The Trump administration is temporarily stopping new home health and hospital providers from enrolling in Medicare because of concerns about fraud in the system. This comes after a conservative outlet reported dozens of home health care businesses in Columbus allegedly billed the other government insurance program, Medicaid, for millions of dollars worth of services that were never provided.
Ohio's legislative leaders are now weighing in on the situation.
House Speaker Matt Huffman (R-Lima) said he believes the report put out by the Daily Wire. Huffman said he is talking with other leaders about the possibility of new legislation on fraud. But he said lawmakers have tried to deal with protecting the program from fraud.
"In 2019, the General Assembly passed as part of its budget the requirement that the state auditor audit Medicaid and its various agencies, a performance audit and a whole number of other things, things that would look at what's in the reports of this," Huffman told reporters on Wednesday. "Gov. [Mike] DeWine vetoed that."
Huffman said the provision requiring the state auditor to audit the Medicaid program, after putting a similar provision in the budget in 2021. The provision would require the Department of Medicaid to use artificial intelligence and technology to clarify who should be on the Medicaid rolls, who shouldn't be and where the money is going. He said the effort was funded and a company was set up to do the work for Medicaid. Huffman said he talked to the Department of Medicaid director at that time but it went nowhere. But DeWine vetoed it twice.
“The buck stops with him," Huffman said.
DeWine responds with actions
Just a couple of hours after Huffman made his comments, DeWine announced several steps his administration is taking to deal with possible Medicaid fraud and saying the state has long been a national leader in fighting it.
“Ohio has one of the best Medicaid Fraud Control units in the country, and, in 2018, Ohio became the first state to implement Electronic Visit Verification in home health care,” said DeWine. “Today, we are ready to begin several new initiatives long in development that will enhance this nation-leading work and further protect taxpayer funds from those trying to defraud the State."
DeWine said he would work with the Trump administration to achieve several initiatives. They include having the Ohio Department of Medicaid ask the Center for Medicare and Medicaid Services (CMS) to allow a six-month moratorium on new home-healthcare and hospice businesses, which would allow the state’s agency to assess existing providers and help remove those at high risk for having committed fraud.
Additionally, the Ohio Department of Medicaid will being removing and suspending payment to providers whose billing practices show “red flags” that indicate a high probability of fraud. In January, the agency began using new data analytics tools to identify billing data anomalies and, to date, the process has identified 87 providers who will be subject to further review and potential payment suspension.
DeWine is also issuing an executive order to allow the state agency to implement emergency rules that require more frequent revalidation of providers identified as higher-risk for committing fraud. The initiatives also call for the requirement that all providers using Electronic Visit Verification (ECC) use GPS when making those visits. It would also require EVV for live-in caregivers.
Since the beginning of 2023, Ohio has secured 4,444 Medicaid fraud indictments, 481 convictions, and 146 civil settlements and judgments, resulting in $78.4 million in recovered taxpayer funds.
Leader of House Democrats reacts
House Minority Leader Dani Isaacsohn (D-Cincinnati) said he isn’t so sure about the situation.
“So far it’s been these huge allegations, and we haven’t seen any investigations," Isaacsohn said.
Isaacsohn said there needs to be an investigation to see if there really is fraud in the system. If there is widespread fraud, Isaacsohn said it’s because Republicans who have been in charge haven’t been auditing, investigating, and prosecuting those who committed it.
"The idea that the people who are currently in government and have been running the government for the last decade would stand up and say 'There's fraud, waste, and abuse. It's rampant'— the finger should point right back to themselves and say they have failed to do their jobs," Isaacsohn said. "They have failed in their jobs as public servants."
