Ohio Republicans target Medicaid fraud with facial scans, tougher felony charges

COLUMBUS, Ohio -- Ohio Republicans want major changes to how Ohio monitors home healthcare workers after raising alarms about billions in potential Medicaid fraud.

A proposal added to House Bill 795 on Wednesday would require some home healthcare workers to scan their faces or fingerprints when checking into a patient’s home.

It would also increase criminal penalties for providers accused of stealing from Medicaid -- an issue many top Ohio Republican leaders and officeseekers have zeroed in on following recent reporting by conservative media.

“This will not be an end-all, be-all fix to every Medicaid problem. That is absolutely impossible,” said Ohio House Medicaid Committee Chair Jennifer Gross, a Butler County Republican, said. “We shall look for the good and not the perfect.”

The revised bill focuses on Medicaid waivers that help elderly and disabled Ohioans receive care at home instead of moving into nursing homes or other institutions.

“We know that having someone in their home is much, much cheaper,” Gov. Mike DeWine said. “But it’s also better for them. It’s better for their health than if they were in a nursing home.”

But because care happens inside private homes—and sometimes involves family members serving as caregivers—lawmakers say the system is vulnerable to both fraud and abuse.

Republicans say their new rules will help catch bad actors. Democrats, however, worried the system might become so complicated that elderly and disabled Ohioans would struggle to navigate it.

More oversight
 
HB 795 would add several new oversight rules for home healthcare providers, including: 

• Requiring home healthcare workers to electronically check in at patients’ homes as a condition of payment.
• Requiring high-risk providers to use fingerprint scans or facial recognition technology to verify they were physically present.
• Mandating in-person inspections before new home healthcare providers can enroll.
• Allowing the state to deny enrollment applications from providers if their addresses are already linked to multiple providers.
   

Medicaid already requires home healthcare workers to electronically log when they arrive and leave a patient’s home through Ohio’s Electronic Visit Verification, or EVV, system.

But right now, missing or mismatched check-ins do not automatically stop providers from getting paid.

“This is a major control failure,” said state Auditor Keith Faber, a Mercer County Republican running for attorney general this year.

A 2024 audit done by Faber’s office found 56% of home care claims—representing roughly $1.1 billion in payments—could not be matched to an EVV visit record.

HB 795 would withhold payments for failure to check in and flag providers as “high risk” if their times were off.

But state Rep. Crystal Lett, a Columbus-area Democrat who has firsthand experience with these systems, said they’re clunky and outdated.

Her son’s caregivers use two separate apps to verify they’ve arrived. Both involve multiple steps and are often completed minutes apart, which the system flags as a mismatch in check-in data.

Lett said Ohio needs to “make sure we’re not flagging providers as high risk simply because they cannot make their math math.”

Stronger punishments
 HB 795 would also increase penalties and expand enforcement tools for Medicaid fraud cases. The bill would:

• Upgrade the lowest=level Medicaid fraud from a misdemeanor to a felony offense.
• Require mandatory prison time in the most serious fraud cases involving $150,000 or more.
• Allow prosecutors to recover up to twice the amount of money stolen from Medicaid.
• Allow the state to reward whistleblowers with up to $10,000 if their information leads to findings of liability against a public official or office.
• Gives Ohio’s state auditor the power to subpoena Medicaid’s records.
• If a subpoena is not answered in a timely or complete manner, the attorney general would then be required, upon the state auditor’s request, to bring a court action to enforce compliance.

Faber told members of the House Medicaid Committee that offering a reward and more whistleblower protections could be a huge help. Most of his investigations, he said, start with someone sending a tip.

What happens next?

Lawmakers are expected to break for the summer in June and likely will not return to pass major legislation until after the November elections.

That’s a tight window to get this bill through both the House and Senate chambers.

“I think we have to get it done,” House Speaker Matt Huffman, a Lima Republican, said. “I think that the public knows that this is a significant problem.”