Ohio Proposes New Rules on Medicaid Provider Suspensions

In a client alert, Shumaker, Loop & Kendrick reports that the Ohio Department of Medicaid has proposed two new administrative rules addressing provider suspensions. OAC 5160-1-17.5 would replace the existing rule governing suspension of Medicaid provider agreements, while OAC 5160-1-17.51 would replace an emergency rule ODM adopted on June 2, 2026, governing suspension of claims payments. The proposals come as CMS intensifies federal scrutiny of Medicaid fraud, waste, and abuse. The rules affect Ohio Medicaid-enrolled providers who could face agreement or payment suspensions under the revised standards.

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