Rep. Mike Dovilla Announces Ohio Medicaid Program Integrity and Fraud Prevention Act

State Representative Mike Dovilla (R-Berea) today unveiled a comprehensive legislative package aimed at fighting fraud, waste and abuse within Ohio's Medicaid program with the goal of protecting taxpayer dollars.

The Ohio Medicaid Program Integrity and Fraud Prevention Act, spearheaded by the Ohio House Republican Caucus, works to strengthen oversight and accountability within the system, target high-risk providers to ensure quality care, boost fraud reporting requirements, implement much-needed guardrails around home-health services, and enhance penalties for Medicaid fraud.

"Medicaid was created to serve the truly vulnerable, not to bankroll scammers, fake providers, and organized fraud rings that treat public assistance like an open checkbook," said Dovilla. "Ohio taxpayers are sick of watching their money disappear into programs without real verification, real enforcement, or real consequences. This effort is about restoring accountability, protecting honest Ohioans who are footing the bill, and making sure Medicaid dollars go to the people who actually qualify and truly need help."

Amendments were accepted today in committee to House Bill 795, sponsored by State Rep. Josh Williams (R-Sylvania Twp.), to include an extensive, targeted list of key reforms brought forward by members.

Sub. House Bill 795 was updated with the following provisions:

• Boosts the electronic verification of in-home personal care services by requiring the Department of Medicaid (ODM) to maintain a statewide electronic visit verification (EVV) performance dashboard and requiring high risk providers to utilize fingerprint scanning, facial recognition, vocal recognition, a secure personal identification number, or other approved verification method as a condition of receiving payment as well as creating a new definition of in-home care services, which will be subject to EVV and on-site clock-in and clock-out requirements in order to receive payment.
  
• Improves the Medicaid provider enrollment process by requiring ODM to conduct in-person inspections before approving any new providers for home and community-based care and automatically investigate a provider seeking enrollment if there are other providers who utilize the same address, business signage or other similarities. The bill also requires ODM to establish criteria for classifying high risk providers, allowing them to impose a temporary payment suspension and conduct an investigation if there is a suspicious increase in claims. Additionally, this bill requires that an alternative payer analysis be conducted prior to payment of all Medicaid claims.
  
• Increases penalties for Medicaid fraud by allowing sentencing all the way up to a first-degree felony relative to the amount of fraud committed and allows the Auditor of State to reward reports of fraud.
  

Substitute House Bill 795 also establishes guidance for state employee fraud reporting, implements further Medicaid waiver oversight, and enhances reporting mechanisms to the Auditor of State and Attorney General.

In addition to accepting the sub. bill, members of the House Medicaid Committee heard testimony from the Ohio Attorney General's Office, Ohio Auditor of State and ODM.

Speaker of the Ohio House Matt Huffman (R-Lima) recently appointed several new members to the committee as interest within the caucus continues to grow around addressing challenges facing Ohio's Medicaid system. New members from the caucus on the committee include Reps. Dovilla and Williams, along with State Representative Brian Stewart (R-Ashville). The committee is chaired by State Representative Jennifer Gross (R-West Chester).

"I wish to thank Medicaid Committee Chairwoman Jennifer Gross and Vice Chairman Tim Barhorst for their leadership and contributions throughout this process, Representative Josh Williams for his work on the original House Bill 795 and his continued contributions to this effort, and the many members of our caucus who have offered ideas, suggestions, and draft language to strengthen the bill," Dovilla added. "This substitute bill is an important first step, and our discussions will continue as we work toward a more finalized product. The mission is clear: verify eligibility, expose fraud, recover misspent dollars, and put bad actors on notice that Ohio is no longer asleep at the switch."

This package of provisions is in addition to the work accomplished through the state operating budget passed in 2025 that implemented a broad range of healthcare transparency and anti-fraud reforms - championed by Ohio House Republicans - that worked to better protect taxpayer dollars.