DeWine Signs Emergency Order to Crack Down on Ohio Medicaid Fraud

CEDARVILLE, Ohio — Ohio Governor Mike DeWine signed Executive Order 2026-01D on May 18 in Cedarville, directing the Ohio Department of Medicaid to immediately amend administrative rules targeting high-risk Medicaid providers. The order goes further than last week’s announcement suggested. It imposes a 6-month moratorium on new provider enrollments in several categories and directs ODM to implement GPS-based electronic visit verification for in-home services. A Decades-Long Enforcement Record Ohio’s Medicaid fraud enforcement history spans two gubernatorial administrations. Under Gov. John Kasich and then-Attorney General DeWine, the state secured 1,224 fraud indictments, 1,124 convictions, and recovered nearly $400 million in fraudulent payments. Since DeWine became governor, his referrals through Ohio Medicaid and Attorney General Dave Yost’s Medicaid Fraud Control Unit added 1,154 more indictments, 1,092 more convictions, and more than $245 million in additional recoveries. The combined total since 2011 stands at more than 2,300 indictments, more than 2,200 convictions, and more than $644 million recovered. The U.S. Department of Health and Human Services consistently ranks Ohio among the top states for Medicaid fraud prosecution. What the Order Requires The executive order directs ODM to immediately amend Ohio Administrative Code rules 5160-1-17.4, 5160-1-42, and 5160-1-17.6 under the authority of Ohio Revised Code Sections 5164.02, 5164.32, and 5164.33. The rule changes allow ODM to terminate provider agreements for any Medicaid provider that has not delivered services or submitted a bill in more than one year. High-risk providers must revalidate enrollment more frequently. The Medicaid director may also require certain providers to recredential. Additionally, ODM may deny enrollment applications when a federally approved moratorium is in effect, even if the application arrived before the moratorium began. Enrollment Freeze for High-Risk Provider Types The order goes a step further by imposing a 6-month moratorium on new enrollments for specific provider categories. Those categories include hospice agencies, home health agencies, waiver individuals and organizations, private duty nurses, personal care aides, and home care attendants. Pending applications in those categories will be denied in accordance with federal CMS requirements. GPS Tracking and Data Analytics The order also directs ODM to move forward with formal rulemaking to implement GPS requirements for Electronic Visit Verification, which tracks in-home service delivery. Ohio is directed to develop a best-in-the-nation approach to GPS monitoring for services subject to EVV requirements. ODM must also expand its use of advanced data analytics and data mining tools to identify high-risk providers and suspend payments immediately when credible fraud allegations arise. Utilization controls for behavioral health and home health services are also required, aimed at preventing overuse that could mask fraud, waste, or abuse. How Emergency Rules Work Under Section 119.03(G) of the Ohio Revised Code, the governor may suspend normal rulemaking procedures when an emergency exists requiring immediate action. Emergency rules take effect upon electronic filing with the Secretary of State, the Legislative Service Commission director, and the Joint Committee on Agency Rule Review. They are valid for 120 days. The order was attested by Secretary of State Frank LaRose and will expire 10 calendar days after DeWine’s last day as governor, unless modified or rescinded before then.