Ohio House Medicaid Committee - 5-19-2026

of the House Medicaid Committee to order, please rise for the Pledge of Allegiance.

Thank you. Will my new clerk please call the roll?

Vice Chair Barhorst. Here.

Representative Craig. Here.

Aye.

Here. Representative Mullins.

Here. And Representative Stevens, here.

Chair Gross.

Thank you for having me. I thought I just needed no introduction.

Thanks. Southwest Ohio. Chair Gross, Vice Chair Barhorst, Ranking Member Baker, and members of the House Medicaid Committee, thank you for allowing me to provide sponsor testimony on House Bill 780, the Medicaid Savings Act, a bill that will move the Department of Medicaid away from the current Managed Care Organization, or MCO, model and to an Administrative Services Only, or ASO, model. This ASO model will integrate Medicaid care management for medical behavioral health and nursing care creating a single line of Medicaid administration which will allow for streamlined management significantly reduced administrative costs and better access to health care for all Ohioans. Most importantly, it is estimated that the ASO model will save the state of Ohio hundreds of millions of dollars per fiscal year and upwards of a billion dollars per biennium. Our current Medicaid system is inefficient, supporting seven different MCOs who have seven different sets of administration costs. These administration costs are not only redundant to taxpayers, but having seven different Medicaid insurers raises the cost and billing time for health care providers, which discourages doctors, nurse practitioners, mental health therapists, and other health care professionals from accepting Medicaid. This, in turn, reduces health care access for those patients with Medicaid insurance. An additional benefit to the Medicaid Savings Act is the increase in transparency and ease of state oversight, which is, I think, on everybody's mind these days. MCOs have limited data and reporting requirements to the state. Under our current MCO system, we simply do not have a clear understanding of how much they are spending on administrative costs versus medical care and quality improvements. There are three strong reasons to support this bill. The Medicaid Savings Act will increase provider participation by streamlining administration processes and by moving to a fee-for-service payment plan with regular evaluation of and increases in reimbursement rates, paying health care providers what they deserve in the current medical economy. With the increase in providers, access to Ohio's health care system will expand in every community, enabling smaller health care practices to better share the caseloads that are growing more and more dependent on hospital care each year. The Medicaid Savings Act will increase positive health outcomes for Ohioans Ohioans. By increasing the number of providers that participate, Ohioans can find their true medical home with their primary care providers no matter where they live in the state. The Medicaid Savings Act will also maintain capitation coverage for care coordination to help reduce barriers to health care, ensuring that even the most difficult to treat Ohioans reduce their dependence on crisis health care. This bill will also reduce administrative burdens for patients, especially those who are either applying to get onto Medicaid or to get off of Medicaid due to changes in eligibility. Finally, the Medicaid Savings Act will provide relief to Ohio's state budget. Although this bill feels like a monumental change, it is not a blind leap. We know this works because Connecticut successfully eliminated all MCOs in 2011 and move to this ASO model. In just their first year following the switch, provider participation increased by 33 percent, and the medical loss ratio went from 12 percent to 3 percent. In other words, the state of Connecticut went from paying 12 percent of their federal Medicaid allotment on administrative overhead down to just 3 percent. And that means that 97 percent of their Medicaid dollars would go and are going directly to medical care for patients So moving to the ASO model would be the single most impactful step towards reducing waste and redundancy in our Medicaid system Another successful Medicaid change has taken place right here in Ohio with the single-line administration of Medicaid pharmacy benefit management. I know you guys are very familiar with PBMs. In 2019, the Ohio legislature voted to cancel the contracts of two for-profit PBMs based on complaints that they were paying lower refill reimbursement rates to independent and small chains as compared to large chain pharmacies. These allegations were investigated, corroborated, and supported the legal path for Ohio to move to the ASO administration of PBMs. And I'm not saying that this is the same boat exactly, but we have this success model. And with the single PBM system that we've had now for three years, the results are, they speak for themselves. Reduced administrative waste, gross savings of $330 million over three years, and net savings of $140 million. The pharmacy reimbursement is now simplified and equitable at a uniform reimbursement rate across all pharmacists. This has increased pharmacy participation to 99% across the state, which means better access for our Ohioans and our voters. And the number of pharmacy closures has dropped to its lowest level in several decades. MCOs have been mandated for Medicaid since 2006, and they're just not working. The Medicaid Savings Act would save us money, increase transparency, and make Ohio a healthier state. Chair Gross, Vice Chair Barhorst, Ranking Member Baker, and members of the Medicaid Committee. Thank you for the opportunity to testify, and I welcome any questions.

Wow, you get off easy today.

Very intriguing. Thank you. And I really appreciate your time today. Thank you so much, Representative. Thank you. Thank you. I know we're waiting on... Yeah.

¶¶ ¶¶ In Thank you. ¶¶ ¶¶ Thank you. Thank you.

