Ohio Medicaid Suspends Payments to 49 Home Health Providers Over Billing Patterns
The Ohio Department of Medicaid suspended payments to 49 home health providers based on suspicious billing patterns, marking an early state-level response to CMS guidance on heightened program integrity enforcement. The suspensions target at-home care providers and reflect a broader shift in Medicaid oversight from traditional post-payment review to proactive payment holds. The timing and scope of the action align with recent CMS directives emphasizing aggressive fraud prevention in home and community-based services. This signals that states are accelerating enforcement activity in the LTSS and home health sectors, where billing irregularities have drawn increased federal attention.
Managed care organizations with delegated provider credentialing or network oversight responsibilities should prepare for increased scrutiny of home health billing patterns and potential disruptions to HCBS provider networks as states adopt more aggressive payment suspension protocols.
LTSS · Long-Term Care · Managed Care
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