I’ll lay out why Ohio’s Medicaid system is a ripe target for waste and fraud, show the scale of the problem with hard numbers, point to specific failures like the EVV rollout, highlight concentrated suspicious billing patterns, and explain how audits and tougher enforcement are the path back to accountability.
When I go to Capitol Hill I’ll make a direct point: Ohio is not immune to the sophisticated schemes that prey on big government programs. The problem isn’t theory. It’s real money disappearing from programs meant for the most vulnerable Ohioans, and taxpayers deserve answers.
Wherever there’s large, federally backed spending you get incentive for bad actors to push the boundaries. That pattern shows up again and again in Medicaid, where complex rules and inconsistent administration create gaps that can be exploited by providers or intermediaries looking to game the system.
My office has been raising the alarm about Medicaid fraud, waste and abuse since 2019. Those warnings are backed by audits that point to systemic weaknesses, not mere bookkeeping slips. When audits show error rates this high you have to treat them as a structural problem that requires leadership to act.
The Ohio Department of Medicaid dominates the biennial budget with roughly $40 billion a year in state and federal funds aimed at about 2.9 million residents. That’s a massive program serving lower-income families, older adults, people with disabilities, pregnant women and children. With that scale comes the obligation to protect every dollar from waste and theft.
Year after year our reviews find troubling error rates that suggest hundreds of millions, maybe billions, in potential unallowable payments. Most recently the State Single Audit reported a 15.6% error rate tied to payments for services for residents who had died or were otherwise ineligible. That error rate translates into potential unallowable costs of $800 million to $4.4 billion, and this excludes numerous provider audits that uncovered more than $20 million in improper payments over the last seven years.
VANCE-LED TASK FORCE CUTS OFF $1.4B FROM HOME HEALTH, HOSPICE PROVIDERS SUSPECTED OF FRAUD
One glaring failure involves home healthcare paid through Medicaid. Federal law requires Electronic Visit Verification systems to confirm in-home services occurred before payments are processed. In 2024 we found roughly half of Ohio’s Medicaid-reimbursed home healthcare services bypassed that verification, despite a $146 million investment to roll out the system.
That weak enforcement leaves a literal backdoor for improper billing. When verification is optional in practice, bad actors can bill for encounters that never happened. That steals resources from legitimate patients and corrodes public confidence in government programs.
Recent reporting has also flagged unusual provider concentrations and billing behavior in a small part of Franklin County. My office is independently digging into these anomalies to see where money flowed and whether controls failed. Audits can expose internal control failures but investigators and prosecutors must determine criminal intent.
Ignoring clear warning signs is irresponsible. Each dollar lost to outside exploitation is a dollar not available to Ohioans who truly need care. That’s why enforcing eligibility, improving cross-state coordination on fraud rings, and strictly applying EVV rules are not optional steps but necessary actions.
Fixing these problems is straightforward in concept but requires political will and administrative discipline. Stronger eligibility verification, better oversight of outlier providers, and rapid follow-up to audit findings will tighten the system and deter abuse. Leadership has to back enforcement with resources and consequences for those who break the rules.
My office will keep auditing state programs independently and publishing the findings. Ohio taxpayers expect competent stewardship of public dollars, and vulnerable residents deserve systems that protect the care intended for them. We will keep pushing for the accountability needed to restore trust and preserve vital services for those who rely on them.
