COLUMBUS, Ohio — Ohio lawmakers are taking a closer look at the state’s efforts to combat Medicaid fraud as a new law aimed at increasing oversight and penalties prepares to take effect later this year.
During a recent meeting of the Ohio Controlling Board, legislators questioned officials from the Ohio Attorney General’s Office about the software used by the state’s Medicaid Fraud Unit to detect potential fraud, waste and abuse.
The discussion comes ahead of the implementation of Senate Bill 315, which takes effect Oct. 8. The law increases penalties for Medicaid fraud and adds new verification and accountability requirements for home healthcare providers.
State Rep. Mike Dovilla, R-Berea, questioned why the Attorney General’s Office has continued using the same fraud analysis software since 2019 without seeking competitive bids from other vendors. Officials responded that changing systems while 29 active investigations are underway could disrupt ongoing cases, but said future alternatives may be considered.
According to the Attorney General’s Office, the software has helped investigators conduct 125 Medicaid fraud investigations and recover approximately $24 million over the past seven years.
However, State Rep. Bride Rose Sweeney, D-Westlake, questioned whether claims about widespread Medicaid fraud are being overstated. She noted that if every fraud referral is being investigated, the number of confirmed cases may not support claims that the system is overwhelmed by fraud.
Despite those concerns, lawmakers from both parties supported Senate Bill 315, which passed the General Assembly with bipartisan backing. The new law is expected to strengthen Ohio’s efforts to detect and prosecute Medicaid fraud while increasing oversight of healthcare providers.
