COLUMBUS — Ohio Governor Mike DeWine announced Wednesday that he is implementing several new fraud prevention initiatives to strengthen and build-upon long-standing efforts to fight fraud, waste, and abuse in the Ohio Medicaid system.

“Ohio has long been a national leader in fighting Medicaid fraud. 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,” DeWine said.

“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.

“I thank the Trump Administration for their partnership and collaboration that is allowing us to proceed with these reforms much faster than previously possible.”

New initiatives

DeWine said he is directing the Ohio Department of Medicaid to implement the following:

• Statewide New Provider Moratorium. The Ohio Department of Medicaid will today ask the Center for Medicare and Medicaid Services (CMS) so Ohio may implement a six-month moratorium on new home-healthcare and hospice businesses being able to become Medicaid providers. This will allow Ohio Medicaid to stop enrollment of new providers and assess existing providers to help remove those at high risk for having committed fraud.
• Immediate Payment Suspension to High-Risk Providers. Ohio Medicaid will today begin a policy of immediately removing and suspending payment to providers whose billing practices show “red flags” that indicate a high probability of fraud. Ohio Medicaid already has a robust payment suspension protocol that is currently used to stop payments to questionable providers. In January, Ohio Medicaid began the process of implementing new data analytics tools to help identify billing data anomalies that could better identify fraud. To date, this process has identified 87 providers who will be subject to further review and potential payment suspension.
• Executive Order for Emergency Rules. The Governor will be issuing an Executive Order that will allow the Ohio Department of Medicaid to implement emergency rules to require more frequent revalidation of providers being identified as higher-risk for committing fraud. Governor DeWine sent a letter to CMS on May 1 committing Ohio to partnering with the Trump Administration and using a more stringent revalidation process to better prevent fraud.
• Mandatory GPS Requirement for Electronic Visit Verification. Ohio Medicaid will file rules to require GPS for all providers using Electronic Visit Verification (EVV). Since March 2025, Ohio Medicaid has begun phasing in EVV as a mandatory requirement for home healthcare provider payment. In December, DeWine authorized Ohio Medicaid to begin the information technology investments needed to make GPS mandatory for EVV. Ohio Medicaid now ready to make this rule change to implement the requirement. Ohio Medicaid has worked collaboratively with Ohio Auditor Keith Faber on identifying solutions to issues identified in the Auditor’s audits of Ohio Medicaid, and this new rule will implement a key recommendation of the audits.
• Mandatory EVV for Live-In Caregivers. Ohio Medicaid will begin the rulemaking process to require live-in caregivers to use EVV during home healthcare and as a requirement for payment. Currently, family and live-in caregivers are exempt from this requirement.

Ohio’s work in prosecuting Medicaid fraud

Ohio has been a national leader in catching and prosecuting Medicaid fraud thanks to a strong partnership between Ohio Medicaid and the Ohio Attorney General’s Office and its Medicaid Fraud Control Unit, the governor said. 

Since the beginning of 2023, Ohio has secured 444 Medicaid fraud indictments, 481 convictions, and 146 civil settlements and judgments resulting in $78.4 million in  recovered taxpayer fund.

Under Ohio Attorney General Dave Yost, the unit received a U.S. Office of the Inspector General’s Award for Excellence in Fighting Fraud, Waste, and Abuse in 2022, and it ranked #1 in the nation for number of convictions secured in 2015 under then-Attorney General Mike DeWine.

Utilizing home healthcare to protect taxpayer dollars

Home and community-based care programs have been a core component of Medicaid services for decades since they were initiated under Ronald Reagan’s Administration.

Ohio is one of 47 states and the District of Columbia that provides such care under a waiver granted by CMS.  

Ohio’s home and community-based care programs are grounded in data showing that legitimate in-home care is typically safer for individuals and significantly more affordable for taxpayers.

In 2024, Ohio saved more than $600 million in taxpayer funds that would have been expended had patients receiving home healthcare been diverted to skilled nursing or other residential care services, saving several billion dollars over the course of the DeWine Administration.

On average, home health care costs half as much as placement in a nursing facility. 

Ensuring access to appropriate home-based care is both a responsible use of public resources and a critical part of meeting the needs of our most vulnerable Ohioans who otherwise would require placement in higher-cost nursing facilities.

Additional efforts to fight fraud, waste & abuse

Providing care in a home setting requires a robust set of controls to detect and prevent fraud.

Ohio Medicaid has been proactively evaluating all program integrity initiatives to ensure taxpayer dollars are well spent and that quality care is being provided.

The governor’s office said the department has been engaged in a thorough review of programs and policies to evaluate any risks to the integrity of the program, identify potential gaps that could be exploited, and explore opportunities to leverage new and emerging AI and data analytic tools to stay one step ahead of anyone looking to exploit the system.

As part of that work, since the start of 2026, the Department has initiated new prior authorization requirements for high-risk services to ensure medical necessity. 

Ohio Medicaid launched efforts to build new data analytic capabilities to identify unique outliers in billing patterns, better assess vulnerable business ownership structures, and improve coordination of fraud fighting efforts.

These efforts are designed to improve the early detection of potential fraud and identify future areas of inherent program risk.

To confirm that billed services are actually rendered, Ohio Medicaid relies on an extensive set of safeguards, including:

• Comprehensive provider screening and continuous compliance monitoring.
• Mandatory electronic visit verification capturing date, time, and service location.
• Advanced analytics that flag unusual billing patterns or service trends.
• Routine and targeted audits performed by program integrity staff.
• Coordination with state and federal partners when concerns arise.