Ohio Audit Flags 15.6% Medicaid Payment Error Rate, Risking Up to $4.4 Billion
Updated
Updated · Fox News · Jun 3
Ohio Audit Flags 15.6% Medicaid Payment Error Rate, Risking Up to $4.4 Billion
1 articles · Updated · Fox News · Jun 3
Summary
Ohio’s annual State Single Audit found a 15.6% error rate in Medicaid payments for dead or otherwise ineligible recipients, implying $800 million to $4.4 billion in potential unallowable costs.
The state auditor blamed lax controls, weak eligibility checks and inconsistent administration in a program that spends about $40 billion a year and covers roughly 2.9 million residents.
Past audits cited $455 million paid to ineligible recipients in 2020, $118.5 million in unrecovered duplicate or improper payments in 2022, and more than $1 billion tied to possible multistate duplicate services in 2024.
Home healthcare remains a key vulnerability: a 2024 audit found roughly half of Medicaid-reimbursed in-home services bypassed federally required electronic visit verification despite a $146 million system investment.
The auditor said his office is reviewing unusual provider concentrations and billing patterns in Franklin County, while stressing audits identify control failures and prosecutors must determine whether fraud occurred.