Medicaid Audits

2024

Electronic Visit Verification (EVV) Audit – Public Interest

Auditors found that ODM failed to ensure Medicaid home-care claims were supported by required Electronic Visit Verification (EVV) data. More than half of reviewed claims lacked matching EVV records, increasing the risk of unsupported or improper payments.

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

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

Medicaid/CHIP Eligibility and IEVS Alerts

Findings identified weak documentation, unresolved alerts, untimely alert resolution, and insufficient statewide and county oversight.

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.

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

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

Medicaid/CHIP Eligibility and NCCI Monitoring

Findings identified eligibility-processing weaknesses, unresolved IEVS alerts, and deficiencies in coding-monitoring controls.

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

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

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.