The Columbus Dispatch first published this opinion piece.

Franklin County made national news in the worst possible way recently.

Reports of massive Medicaid fraud spurred the General Assembly to pass overdue bipartisan legislation that stiffens penalties and strengthens program oversight. And Gov. Mike DeWine announced his own new fraud-prevention measures in May. None of this is a surprise, given Vice President JD Vance’s warning to states that they would lose federal funding if they did not reduce fraud, specifically calling out his home state of Ohio

Large government programs are susceptible to waste, fraud and abuse, and Medicaid has proven no exception. Ohio spends more than $40 billion a year on Medicaid, and improper payments for overbilling and ineligible recipients can cost taxpayers hundreds of millions more.

An unfortunate contributing culprit has been the state’s home and community-based care services that have exposed Medicaid to fraudsters and siphoned public funds from those who need it most.

Ohio increasingly relies on home-care services to help seniors and patients with disabilities receive humane, flexible, personalized and more affordable care. But audits and enforcement actions consistently find that home-based care programs often bill for services they never provided, inflate their billable hours, and recoup payment for “phantom” aides who only exist on paper. Organized fraud rings exploit weak verification systems and pressure patients to sign timesheets for care they never received.

Part of the problem is Medicaid’s “pay and chase” model. The program releases funds first and attempts to recover erroneous payments later. By the time auditors uncover a fraud, the money is gone, the care provider has disappeared, or the cost of recovery exceeds the potential savings.

Fortunately, Ohio is taking steps to change programmatic incentives and tighten oversight to fight the fraud, waste and abuse.

Recent reforms look to revamp the “pay and chase” model, stop faulty payments before they are made and require prior authorization for personal care services and some therapies before providing them. New fraud-prevention legislation wisely adopts electronic visit verification that requires and allows Medicaid workers to prove that they actually provided the billed-for services. And Ohio now requires would-be care providers to appear for in-person inspections before they are eligible for Medicaid reimbursement – another common sense, fraud-fighting step in the right direction.

Better yet, Ohio should begin using advanced data analytics and artificial intelligence to identify potential billing errors or fraudulent behavior in near real time. And Medicaid managers should start making old-fashioned surprise visits to inspect and confirm whether care providers are in fact performing the billed services. More robust payment-prevention and service-verification protocols can go a long way toward reducing scandalous Medicaid fraud.

Fraud, waste and abuse perpetrated against government programs like Medicaid erode public trust. They fleece taxpayers of their hard-earned dollars. And they rob the ill and the infirm of the care they desperately need.

Eliminating homecare and community-based medical services isn’t the answer. Families, patients and Medicaid rely on that care and for good reason.

Oversight, accountability, strategic enforcement audits and the political will to find and punish Medicaid scammers and crooks are what’s needed. Verifying services before payment, holding managed care plans more accountable and prosecuting hucksters will help policymakers restore faith in a beleaguered, scandalized program. Ohio taxpayers and patients are counting on it. 

Rea S. Hederman Jr. is vice president of policy at The Buckeye Institute.