House task force hears Ohio auditors and reporters on alleged Medicaid home‑health fraud

Chairman Gil convened a task force hearing that opened with allegations that Ohio’s Medicaid waiver program has been widely exploited by fraudulent home‑health providers. Investigative reporter Luke Rosiak told lawmakers that his reporting and data analysis pointed to concentrated billing in parts of Columbus, abandoned-looking office suites hosting large numbers of provider names, and rapid unexplained revenue growth for some companies. "A refugee family can collect $90,000 a year simply by having one family member claim to be the other's caregiver," Rosiak said, arguing that weak verification and limited oversight make it easy to bill for services that may not have occurred.

Ohio Auditor Keith Faber told the panel his office had identified systemic weaknesses and, in a single‑state audit, "identified potentially up to $4.4 billion in fraud‑related exposure connected to ineligible recipients in Ohio's Medicaid programs," and reported an ineligible rate of 15.6% in sampled testing. Faber flagged the electronic visit verification (EVV) system as a critical control with substantive gaps: his office found roughly 56% of home‑care services were not processed through EVV, representing an estimated $1.1 billion of nearly $2 billion in paid claims not matched to EVV visits. He urged expanded predictive analytics, improved interstate data sharing and stronger provider screening to detect abnormal billing sooner.

State Rep. Michael Davila described the legislative follow‑up he has pursued in Ohio, including a data‑sharing requirement and a full ABD (aged, blind, disabled) audit included in a biennial budget provision he sponsored (House Bill 356). Davila said his objective is to verify eligibility, identify high‑risk providers earlier and ensure recovery and consequences when improper payments are identified.

Democratic members on the dais urged caution about framing and consequences. Ranking Member Simon acknowledged fraud must be investigated but said hearings should not be used to "gut the social safety net" or stigmatize entire beneficiary communities. State Sen. Nickie Antonio warned that program integrity work must avoid demonizing immigrant or other communities and emphasized the human stakes for seniors and people with disabilities who rely on Medicaid waiver services to remain in their homes.

Lawmakers entered multiple news reports and past hearing transcripts into the record. Members asked witnesses for specific indicators of fraud — concentrated billing by ZIP code, dozens of company names registered to a single address, owners with tax liens or criminal records, and rapid first‑month billing spikes — and directed staff to follow up with written questions. The task force allowed five legislative days for additional materials and adjourned with instructions for further oversight activity.

Next steps included requests for additional documents, potential referral to enforcement partners where criminal activity is suspected and legislative proposals intended to tighten provider enrollment and prepayment reviews. No formal votes or policy changes were adopted during the hearing.