As federal officials intensify scrutiny of Medicaid-funded home care, Ohio has become the latest state to take aggressive enforcement action against providers.
The Ohio Department of Medicaid (ODM) announced Thursday that it has suspended payments to 49 home health providers whose billing patterns triggered potential fraud concerns. The suspensions follow an executive order from Governor Mike DeWine designed to speed enforcement actions and align Ohio’s approach more closely with federal Medicaid fraud prevention efforts.
The suspensions followed an executive order by Ohio Governor Mike DeWine issued on Tuesday that aligned Ohio’s payment suspension process with CMS’, effectively allowing the state to immediately suspend payments to providers upon the determination of a credible allegation of fraud.
“These initial suspensions mark a critical step forward in ensuring accountability and deterring abuse within the Medicaid system,” ODM Director Scott Partika said in a statement. “We will continue using advanced analytics and enforceable action to protect Ohioans and preserve program integrity.”
The ODM has recently upgraded its data analytics tools, according to the department, and utilized them to identify 49 home health providers with billing patterns that raised concerns. The ODM placed the providers under review and temporarily suspended payments to them.
“This action reflects Ohio’s commitment to protecting taxpayer dollars and safeguarding the integrity of Medicaid — particularly for services delivered through home health, hospice, and waiver programs,” the ODM stated.
The suspensions align with DeWine’s strategy to prevent fraud before payments are made, the ODM said. In this pursuit, the state plans to enforce a six-month moratorium on new enrollments for high-risk provider categories, requiring more frequent revalidation of high-risk providers and accelerate the implementation of GPS-based electronic visit verification (EVV). Together, these measures signal a shift toward preemptive enforcement rather than the traditional “pay-and-chase” model. Together, these measures signal a shift toward preemptive enforcement rather than the traditional “pay-and-chase” model.
Other states are also experiencing their own fraud-related crackdowns. The second Trump administration has directed sharp attention to home-based care fraud in several states, including Minnesota and New York. In those cases, federal officials have tied alleged fraud to broader concerns about rapid Medicaid spending growth and program oversight.
On a sweeping federal level, the administration has also reshaped the Medicaid program. The One Big Beautiful Bill Act (OBBBA) dramatically cut Medicaid spending, eliciting concern from home-based care providers. Most recently, CMS announced an 80-hour work requirement for certain Medicare beneficiaries, which the agency estimated would save $391.9 billion over the next decade.
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