Thank you, Chairman Gross, Vice Chair Barhorst, Ranking Member Baker, and members of the House Medicaid Committee. Thank you for the opportunity to testify in support of the SHIELD Act today. When countless allegations of daycare fraud broke out in Ohio late last year, a veil was pierced. These rumors we'd heard for so long that our various Medicaid or medical reimbursement systems were being systematically abused were simply true, and we had did little or nothing about it. While I worked on and rewrote House Bill 649, the Child Care Fraud Prevention Act, another industry I'd repeatedly heard of abuse came into mind, home health services and Medicaid reimbursement. Ironically, these fraud allegations seem to come from a very similar lack of oversight that our departments urgently needed. Enshrined in these departments' operations was a lack of real-time confirmation, tracking, and verification of services. When I introduced the SHIELD Act in March, the extent of scams within our home Medicaid infrastructure was not immediately evident at that time. But then Luke Rosick, with the Daily Wire, dropped a massive expose on this multi-billion dollar scheme confirming the existence of these literal Medicaid millionaires, which many of us have suspected for a while. For example, billing for Medicaid reimbursement transportation services has almost doubled in the last two years, while 50% of Medicaid reimbursed transportation companies have not even proven that they own a single vehicle to provide these services. Of those companies that do allegedly provide Medicaid reimbursement transportation, these vehicles have been involved in countless crashes, including fatalities in the state of Ohio. A significant amount of these crashes come from companies housed at one single address, a nearly empty office building at 2700 East Dublin Granville Road. While the fact our state is subsidizing scammers to run over innocent bystanders is bad enough, 15% of all Medicaid-reimbursed home health care spending happens within four square miles in Columbus, ironically in the same community where most of the state-reimbursed daycare fraud was and is currently taking place. Our state is being robbed blind to the tune of billions of dollars, and the fact our state government has allowed itself to be blindsided by substantial fraud allegations multiple times within the past year is simply embarrassing. It is time for true anti-fraud waste and abuse legislation, like the SHIELD Act, to prevent this from happening again. The SHIELD Act takes many of the same common-sense approaches to slowing down Medicaid abuse in our state that other departments have used and requested in the past. The SHIELD Act simply requires that providers be required to use GPS-based tracking and electronic verification systems to receive state funding for their home health care businesses. These tracking systems will record things that every hospital and serious health provider already require, like pick-up drop-off locations for their patients, time stamps for recorded actions, travel routes and distances for emergency medical problems, clocking in and clocking out for data in-home caregivers, and location data for tracking providers whereabouts there are no services. Much has already been requested by other departments. Privacy protections are included, such as encryption, access controls, audit logs, and limits preventing use of data for unrelated purposes. With this private information, Medicaid will integrate the systems with existing claims databases and eventually cross-reference transportation claims with medical service claims to verify recipients actually receive Medicaid services. The department would also create automated fraud detection tools to flag suspicious activity including unusual routes repeated exemption requests and discrepancies between claims and location data As is reasonable, providers can receive exemptions for issues like equipment failure, rural connectivity problems, emergencies, or patient safety concerns. The SHIELD Act also provides a reasonable timeline for the contracting of these services, which are already available in the private sector. The SHIELD Act ensures that, like any other contract, the punishment for refusing to abide by these guidelines is to not be paid by the government for the services you allegedly render. Hospitals already hold their employees to these standards. Why shouldn't the state of Ohio? When we contract out the care of our most vulnerable population, we should expect the people the state pays to render these services actually do the services. Yet, as we've been shown, Ohio pays fraudsters billions of dollars a year for work they did not do. Meanwhile, our Medicaid recipients suffer and our taxpayers foot the bill. I am proud to offer the first step in eliminating waste, fraud, and abuse once and for all with the SHIELD Act. Once again, I thank you, Chairwoman Gross, for your diligence on this issue and allowing me to testify in support of this legislation. And I open it up for any questions that you may have.

Thank you, Chair. Thank you, Representative, for this bill. I was reading through it, and I had a question about the transportation. I used to sit on the Ohio Medical Transportation Board, which no longer exists. And one of the things we did as an insurance guy, we made sure that every entity that was licensed to do either ambulance or ambulette service had a viable proof of insurance certificate. Because if an entity is legitimate, it is going to have legitimate liability insurance from a legitimate insurance company. Does your bill allow Medicaid to do two things, either work with the ambulance board in its current form or to provide rules to make sure that insurance, or does it mention it in there? I tried to find it in the bill. I didn't see if it mentioned insurance coverage or limits of insurance for Medicaid providers.

