After an investigative journalist at The Daily Wire uncovered fraudulent home health companies billing Medicaid in Ohio, federal law enforcement officials joined the Ohio Medicaid Fraud Control Unit to fight fraud in the state.
The report from The Daily Wire used data released by the Department of Government Efficiency to find out how much healthcare companies have been billing Medicaid. Focusing specifically on home health companies, the report details how 94 different companies have been billing Medicaid out of one large office building.
After the report uncovered many possible fraud schemes in Ohio, the U.S. Department of Justice announced charges against nine defendants over $42 million in fraud. The Department was able to fight this fraud thanks to Ohio leaders partnering with federal enforcement officials to detect different types of fraud in the government program.
While every state must have a Medicaid Fraud Control Unit to handle individuals defrauding the government program, not every state adequately investigates fraud in its Medicaid programs. This is why the Department of Justice is partnering with Ohio to build a model of federal-state cooperation in fraud investigations. Both state and federal agencies are responsible for protecting the Medicaid program from fraud, so Ohio’s steps to partner with federal agencies only sped up the process for detecting and prosecuting these fraud schemes. These steps include sharing data on corporate registrants, cross-designating prosecutors from the Ohio Attorney General’s office to the Fraud Division’s Health Care Fraud Strike Forces, and working with the Centers for Medicare and Medicaid Services to identify Medicaid fraud.
Through this cooperation across several agencies, the Ohio Medicaid Fraud Control Unit was able to charge four defendants with a $30 million behavioral health scheme claiming to provide therapeutic services to children, and one man with a $12 million scheme billing Medicaid for services not actually provided to children in after-school programs. The Department of Justice seized bank accounts with $496,000 in funds and 14 vehicles worth $800,000.
In addition to partnering with states to effectively combat healthcare fraud, the FBI also announced the “Most Wanted Fraudsters” program in order to gain public help in finding the fraudsters. The efforts used to detect, investigate, and prosecute fraud are led by the Task Force to Eliminate Fraud, chaired by Vice President J.D. Vance. By partnering with other government agencies and states to tackle fraud, the Vice President has been successfully identifying and stopping fraud across federal entitlement programs.
Bottom Line
States and federal agencies have a responsibility to be watchful for fraud in taxpayer-funded programs. Rather than defending misspending as California has, states can actively participate in fraud prevention efforts. Ohio provides a strong example of a state working to end fraud and reduce misspending in one of the country’s largest entitlement programs. By providing data and resources in the fight to end fraud, schemes can be detected more easily and ended more swiftly.