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Auditor Yost and Senator Lehner Introduce Bill to Curb Medicaid Fraud
Columbus – Auditor of State Dave Yost and Sen. Peggy Lehner today announced legislation to stop the kind of Medicaid fraud and overpayments that have cost taxpayers nearly $29 million since 2011 and deprived Medicaid patients of the care those dollars are intended to provide.
The proposal would require high-risk providers of Medicaid services to have surety bonds that would allow the state to recoup some of the losses resulting from fraud and overpayment.
The measure also would require that these providers undergo training in billing, records retention and Medicaid compliance before being certified to provide Medicaid services.
Senate Bill 218 is aimed at providers of transportation and home health care for Medicaid customers. These providers make up just 16 percent of Ohio’s 92,000 Medicaid providers, but account for more than 84 percent of fraud and overpayments in the program.
Typically, the problem is that providers are charging for care that they are not certified to provide, or they are charging for services without the necessary documentation. The Auditor of State’s office has issued recoverable findings against 123 businesses and individuals since 2011.
Based on the most recent estimate, only about 5 percent of the losses have been recovered.
“Taxpayers assume the burden of providing health care for less affluent and less fortunate Ohioans, and they expect that money to be used efficiently and effectively,” said Yost. “When it isn’t, taxpayers and needy Ohioans are cheated. It diminishes the quality of care provided to those who need it and it undermines faith in government. I thank Senator Lehner for taking the lead on this matter and call on her colleagues in the General Assembly to join us in fixing this.”
Lehner cited a case in her Montgomery County district in which a recoverable finding of nearly $4 million was made against provider Healing Touch Home Health Care. An examination showed that 16 of 37 employees lacked a certification for first aid and that 69 percent of personal-care services scrutinized were provided by staffers who were ineligible.
“This fraud not only robs Ohio tax payers of their hard earned money, but of the care they deserve. We need to ensure that Ohio families have access to quality Medicaid services and by weeding out the bad actors we can do just that,” Lehner said.
Under the measure, transportation and home-healthcare Medicaid providers would have to procure a $50,000 surety bond, while home health aides would need to have a $10,000 bond. According to Lehner, bonds typically cost 4 percent or less of the bond amount for established providers, and 5 percent to 12 percent for newer providers.
While current regulations require that these providers affirm that they have read and understand their responsibilities for documentation, licensing and certification, the bill would mandate training in these areas before allowing providers to participate in the Medicaid program.
Indiana, Texas, Florida and New York use a similar approach. The idea previously was proposed in the 129th General Assembly by Rep. Barbara Sears.
The Auditor of State’s office, one of five independently elected statewide offices in Ohio, is responsible for auditing more than 5,900 state and local government agencies. Under the direction of Auditor Dave Yost, the office also provides financial services to local governments, investigates and prevents fraud in public agencies and promotes transparency in government.