When Ohio Auditor Keith Faber heads to Capitol Hill, his message is expected to be straightforward: Medicaid fraud, waste, and abuse are not abstract problems discussed in policy papers—they are real issues costing taxpayers enormous sums of money and threatening resources intended for some of the state’s most vulnerable residents.
For years, Faber has argued that Ohio’s Medicaid system contains weaknesses that leave billions of dollars exposed to improper payments and potential fraud. As the state’s chief auditor, he has repeatedly highlighted oversight failures, eligibility errors, and administrative shortcomings that he believes demand far greater attention from policymakers.
The stakes are substantial. Ohio’s Medicaid program is the largest component of the state budget, distributing roughly $40 billion annually through a combination of state and federal funding. The program serves approximately 2.9 million residents, including low-income families, seniors, individuals with disabilities, pregnant women, and children.
Given its size and complexity, some level of administrative error is inevitable. But Faber argues that the problems identified by his office go well beyond routine mistakes.
Over the past several years, audits have uncovered a series of troubling findings. In 2020, auditors identified more than $455 million in Medicaid benefits paid to recipients who were not eligible for the program. Two years later, auditors found that state officials failed to recover $118.5 million in duplicate or improper payments connected to prison inmates and deceased individuals.
That same year, auditors reported that state agencies failed to properly respond to multi-state enrollment alerts, potentially costing taxpayers another $24.5 million. In 2024, an audit identified more than 124,000 individuals enrolled in Medicaid programs across multiple states simultaneously, with Ohio paying managed-care organizations more than $1 billion for potentially duplicate services.
The most recent State Single Audit raised even larger concerns. Auditors reported a 15.6 percent error rate involving payments made on behalf of deceased or otherwise ineligible beneficiaries. Based on the size of the program, that translates into potential unallowable costs ranging from approximately $800 million to $4.4 billion.
“These are not minor bookkeeping errors,” Faber argues. “They are the direct result of an administrative unwillingness to enforce the strict boundaries of the law.”
One of the most significant concerns involves Medicaid-funded home healthcare services. Federal law requires states to use Electronic Visit Verification systems, commonly known as EVV, to confirm that home healthcare visits actually occur before taxpayer funds are disbursed.
Despite Ohio investing approximately $146 million to implement the system, auditors found that roughly half of Medicaid-reimbursed home healthcare services in 2024 bypassed the required verification process altogether.
Critics argue that failing to enforce EVV requirements creates opportunities for improper billing and opens the door to potential abuse by providers who may bill for services that were never delivered.
Additional questions have emerged regarding unusual billing patterns and provider concentrations within portions of Franklin County. Faber’s office is reviewing those findings but has emphasized the distinction between identifying risk factors and proving criminal wrongdoing.
“Audits expose internal control failures,” he notes. “Investigators and prosecutors must determine if specific conduct constitutes fraud.”
Still, Faber argues that repeated warning signs cannot be ignored. Every improperly spent Medicaid dollar is a dollar unavailable to individuals who genuinely depend on the program for healthcare and essential services.
The auditor maintains that the solutions are not complicated. Stronger eligibility verification, improved coordination between states, more aggressive recovery efforts, and strict enforcement of electronic verification requirements could significantly improve program integrity.
