House Task Force Examines Alleged $1.2 Billion Medicaid Waiver Fraud in Ohio
A congressional task force held a hearing examining allegations that fraudulent home health services claims have cost Ohio's Medicaid waiver program approximately $1.2 billion.
House Task Force Examines Alleged $1.2 Billion Medicaid Waiver Fraud in Ohio
A congressional task force held its inaugural hearing Wednesday to examine allegations of widespread fraud within Ohio's Medicaid Home and Community-Based Services waiver program.
Task Force Chairman Brandon Gill (R-Texas) opened the proceedings, titled "Universal Basic Fraud: Vulnerabilities in Medicaid Waiver Programs." He stated that an estimated $1.2 billion has been lost to fraudulent billing in Ohio's personal care waiver program alone.
Medicaid HCBS waivers authorize states to provide home-based healthcare and non-medical personal care services including cooking, cleaning, and companionship. The hearing examined how fraudulent home health businesses allegedly bill for services never rendered.
According to testimony, the scheme involves finding elderly individuals who may qualify for federally funded services, obtaining medical documentation of their needs, and contracting with home health businesses that facilitate Medicaid payments while taking a percentage. In some cases, family members allegedly bill for caring for their own relatives.
Investigative reporting cited during the hearing identified numerous home health companies operating from shared or abandoned locations. One address at 6161 Busch Boulevard reportedly housed 94 different entities that had recently billed Medicaid $66 million.
The hearing also examined concerns about Electronic Visit Verification systems, including GPS tracking, which witnesses said were not properly utilized to verify whether billed services were actually provided.
Administrator Mehmet Oz of the Centers for Medicare & Medicaid Services also testified. He noted that approximately half of all fraud in federal programs occurs within Medicaid.
Source: House.gov
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