Ohio Toughens Medicaid Fraud Prevention with New Initiatives

On May 13, 2026, Ohio Governor Mike DeWine announced new Medicaid fraud prevention initiatives focusing on home health and hospice providers from the Ohio Department of Medicaid (ODM).

Governor DeWine also issued an Executive Order on May 18, 2026, directing new emergency rules for multiple provider enrollment enforcement actions including revalidations of identified high-risk providers.

The move follows a nationwide moratorium by the Centers for Medicare and Medicaid Services (CMS) on new Medicare enrollment for hospices and home health agencies. As our colleagues have written, CMS will let each state decide “whether some form of home health provider moratorium is appropriate for their respective Medicaid and [Children’s Health Insurance Program (CHIP)], and the scope of such moratorium,” encouraging states to engage in this analysis.

What You Need to Know

• Moratorium on New Enrollments: ODM has requested that CMS allow Ohio to implement a six-month moratorium on new home-healthcare and hospice business enrollment as Medicaid providers, including denial of enrollment applications currently pending.   The CMS Medicare moratorium also blocks non-exempt changes in majority ownership (CIMOs) under 42 C.F.R. § 424.550(b) where the change occurs within 36 months of initial enrollment or the most recent CIMO. CMS treats those as new enrollments and will not process them during the moratorium period. Parties to pending or planned home health and hospice transactions should evaluate whether the 36-month rule is triggered.
• Payment Suspension of High-Risk Providers: ODM will immediately begin halting payments to and beginning termination proceedings for any Medicaid provider that has been “red flagged” for a high risk of committing fraud.
• Enrollment Terminations: ODM may terminate providers who have not provided Medicaid services or billed Medicaid in the last year.
• Mandatory GPS on Home Health Visits: Home health providers will now be required to use GPS for all visits relying on Electronic Visit Verification (EVV).
• Mandatory EVV for Live-In Caretakers: All live-in caretakers (including family caretakers) will be required to use EVV as a requirement for payment.

• Executive Order for More Frequent Revalidation for High-Risk Providers: ODM will require providers identified as higher risk for committing fraud to revalidate more frequently than other providers.

Background: Ohio’s Ongoing Effort to Identify and Eliminate Medicaid Billing Fraud

Ohio’s actions also respond to direct federal attention: in announcing its nationwide moratoria, CMS identified Ohio among the states with elevated fraud risk warranting heightened oversight of newly enrolled Medicare hospice providers (alongside Arizona, California, Georgia, Nevada, and Texas). At the direction of Governor DeWine, ODM has embraced directives from the White House to identify and eliminate Medicaid billing fraud, particularly in the home health arena. Executive Order 2026-01D, signed May 18, 2026, authorizes ODM to issue the emergency rules implementing more frequent revalidation of higher-risk providers. These latest initiatives continue previous efforts on these lines. Beginning in 2026, ODM initiated new prior authorization requirements for high-risk services to ensure the medical necessity of those services. ODM has also continued to build new data analytic capabilities to improve the early detection of potential fraud by identifying outliers in billing patterns and assessing high-risk business ownership structures. These analytic tools also aim to improve coordination of fraud-fighting efforts.

What Affected Medicaid Providers Should Do Now

• Monitor Rulemaking from ODM: The Governor’s executive order directs ODM to prepare and issue numerous new regulations, but it is unclear the timeframe or structure in which ODM will issue these new rules.
• Evaluate Effects of Enrollment Moratorium: Any entities that have submitted enrollment applications for home health and hospice, even if those submissions occurred prior to the Executive Order, will be impacted by the moratorium. This could impact transactions and planned business operations. Some Ohio licensing authorities (e.g., the Ohio Department of Developmental Disabilities) have already published notification of the moratorium on its provider website.
• Perform Compliance Audits on Existing Enrollments: Existing home health and hospice providers should perform compliance audits for potential overpayments or billing issues on their existing enrollments to comply with enhanced fraud enforcement by ODM and the federal government.
• Review Current Enrollments: Existing home health and hospice providers should review current enrollments, including the status of owners and individuals relative to exclusion and licensure lists, and audit information contained in their enrollments in preparation for compliance with the impending revalidation requirements.

* * * *

For additional information about the issues discussed in this Insight, please contact the attorney(s) listed on this page or the Epstein Becker Green Health Care and Life Sciences attorney who regularly handles your legal matters.