05/28/2026

House Medicaid Committee Advances Broad Medicaid Anti-Fraud Proposal

The Ohio House Medicaid Committee this week unveiled the first phase of a sweeping Medicaid anti-fraud package as lawmakers continue responding to heightened scrutiny surrounding home- and community-based services and other Medicaid-funded programs.

House Bill 795, originally focused on electronic visit verification requirements, was expanded into a wide-ranging Medicaid oversight proposal that House leaders say is intended to “stop the bleed” while additional reforms are developed later this year.

Committee leaders indicated the legislation is moving quickly, with additional hearings planned next week and a possible House floor vote in early June.

The substitute bill includes numerous new enforcement and oversight provisions, including increased criminal penalties for Medicaid fraud, more frequent provider agreement renewals, enhanced provider screening requirements, mandatory investigations tied to suspicious billing patterns, expanded data-sharing authority, and stronger front-end verification measures for high-risk providers.

Lawmakers and agency officials repeatedly emphasized that the focus must remain on identifying bad actors without creating unnecessary burdens for quality providers serving Ohioans appropriately and ethically.

“This is not the end-all, be-all fix,” House Medicaid Committee Chair Rep. Jennifer Gross said during the hearing. “We’ll do our best not to harm the good actors in our system.”

Testimony throughout the hearing highlighted the growing focus on front-end prevention, provider transparency, ownership disclosure, and stronger enrollment safeguards — themes that closely align with LeadingAge Ohio’s recent hospice integrity work.

Last week, LeadingAge Ohio-backed House Bill 945 was introduced to strengthen hospice oversight and accountability in Ohio. Developed in collaboration with fellow stakeholders, nonprofit hospice leaders, the Ohio Department of Health, and Rep. Andrea White, the legislation includes enhanced licensure standards, stronger ownership transparency requirements, criminal background checks, expanded quality monitoring, and additional enforcement authority designed to prevent questionable operators from entering or exploiting Ohio’s hospice system.

LeadingAge Ohio has consistently supported thoughtful, targeted oversight measures that protect Medicaid resources while preserving access to high-quality care. The association has emphasized that mission-driven providers welcome appropriate accountability measures that reinforce public trust and help distinguish responsible providers from bad actors.

During Wednesday’s hearing, lawmakers, the attorney general’s office, State Auditor Keith Faber, and Ohio Medicaid Director Scott Partika all stressed the importance of stronger front-end controls, better data sharing, and earlier intervention to prevent fraud before taxpayer dollars are lost.

At the same time, several lawmakers and advocates cautioned against policies that could unintentionally create barriers for individuals relying on home- and community-based services. Discussions also highlighted the operational realities providers face with electronic visit verification systems, administrative requirements, and workforce shortages.

House leaders described the legislation as only the beginning of broader Medicaid integrity discussions expected to continue throughout the year.