Ohio Marks Fraud Prevention Month with Expanded Medicaid Safeguards, Data Analytics, and Community Reporting
COLUMBUS, Ohio – The Ohio Department of Medicaid (ODM) is marking Fraud Prevention Month by highlighting the work to protect taxpayer dollars and make sure Medicaid services go to the Ohioans who truly need them. By strengthening partnerships, expanding data‑sharing, improving analytics, and making it easier for people to report concerns, ODM continues to build a Medicaid program integrity system that is more effective, responsive, and protective of taxpayer dollars.
“Every dollar we protect is a dollar that stays focused on care for Ohioans,” said ODM Director Scott Partika. “Fraud Prevention Month is a reminder that integrity is everyone’s job, from data scientists and auditors to front-line providers and consumers. If you see something, say something. Our teams and partners will move quickly to investigate and take action.”
Strong Protections at Every Step
ODM builds fraud‑prevention safeguards into every stage of the Medicaid process. When providers enroll, ODM verifies information across dozens of federal databases and checks state licensing boards to ensure only qualified professionals can participate.
During care, tools like Electronic Visit Verification help confirm that home‑based services are actually delivered before payment is made, and prior authorization policies make sure services are medically necessary.
After care is provided, ODM reviews whether another insurer should pay first, examines cost reports from long‑term care providers, and audits facility assessments to ensure payments are accurate. Advanced analytics also help ODM spot unusual billing patterns, compare providers to their peers, and identify early signs of suspicious activity.
Continuous Program Review and Modernization
ODM is reviewing more than 60 parts of the Medicaid program to find ways to strengthen its oversight efforts. Recent updates include improvements to eligibility checks, such as adding verification for zero‑income cases and increasing cross‑household data reviews. The agency is also preparing for new federal rules aimed at preventing duplicate enrollments across states. In addition, ODM is taking a fresh look at policies involving higher‑risk providers, institutional settings, and non-traditional care environments to ensure safeguards stay strong as the health care system continues to evolve.
How Ohioans Can Report Concerns
ODM encourages both providers and consumers to report suspected fraud, waste, or abuse through established, secure channels.
You can also go to the Ohio Medicaid website to report suspected fraud.
How ODM Investigates Allegations
Fraud allegations are either vetted by the Clearinghouse and sent to the Ohio Attorney General’s Medicaid Fraud Control Unit (MFCU) for review and acceptance, or it could be handled internally by ODM through one of our specialized audit teams.
ODM reviews provider billing each year, monitors for unusual trends, checks that managed care plans follow fraud‑prevention rules and works with providers to promote compliance. Managed care organizations, the Attorney General’s Office, and the Auditor of State all add additional layers of oversight, helping keep the Medicaid program accountable and protected.
When someone reports possible fraud, waste, or abuse, ODM reviews the information carefully to determine whether it should be referred to the MFCU, which handles criminal investigations and prosecutions. Ohio’s strong partnership with the Attorney General’s Office, combined with advanced data tools, has helped the state quickly identify suspicious billing and take action.
Impact on Ohio
The below numbers indicate the last five years:
Number of investigations closed with findings of fraud (Indictments): 757
Number of cases referred for prosecution (Convictions): 769
Referrals accepted by MFCU: 3,475 (Data for 2021 and 2022 not available)
Total dollars saved or recovered: $114.5 Million
ODM’s Commitment
The Ohio Department of Medicaid remains committed to ensuring that Ohioans receive necessary, high quality health care and that program funds are used responsibly and in accordance with state and federal law. ODM will continue partnering with the Legislature, state and federal agencies, managed care organizations, and local communities to maintain a best-in-class Medicaid program rooted in integrity, accountability, and transparency.
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