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Ohio Did Not Always Comply With the Requirements of the Affordable Care Act in its Review of Cases of Credible Allegations of Medicaid Fraud

The State agency did not always comply with the requirements of the Affordable Care Act in its review of cases for which there were credible allegations of fraud between July 1, 2011, and June 30, 2013. Of the 401 cases for which it found credible allegations of fraud by Medicaid providers, the State agency provided good cause to not suspend payments in 321 cases. For the remaining 80 cases, the State agency suspended payments to the Medicaid providers but continued to pay claims associated with 24 of the 80 cases and received Federal reimbursement totaling approximately $97,000.

Filed under: Centers for Medicare and Medicaid Services