Ohio Auditor Highlights Massive Medicaid Fraud and Funding Adjustments

Ohio State Auditor Keith Faber highlighted significant Medicaid fraud in Ohio during a Capitol Hill hearing. Faber discussed systemic failings that allowed billions to be lost, citing over $455 million in payments to ineligible recipients in 2020. These recipients included deceased individuals and those enrolled in multiple states. He urged immediate measures to prevent waste and protect taxpayer funds.

In response to related issues, Ohio lawmakers approved an $875 million payment package to address underpayments to nursing home providers. This decision followed an Ohio Supreme Court ruling which found state officials used incorrect methods to calculate Medicaid reimbursements for nursing facilities, resulting in substantial shortfall in payments.

The funding, supported by both state and federal contributions, aims to amend errors dating back to the 2024-25 budget cycle. The package, pending approval by Governor Mike DeWine, is set to settle disputes over payment calculations that failed to consider the medical complexity of residents adequately.

State Representative Jean Schmidt described the situation as highly concerning for those who assist the elderly, stating that rectifying the mistake was necessary to ensure quality care. Revisions to the calculation formula were made, but the state remains liable for previous budget periods.

The Ohio Statehouse addressed the financial ramifications, which could raise costs significantly. According to Ohio Medicaid, recalculating the payments following the court’s guidance may cost an additional $285 million annually, nearing a billion over two cycles.

The legislation stipulates that providers agreeing to the new funds forgo any future claims on the disputed formula. Scott D. Wiley, CEO of the Ohio Health Care Association, called on Governor DeWine to enact the bill swiftly, emphasizing the critical nature of these funds for providers and families they support.