This past December, whistleblowers came to me, and they started warning about what they believed to be massive Medicaid home health care fraud here in the state of Ohio. They weren’t just talking about a few bad claims. They were actually describing what they believed to be a systemic fraud pipeline right here in Columbus.
These whistleblowers told me providers were being pressured to rubber stamp home health care paperwork, and for people who actually didn’t medically need it. They said individuals would come into their office, ask for home health care services. Some appeared to be actually coached on what to say to get those services, with somebody many times who didn’t even speak English, so you had a translator in the office, and they were pushing aggressively for paperwork to be approved.
But these providers did the right thing. They conducted physical exams, they evaluated the person that was pushing for home health care services, and when the person didn’t qualify, they flat out denied them. They refused to rubber stamp Medicaid paperwork, which was the right thing to do.
The whistleblowers told me much of the pressure that they were seeing was actually coming through individuals and businesses operating within the Somali, Bhutanese, and Nepalese communities here in Ohio.
And they said that some of the health care agencies were even going so far as to suggest, and I quote, “I will make this worth your while if you approve the paperwork.”
Again, these providers flat out said no. This is not about health care anymore. This is an alleged fraud operation that we uncovered back in December. These whistleblowers actually tried to sound the alarm long before the public even knew anything about this. These whistleblowers went to legislators in the state of Ohio, state office holders.
They even went to the attorney general’s office. They repeatedly were ignored at the highest levels in Ohio. And when they went to the AG’s office, they asked a very serious question, “Can you protect us? And can you protect our confidentiality?” Because they specifically said if they said anything about this home health care fraud, they would literally be stoned to death for speaking the truth.
They didn’t feel that their concerns were being taken seriously. So in December when they came to me about the potential home health care fraud… I reviewed the information, I investigated it, and I discussed these allegations. I shared the list of potential fraudsters right here in central Ohio with the Ohio Attorney General’s Office, the Ohio Department of Medicaid, and even the Auditor’s Office.
And here’s why this matters. Ohio’s own Medicaid reimbursement rates show exactly how home health care fraud actually can open and explode in terms of fraud operations. One elderly or older recipient can actually gain $75,000 to $90,000 a year of personal care billing through high daily hours that are authorized.
So a family member can come in and take care of a parent. Two parents, you can push that number to $180,000, and then you add your in laws. In one household, you can start making $250,000 plus for Medicaid billing. This is the financial incentive, this is the vulnerability, and this is what the whistleblowers were trying to warn the state about months and months ago.
This could have been stopped a year ago.
After I brought this information forward to the Attorney General’s Office, initially, they asked me for the names of my whistleblowers. Now, as an attorney, I said, “No, attorney client privilege.” But I did ask them one simple question, “Can you protect these whistleblowers? Because then a hundred percent, I’ll give you the names.”
They told me no, so I refused.
The Attorney General’s Office then called me back, and they said they had orders from higher up, we know who that is, that they could subpoena me before a grand jury and that I would be protected, but they needed the names of the whistleblowers.
So I asked again, “You subpoena me, you put me in front of a grand jury, great, you’re gonna protect my confidentiality, but what about the whistleblowers, the ones that are actually fearing for their lives? Can you protect them?” They said, “No.”
They continued to press me. They actually went so far as to threaten subpoenas, and at one point they even floated the idea of reading off names of everybody who’s been a confidential informant that has come forward to their office.
And all I had to do was confirm or deny if that was the individual who were my whistleblowers. And again, I said, “Absolutely not. That’s unethical.” That would actually violate attorney client privilege, and they should know better being attorneys.
I was never going to help the state intimidate the very people who actually had the courage to speak up after the state actually failed to listen, especially when these allegations were in the official hands for months.
So I told them directly, “You have the information, you failed to take it seriously, and now I’m not going to allow your office to threaten me or betray these whistleblowers who came forward because they believed Ohio was looking the other way.”
So I kept investigating. I actually personally went to buildings in Columbus, Ohio, that house dozens of home health care companies.
