In a report that underscores the ongoing challenges of curbing Medicaid fraud, the Auditor of State's Office revealed that Ohio's attempts at introducing electronic checks to verify in-home healthcare services have fallen short, with a significant slice of these services going unverified in 2022. The details were laid bare in an audit in the public interest of electronic visit verification (EVV), released today.
The federal mandate for Electronic Visit Verification came down from the 21st Century Cures Act of 2016, requiring digital validation for Medicaid-reimbursed personal and home healthcare services. Still, like many states, Ohio has been slow on the uptake, with 56% of home health services reimbursed without the mandated electronic verification, a concerning gap that exposes the system to potential inefficiencies and abuses. The Ohio Department of Medicaid, which kicked off the EVV system implementation six years ago, has reportedly dropped about $146 million into the system's development but is only now making strides toward making EVV a requisite for payment in the coming year.
The audit, which covered data from January 1 to December 31, 2022, discovered that a staggering $1.1 billion out of $2 billion in paid claims lacked corresponding verified electronic visit data, indicating that compliance rates were sorely lacking, the state auditors probed into a sample size of 100 providers and learned that 37 of them hadn't submitted any EVV data whatsoever. These figures indicate a clear need for tighter controls and greater urgency in compliance enforcement.
Auditors have prodded the state Medicaid department to lift its communication game, to educate providers about EVV requirements, and, crucially, to have electronic verification as a conditional requirement for the payment. Additionally, auditors suggested creating an electronic scorecard to share compliance levels with providers, which may serve as both a carrot and a stick, fostering a culture of accountability and a deterrent against potential fraud.
According to the Auditor of State's Office's findings, Ohio is among 34 states that were not enforcing EVV, contributing to the dismal compliance numbers and leaving the system vulnerable. The audit's full findings can be accessed online, and the Ohio Department of Medicaid indicates that future compliance will be more rigorously pursued.
