Medicaid Audits
The Auditor of State is responsible for conducting Medicaid audits to review provider claims, documentation, and billing practices for compliance with state and federal requirements, verify beneficiary eligibility, and identify improper payments, including potential fraud, waste and abuse.
Medicaid Audit Work
The Auditor of State’s Medicaid unit conducts provider-specific audits annually through a contract with the Ohio Department of Medicaid that identify improper payments. Since 2019, the unit also has issued multiple Public Interest Audits that have identified issues and offered recommendations to improve accountability, oversight, and program integrity.
The Auditor of State’s Office also annually audits the Ohio Department of Medicaid as part of the State Single Audit. We review financial controls and compliance with state and federal laws and identify questioned costs.
Report Suspected Fraud
If you suspect public fraud, report it to the Auditor of State’s office.
Report Fraud (opens in a new tab)Public Interest Audits Related to Medicaid
The following Public Interest Reports include Medicaid-related reviews, findings, and recommendations.
Ohio Department of Medicaid
Cost of Concurrent Enrollment
More than 124,000 individuals enrolled in Ohio Medicaid were also enrolled in other state programs, with more than $1 billion paid for potentially duplicate participation.
Ohio Department of Medicaid
Electronic Visit Verification
Half of Medicaid-reimbursed home health services lacked required electronic verification despite approximately $146 million spent implementing the system.
Ohio Department of Medicaid
Improper Capitation Payments
The Ohio Department of Medicaid failed to recoup more than $118.5 million in erroneous duplicate payments or improper payments for managed care of prison inmates and deceased residents over a three-year period.
Ohio Department of Medicaid
Public Assistance Reporting Information System Alerts
County caseworkers were not required to process system alerts identifying possible duplicative assistance across states, potentially costing up to $24.5 million.
Medicaid Program Review
Eligibility Determination Process
Ohio’s Medicaid eligibility determination process, identifying a potential loss of more than $455 million in fiscal year 2019 benefits paid to ineligible recipients.
Related Medicaid Resources
Find related Medicaid audit reports, fraud reporting resources, press releases, and annual audit information.
Report Suspected Fraud
If you suspect public fraud, waste, or misuse of public funds, report it to the Auditor of State’s office.
Report Fraud (opens in a new tab)Fraud reporting is handled through the Auditor of State’s Special Investigations Unit (SIU). Learn more about fraud reporting and investigations: Explore Now (opens in a new tab)
Legislative Testimony
Auditor Faber discussed Medicaid audit findings, questioned costs, fraud concerns, and related oversight issues during a March 2026 joint Medicaid committee hearing.
Medicaid Press Releases
View related announcements and updates about Medicaid audit activity and fraud reporting.
Medicaid Audit Timeline
The Auditor of State has identified Medicaid-related findings, questioned costs, eligibility issues, provider integrity concerns, and public interest audit recommendations over multiple audit cycles. The timeline below highlights major milestones and audit activity.
Use the left and right arrow keys to move between tabs.
2025
Provider Improper Payments: $4,457,313
Medicaid Questioned Costs: $43,983
Medicaid/CHIP Eligibility and Provider Integrity Controls
Findings identified weaknesses in Medicaid eligibility determinations, provider revalidation, and provider integrity monitoring within Ohio Benefits and OMES. These issues increased the risk of improper Medicaid payments and fraud.
2024
Provider Improper Payments: $2,942,036
Medicaid Questioned Costs: $280,847
Medicaid/CHIP Eligibility and Provider Integrity Controls
Findings identified weaknesses in Medicaid eligibility determinations, IEVS monitoring, provider revalidation, and provider licensing controls.
Medicaid EVV Audit – Public Interest
Auditors found that ODM failed to ensure Medicaid home-care claims were supported by required Electronic Visit Verification data.
Medicaid Concurrent Enrollment Audit – Public Interest
Auditors found that more than 124,000 individuals were simultaneously enrolled in Ohio Medicaid and another state’s Medicaid program between 2019 and 2022. Weak residency verification and interstate data-sharing controls contributed to more than $1 billion in potentially improper payments.
2023
Provider Improper Payments: $1,985,071
Medicaid Questioned Costs: $0
Medicaid/CHIP Eligibility and Provider Integrity Controls
Findings identified weaknesses in Medicaid eligibility, provider enrollment, provider revalidation, and exclusion screening processes. These issues increased the risk of improper Medicaid payments and fraud.
2022
Provider Improper Payments: $1,135,406
Medicaid Questioned Costs: $181,308
Medicaid/CHIP Eligibility and IEVS Alerts
Findings identified weak documentation, unresolved alerts, untimely alert resolution, and insufficient statewide and county oversight.
Medicaid Capitation Audit – Public Interest
Auditors found that ODM made improper Medicaid capitation payments to managed care organizations, including duplicate payments and payments for deceased or incarcerated individuals. The audit identified approximately $118.5 million in improper payments.
Medicaid PARIS Alert Review – Public Interest
Auditors found that ODM failed to ensure counties processed PARIS alerts designed to identify recipients enrolled in Medicaid in multiple states.
2021
Provider Improper Payments: $1,724,009
Medicaid Questioned Costs: $1,122,338
Medicaid/CHIP Eligibility and IEVS Controls
Findings identified weak documentation, unresolved alerts, inconsistent county oversight, excessive alert backlogs, and insufficient monitoring controls.
NCCI Requirements and Monitoring
ODM failed to fully implement and monitor federally required NCCI edits within MITS, increasing the risk that Medicaid claims were improperly coded, processed, or paid.
Ohio Benefits Governance Controls
DAS, ODM, and ODJFS findings identified weak interagency coordination, unresolved system defects, and ineffective alert management across multiple programs.
2020
Provider Improper Payments: $5,933
Medicaid Questioned Costs: $109,391
Medicaid/CHIP Eligibility and NCCI Monitoring
Findings identified eligibility-processing weaknesses, unresolved IEVS alerts, and deficiencies in coding-monitoring controls.
Medicaid Eligibility Audit – Public Interest
Auditors found significant weaknesses in Ohio Medicaid eligibility verification and oversight, including improper approvals and continued enrollment of ineligible individuals. Testing indicated an estimated $455 million in potential losses tied to Ohio Benefits system failures.
2019
Provider Improper Payments: $7,771,885
Medicaid Questioned Costs: $27,920
Ohio Benefits System and Oversight
Findings identified weaknesses in governance, system oversight, data integrity, vendor oversight, and eligibility documentation across assistance programs.
CHIP/MFP Eligibility and IEVS Monitoring
ODM findings identified unsupported eligibility decisions, unresolved IEVS alerts, and weak coordination among ODM, DAS, ODJFS, and county agencies.
2018
Provider Improper Payments: $17,207,848
Medicaid Questioned Costs: $99,006
Medicaid/CHIP Eligibility and IEVS Monitoring
Findings identified weaknesses in Medicaid and CHIP eligibility controls, unresolved IEVS alerts, system limitations, and county oversight. These issues increased the risk of improper payments and inaccurate federal reimbursement claims.
Money Follows the Person
Findings identified eligibility and payment-processing weaknesses within the Money Follows the Person program, including payments continuing for an ineligible participant.