In one building after another, what I saw was empty offices. In fact, one building had 34 to 36 home health care companies, one to two people present, letters sitting under doors from the attorney general’s office unopened. People could not explain how health care operations work.
Now federal oversight is confirming just how serious these red flags are.
On May 12, the House Oversight Committee actually sent a letter to the Ohio Department of Medicaid announcing an investigation into the widespread waste, fraud, and abuse in Medicaid personal care services authorized through Ohio’s home and community based waiver programs. So this is a home health care program we’ve been flagging for almost a year now.
The letter cites reports of providers billing for services never performed, relatives billing Medicaid to care for families, abandoned office buildings packed with Medicaid companies, and estimates that Ohio’s fraud waiver program could exceed $1.2 billion.
The committee also noticed one Columbus office reportedly alone housed 288 providers that collectively billed $250 million to Medicaid between 2018 and 2024.
And you just have to look at the timeline. Look at what happened in Ohio. You had whistleblowers come forward, then I came forward with allegations to Ohio officials in December. The state failed to act with urgency, and it’s now only when Congress is demanding answers and documentation. There’s no leadership, there’s no accountability until there’s actually a scandal brewing, and it was impossible to ignore, and that’s why the state of Ohio is stepping up.
So yes, now the governor has decided he’s announcing a new fraud prevention program, and steps include a proposed moratorium on new home health care, hospice providers, payment suspensions for providers, fraud red flags, and more frequent revalidation of higher risk providers, tighter electronic visit verification controls.
But all of that’s fine. Here’s the big problem. This is not enough. A moratorium on new providers doesn’t actually do anything to expose the fraud that’s already happening within the system, that was already reported. GPS tracking does nothing if the person should have never been approved for home health care in the first place.
Remember, people have been rubber stamping this. This is why the fraud is occurring. Electronic visit verification also does not do anything if providers were allegedly being pressured to approve services that were never really medically necessary.
Ohio needs to go further. The governor’s office and the Department of Medicaid should immediately require full audits and reverification of any high dollar home health care provider and recipient.
There’s tons of them. This is an automatic red flag. Conduct unannounced site visits of providers that are clustered at suspicious addresses. That’s something that I can give you and so many others can.
Cross check companies for shared office space, related ownership, duplicate billing, shell company patterns, and abnormal billing spikes.
Again, these are also red flags that should be immediately accounted for. Review every provider flagged for billing large amounts through family care arrangements. Again, if you have a home health care provider in your home that’s a family member, that’s an issue. Also, we have to strengthen our clinical verification. It should only be for documented, real medical need.
And most importantly, Ohio must protect whistleblowers instead of making them feel like they’re the ones that are under investigation, because the scandal here is not just the alleged fraud of billions, it’s the people who tried to warn the state of Ohio, and they were ignored.
They were terrified for their lives, that they would allegedly be stoned to death. And when they finally found someone willing to fight for them, the state’s first instinct wasn’t to protect the whistleblowers, it was to get their names.
And here’s what makes this even more maddening. This is the same DeWine administration whose office, when it was pressed earlier about these fraud allegations, said, “It’s the cost of doing business.”
And they’ve said Ohio has a robust anti fraud measure. That’s unfortunate, and that’s not true, and they didn’t take these allegations seriously.
Fraud is not the cost of doing business. Fraud is the cost of government failure. I reached out to Gov. DeWine’s office repeatedly to share the patterns of alleged fraud that were brought to me by the whistleblowers that I have witnessed.
To date, nobody from his office has called me back.
I even called the governor personally to explain to him how the fraud is actually occurring. I haven’t heard back.
Ohio taxpayers really deserve answers. Vulnerable citizens, disabled Ohioans, they deserve a system that protects them and not scammers. And every official who dismissed these warnings should be asking one simple question, how much taxpayer money was lost because you refused to listen?
Congress is now investigating, and I have full faith in the team. The receipts are going to be coming out, and this story is far from over. So stay tuned. There’s much more to come on Ohio fraud.
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