On the Job 

The state’s Medicaid program is an essential safety net for Ohioans, providing healthcare services for our most-needy citizens. Unfortunately, bad actors are always looking to exploit the programs and enrich themselves with the public’s money.

My office serves as the state’s watchdog to ensure that cheaters and those who scam the system are brought to justice.

Every year, healthcare fraud costs Americans tens of billions of dollars. But when scammers bilk the government for unlawful payments and benefits, they’re doing much more than ripping off taxpayers. They’re driving up the cost of premiums and health care for everybody.

Even more alarming, the well-being of patients who fall victim to corrupt health-care providers — or to those posing as health-care providers — is put at risk. Examples of fraud are when:

Necessary services might not be provided even though insurers are billed for them.

Unnecessary diagnostic tests and invasive treatments might be ordered as a way to pad the bill.
Prescriptions might be stolen or diverted.

Unscrupulous medical offices or long-term-care facilities might cut corners by hiring unqualified or abusive staff, further jeopardizing the health of patients.

In short, healthcare fraud is a cancer that undermines the efforts of the nation to care for its people. In Ohio, the dedicated men and women in our Health Care Fraud Section — specifically, the Medicaid Fraud Control Unit (MFCU) — lead the nation in fighting to eradicate this tumor.

But we can’t — and don’t — do it alone. Our success depends on referrals to initiate the investigations that ultimately allow us to prosecute bad actors. The Ohio Department of Medicaid, other state agencies, managed-care organizations, local prosecutors, private citizens and others collectively serve as a pipeline, reporting cheaters to our MFCU.

We are a force multiplier for law enforcement around the state. We know agencies are doing more with less these days. We want law enforcement to know that we’re here to help. If you receive a call within your community regarding healthcare fraud or abuse, give us a call. We’re happy to assist in these cases to free up resources elsewhere within your department.

If you know of or suspect corrupt or deceptive practices by Medicaid providers, or if you know a patient in a long-term-care facility who is being abused or neglected, please contact our Medicaid Fraud Control Unit at 614-466-0722, or the Attorney General’s Help Center at 1-800-282-0515.

We, like you, won’t be satisfied until all of the fraudsters are convicted. My office looks forward to partnering with you to root out the fraud.

Yours,
Dave Yost, Ohio Attorney General

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AG continues his push for better tools in fight against healthcare fraud

In recent testimony before a joint meeting of the Ohio House and Senate Medicaid committees, AG Yost spoke about the growth in Medicaid fraud and his office’s leading role in investigating and prosecuting offenders.

Ohio’s MFCU is widely viewed as a national model; it routinely hosts trainings to show other states how to investigate and prosecute fraud because it does it well.

Also as part of his testimony, AG Yost encouraged the legislators to consider strengthening Ohio’s laws to ensure that more bad apples face justice. Among the suggestions:

Don’t treat Medicaid fraud as less serious than theft. The statutory penalties for Medicaid fraud should mirror the theft statutes by allowing sentencing all the way up to first-degree felony instead of capping punishment at third-degree felony.

Restore the GPS requirement in the Electronic Visit Verification System. Until about a year ago, home-health professionals had to use the system to log in and out to document the times for their services. Since then, the requirement has become optional. The lax oversight has invited exploitation from dishonest providers.

Require prior authorization for more services. The MFCU shouldn’t have to chase down our dollars after they’re out the door. It is a preventable exhaustion of precious time and resources. 

Grant subpoena authority to Ohio’s MFCU. Civil subpoena authority would untie the unit’s hands when gathering evidence for civil cases. Other sections within my office have this power.

These changes would expand the AG’s ability to uncover those who exploit the Medicaid system.