Ohio Medicaid Initiates First Provider Suspensions Under Governor DeWine’s Anti-Fraud Executive Order, Identifying 49 Providers of Concern
COLUMBUS, Ohio – In alignment with the fraud prevention initiatives directed by Governor Mike DeWine, the Ohio Department of Medicaid (ODM) today announced it will be taking its first enforcement actions by suspending payments to 49 high‑risk Medicaid home health providers exhibiting potential fraud red flags. The suspensions are made possible following an Executive Order by Governor Mike DeWine to establish emergency rules to make the immediate suspensions feasible operationally.
“These initial suspensions mark a critical step forward in ensuring accountability and deterring abuse within the Medicaid system,” said ODM Director Scott Partika. “We will continue using advanced analytics and enforceable action to protect Ohioans and preserve program integrity.”
Under the Executive Order, ODM is authorized to immediately suspend payments to providers whose billing patterns and data anomalies suggest a high probability of fraudulent activity. Using its newly upgraded data‑analytics tools, ODM has identified 49 home health providers whose billing patterns raised concerns, and those providers are now under review with payments temporarily suspended while investigations move forward
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 suspension aligns with the broader strategy from Governor DeWine to:
- Enforce a six‑month moratorium on new enrollments for high-risk provider categories
- Require more frequent revalidation of providers identified as high-risk
- Accelerate the implementation of GPS-based Electronic Visit Verification (EVV) to better monitor in‑home services
Ohio’s comprehensive approach combines rigorous provider screening, real-time billing analysis, and interagency collaboration. These steps are designed to swiftly detect and disrupt fraudulent behavior. ODM will continue to monitor high-risk providers, enforce suspensions as warranted, and coordinate with state and federal partners to administer strong oversight.
This emergency rule, authorized through Governor DeWine’s Executive Order 2026‑02D, was adopted to address needs identified by Ohio Medicaid in stopping fraud before payments are made. The previous process created the risk of service disruption for vulnerable Ohioans.
“Safeguarding Medicaid resources and ensuring uninterrupted access to care are equally important,” said ODM Director Scott Partika. “This emergency rule allows us to take swift action against potential fraud without jeopardizing the health and safety of our members.”
Rule 5160-1-17.51 outlines:
- Conditions under which ODM may suspend provider claims payments based on credible allegations of fraud or indictments involving non‑institutional providers.
- Expectations for provider cooperation during investigations.
- Notice procedures and criteria for lifting a suspension when allegations are resolved or good cause exists.
The rule takes effect upon filing with the Secretary of State, the Legislative Service Commission, and the Joint Committee on Agency Rule Review (JCARR), and will remain in effect for 120 days or until made permanent through the standard rule‑making process.
Federal Fraud Enforcement Press Conference
The Ohio Department of Medicaid (ODM) is deeply grateful for the unprecedented partnership and support of our federal colleagues, whose ongoing commitment and resources have reinforced Ohio’s efforts to combat fraud, waste, and abuse. We appreciate the Centers for Medicare & Medicaid Services (CMS) recognition and appreciation of ODM’s recent, proactive steps to prevent fraudulent payments, safeguard taxpayer dollars, and ensure that Medicaid resources are directed to the Ohioans who truly rely on them.
The indictments -involving allegations of more than $42 million- directly stem from irregularities initially detected by Ohio Medicaid’s vigilant oversight processes.
ODM referred these cases to the Ohio Attorney General’s Medicaid Fraud Control Unit (MFCU), which federal leaders recognized as a national gold standard for its rigorous and effective approach to protecting the integrity of public programs. MFCU conducted the investigations that led to the indictments.
Beyond these cases, ODM has advanced a wide range of program integrity initiatives, including targeted policy updates, enhanced provider screenings and revalidations, data‑driven utilization management improvements such as prior authorization requirements and other updates in behavioral health, focused reviews like skin substitute evaluations, targeted provider audits, and expanded data sharing with the Attorney General’s Office to ensure bad actors are held fully accountable.
ODM remains committed to working with our state and federal partners to detect, investigate, and prevent fraud, waste, and abuse to ensure Medicaid resources are used appropriately for the Ohioans who rely on these services. As always, if you see something, say something. Fraud can be reported directly to the Attorney General’s Office, as well as the Ohio Medicaid Consumer Hotline.
Ohio Medicaid is working to be responsive and transparent about the fraud prevention initiatives. The Strengthening Medicaid Program Integrity webpage is being continually updated with news as well as information and resources for providers and members.
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