Ohio Legislature Passes Medicaid Fraud Crackdown After Daily Wire Exposé

A crackdown on fraud in Ohio’s home-health program is poised to be signed into law by Republican Gov. Mike DeWine after the bill passed the state’s House and Senate with overwhelming bipartisan support. The legislation addresses Medicaid abuse unearthed by a Daily Wire investigation.

Democrat Rep. Bride Rose Sweeney told Statehouse News Bureau that “Going through this process, I can say I was generally bewildered by some of the shortcomings and gaps within Medicaid.”

State Rep. Jennifer Gross (R), chair of the House Medicaid Committee, told The Daily Wire that the House and Senate sent a unified bill to the governor on June 24 for his signature. The governor has 10 days to sign bills, so he must sign it this week, she said.

After The Daily Wire’s series “Medicaid Millions” ran in May, as the Ohio legislature was wrapping up its session, the Senate added Medicaid reforms to an in-progress bill targeting food stamp fraud.

Gross said the move is “a major step forward,” saying it delivers in-person provider inspections, strong electronic visit verification, tougher penalties for fraud, and oversight tools that “will protect taxpayer dollars and safeguard services for those who truly need them, we know this is only the beginning.”

The law requires the state to “deny, refuse to revalidate, suspend, or terminate a provider agreement” if the company is “located at the same address as more than six other active home and community-based services Medicaid providers.” That’s a response to The Daily Wire’s finding that a single building housed 94 Medicaid companies, while seven other buildings, once owned by the same landlord, housed 288 companies.

It also requires an in-person review of a company before it is authorized, as well as every three years.

To address issues with shell ownership or silent partners, providers must “disclose to the department the identity of each person with at least a five per cent direct or indirect ownership interest.”

The state must check those ownership disclosures against lists of people who have been convicted of fraud or sanctioned by the government in the past, like Alieu Conteh, who started a $1 million home health care company after being convicted of fraud multiple times. Conteh told The Daily Wire, “I was just too dumb I didn’t even know what is law.”

Providers shall also be denied if they previously owned another company that defrauded the government, or reside with someone who did, like Esther Acheampong, whom The Daily Wire revealed was paid more than $5 million by Ohio Medicaid after her husband was convicted of related fraud and she opened up a business in her name.

Medicaid fraud is now elevated to a high-level felony instead of a low-level felony or misdemeanor.

The bill requires the Ohio Department of Medicaid to use GPS to track whether providers actually visit elderly clients and publish public reports about how many payments were blocked due to the data not supporting them.

The Daily Wire revealed that although Congress required states to implement Electronic Visit Verification (EVV) by 2020, Ohio had spent hundreds of millions of dollars setting up a system, but continued paying claims even when it wasn’t used. About half of the providers turned off their GPS tracking.

The bill also orders the Medicaid department to investigate any time the number of payments doubles in a month. The Daily Wire found numerous companies whose billing skyrocketed in ways that were inconsistent with organically building a business.

The legislation requires “prior authorization” of home health care spending, limits it to the minimum time necessary for documented ailments, and says the Department of Medicaid “shall develop and implement automated fraud-detection tools… capable of flagging irregular patterns.”

Top House lawmakers offered an aggressive several-hundred-page bill to overhaul the home-health program, including barring family members from being paid to care for their own relatives — a top reason for the increase in people claiming to need care. A bill offered by Rep. Josh Williams that required GPS tracking became the vehicle for those major reforms.

But the final bill was more modest, focusing primarily on requiring GPS tracking to ensure that purported caregivers were actually near their patients. The watered-down version came after dozens of disability activists and companies testified to lawmakers, and as a compromise with the more moderate Senate.

Family members are still exempt from GPS, and non-relatives only need to check in and check out using GPS rather than be tracked in real time during their shift, which is what Williams’ House bill originally proposed.

Williams called the new law “a step in the right direction toward restoring accountability and integrity to Ohio’s Medicaid system. Requiring prior authorization for personal services waivers, limited to only the minimum amount of time necessary, helps ensure that services are truly needed and appropriately tailored to each recipient. Likewise, strengthening electronic visit verification and GPS requirements provides greater assurance that caregivers are actually making contact with Medicaid recipients and delivering the services taxpayers are funding.”

The final bill creates a “high-risk” designation under which companies with repeated suspicious patterns or violations would have to use “fingerprint scanning, facial recognition, vocal recognition, a secure personal identification number, or other approved verification method as a condition of receiving payment.” That addresses concerns that even GPS technology is easily thwarted.

The legislation also encourages employees to come forward with evidence of fraud, saying that if they are fired as a result, they can seek damages. And it requires the insurance companies that administer Medicaid in Ohio to report all instances of possible fraud to the attorney general.

Gov. DeWine is not permitted to amend the bill, only to veto it, Gross said. DeWine, a moderate Republican, made headlines this week when he vetoed Republicans’ voter ID law and lambasted the Trump administration for terminating a temporary program for Haitians.

DeWine is unlikely to veto the bill because the compromise version is already watered down, and the GPS requirements codify a pledge from DeWine’s own administration to begin requiring them.

Other reforms that were stripped out of the House’s original overhaul include:

• Giving 10% of the recovery to tipsters who disclose fraud
• Creating a Medicaid Program Integrity Fund that uses recovered fraud proceeds to fund more fraud detection
• Giving the inspector general more police powers
• Permitting a court to require a convicted Medicaid fraudster to pay more restitution

The reform does not focus on doctors and nurses who write paperwork claiming someone is severely ill when they are not. The law still allows nurse practitioners to conduct the examinations used to authorize home health care, instead of requiring physicians or specialists. Doctors were originally required, but nurses were added during COVID and never removed.

Following The Daily Wire’s Medicaid Millions series, this reporter testified to the Ohio House and the U.S. House and Senate. Dr. Mehmet Oz, head of the federal Centers for Medicare and Medicaid, traveled to Columbus to rail against the 288 companies on one road and the refugee Medicaid company owner whom The Daily Wire found drinking champagne on a private jet.

Vice President JD Vance’s anti-fraud task force implemented a six-month moratorium on new home health companies, and the Ohio Department of Medicaid suspended 50 firms, half of them from the addresses mentioned in The Daily Wire’s series.