-risk for fraud.

Ohio’s Proactive Measures

Ohio has been recognized for its proactive stance against Medicaid fraud, with the state securing numerous indictments and convictions. Since 2023, Ohio has achieved 444 Medicaid fraud indictments and recovered $78.4 million in taxpayer funds. The state’s efforts are supported by advanced data analytics and electronic visit verification compliance to identify and prevent fraudulent activities before payments are made.

Vice President J.D. Vance, commenting on the issue, emphasized that Medicaid fraud is a bipartisan concern, affecting both red and blue states. He praised Ohio’s commitment to addressing these challenges, highlighting the state’s collaboration with the Trump Administration to implement new fraud prevention reforms.

Future Steps and Collaboration

Governor DeWine has instructed the Ohio Department of Medicaid to amend administrative rules to enhance compliance and credentialing processes. This includes the ability to terminate agreements with providers who have not billed Medicaid in over a year and to deny enrollment applications during federally-approved moratoriums.

DeWine’s commitment to combating Medicaid fraud is longstanding, dating back to his tenure as Ohio’s Attorney General. His administration continues to work closely with federal partners to ensure robust oversight and accountability within the Medicaid program.

Original reporting: Dayton Daily News — read the source article.