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

When I testify on Capitol Hill, I’ll be addressing the fact that my home state of Ohio is not immune to the sophisticated fraud and abuse plaguing Medicaid and other government programs nationally.

Wherever there are big government programs backed by big government spending, there will be people who find ways to exploit loopholes and lax controls to fill their own pocketbooks.

Left unaddressed by the state bureaucracies, these weaknesses invite outside manipulation and erode public trust. The crimes are even worse when they affect the most vulnerable among us, taking resources for programs that serve truly needy residents.

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

I’ve been sounding the alarm about Medicaid fraud, waste and abuse since becoming Ohio’s Auditor of State in 2019. I’m thankful more people are taking notice and voicing a commitment to addressing the misuse of tax dollars.

The Ohio Department of Medicaid makes up the biggest part of the state’s biennial budget, with about $40 billion annually in the state general fund and federal funding directed to health care and related programming for about 2.9 million lower-income residents, older adults, individuals with disabilities, pregnant women, infants and children, and others. It’s a large, complex program administered (often inconsistently) with confusing rules and ample system and human error.

Year after year, my office has pointed out issues in the Medicaid system and error rates that are likely leading to hundreds of millions or billions of dollars in potential fraud, waste and abuse.

Consider:

Most recently, the annual State Single Audit reported an error rate of 15.6% for payments made for services for residents who had died or were otherwise ineligible for Medicaid programming, meaning potential unallowable costs of $800 million to $4.4 billion. That’s not including the dozens of other Medicaid provider audits we’ve conducted that have included more than $20 million in improper payments in the past seven years.

The list goes on and on.

These are not minor bookkeeping errors. They are the direct result of an administrative unwillingness to enforce the strict boundaries of the law.

One glaring example involves Medicaid-funded home healthcare. Federal law requires states to use Electronic Visit Verification (EVV) systems to confirm that in-home services actually occurred before payments are processed.

In 2024, we found that roughly half of Ohio's Medicaid-reimbursed home healthcare services skipped this required verification entirely, despite a $146 million investment to implement the system. 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.

Furthermore, recent reporting has raised questions about unusual provider concentrations and billing patterns within Ohio’s home healthcare sector, particularly within a small geographic area of Franklin County.

My office is independently evaluating these anomalies to expose any bad actors involved. That said, we must distinguish between identifying risk and making criminal allegations. Audits expose internal control failures; investigators and prosecutors must determine if specific conduct constitutes fraud.

Still, ignoring repeated warning signs is irresponsible. Every dollar lost to outside exploitation is a dollar unavailable to Ohioans who genuinely rely on these services.

These problems are entirely fixable. Leadership is committed to accountability, but success requires state agency administrators to match that commitment. Stronger eligibility verification, better cross-state coordination, and ruthless enforcement of EVV requirements will restore program integrity.

My office will continue independently auditing state programs and reporting findings transparently. 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.