The legislation as it is sits now does not. this legislation was initially introduced to at least provide what I think is the minimum we should be providing, which is electronic verification for the services being rendered. That was something that previously was required. Then it was turned to be optional. I don't know why it's a good idea that the people that are actually going to commit fraud have the option to turn off their location while they commit the fraud. I think that's a bad policy for the state of Ohio to be implementing. So I know that this legislation is going to become the vehicle for substantial change. and the members of the committee and the rest of the members of the General Assembly, this is going to be the opportunity for us to step forward, come up with ideas, to be able to cut down on one of the biggest expenditures we have in the state of Ohio's budget, period. We've seen that a very small growth in the number of Medicaid recipients has happened over the last few years, but we watched the budget for the Medicaid services explode. And this is one of the reasons. You know, the coffers of the taxpayers should not be used to fund a lavish lifestyle for fraudsters here in the state of Ohio. Regardless of what area of the state of Ohio you reside in we do not want to be a beacon to the rest of the nation to allow that fraud to continue So any idea that we have including just simple making sure that they have insurance because you know at my law firm we do personal injury claims And we've we've we've talked to people before that were barely insured with the state minimum and got hit by a transportation company before and didn't have insurance. And now they're sitting there with hundreds of thousands of dollars of medical bills. Their insurance doesn't cover it. The other driver didn't have insurance and they're left out in a whim months off of work. no way to pay for the medical bills, no way to pay for their daily expenses because of that injury. So that's something I would love to address in this bill. So I'd love to work with your office about making sure that we get that added in.

Through the chair to the representative, again, great question. So, I mean, we've done electronic verification before. We're providing exceptions for when there is connectivity issues. You know, with the hundreds of millions of dollars that Ohio has invested in broadband expansion, there's opportunities to log into Wi-Fi. If you're going to treat a patient in their home, there may be opportunity for you to be able to log on to the Wi-Fi to be able to have the app connectivity. You know, with Starlink nowadays, many of the rural communities are able to get Internet access. So I will continue to work to make sure that we provide exceptions for areas where we have that type of concern. But let me be clear, those aren't the areas we're seeing widespread fraud in. That's not the areas where we're seeing hundreds of millions of dollars spent. I heard earlier today at a press conference where an individual switched their LLC from one transportation company to a home health care and within a month was billing $100,000 in the first month. clearly indicating fraud. We want to make sure that we're attacking those hotspots. And we have the technology, and we've tried in the General Assembly for a few General Assemblies now to get the type of technology to the Department of Medicaid and get them to comply with the request from the General Assembly to use the tools that are available in 2026. There are so many tools available to be able to spotlight where we have an increase in Medicaid expenditures that do not justify, based on the total population and the number of Medicaid recipients, in that area. So I do understand the connectivity issue, but to be frank, those aren't the areas of the state of Ohio where we're seeing widespread, concerted, organized crime that's committing fraud at wide scale. Representative? Representative Simani. Thank you. Through the chair. So in your testimony, you talk about a reporter that confirms some of your suspicions, but I'm curious why you would believe a reporter who actually has had two settlements against him for false reporting on other similar situations.

I not saying that I base those suspicions just off of one single report I also talked to the auditor office directly who has that same type of data and seen widespread report and has turned over that data to the Department of Medicaid with no activity from the Department of Medicaid. We've tried for several general assemblies to get the Department of Medicaid to crack down on this fraud, and through lack of leadership within the previous director, we see the problem now that's come home to roost. And we're simply saying that, look, if we want to provide for the things that are important in this state of Ohio, if we continue to have conversations about school funding and cutting down on taxes of our constituents, I think we have to have an honest conversation about the fraudsters that are stealing billions of dollars from taxpayers on a yearly basis here in the state of Ohio. If we can't have that honest conversation, how can we have a conversation about what our priorities are? This bill has a very simple premise. We owe it to the taxpayers who pay their taxes. And many people do not receive these Medicaid services. We owe it to them that they at least know when we are going to be good stewards of their taxes, and the people that deserve the services that Medicaid is providing a lifeline for are actually getting those services instead of fraudsters becoming enriched by those taxpayer dollars. I'm just asking for what other sources you have that suggest to this widespread fraud and abuse. That's all I'm asking for. Besides the reporter's quotes that you have in here. Through the chair to the representative, you can look at the Medicaid data that's publicly available now. You can also talk to the state auditor's office who has did extensive, extensive investigations into Medicaid fraud and referred that data over to the Department of Medicaid. And the legislation that we've tried to introduce that's been vetoed and ignored by the Department of Medicaid. So I don't think there's any debate that there's an issue when it comes to Medicaid fraud. I think the debate is about how do we address it effectively, efficiently, and get the best way forward to make sure that fraudsters are not being enriched here in the state of Ohio. Thank you.

Thank you, Chair. To the Chair, to the witness, thank you for testimony, Rep. Williams. Quick question about electronic visit verification process. Is it your understanding that the EVV and the GPS monitoring was removed by the vendor, I think its name is Sand Data, in Ohio Medicaid a couple years ago? If you're aware of that, do we know why Ohio Medicaid removed that? Because I feel like that was a key part that at least would track and we could be part of the verification. That's why it was there in the first place. I apparently got turned off by this vendor.

is this something that could be part of the future where it's more required and reviewed and made sure that all providers in all parts of the system, do this as a best practice so we don't get in a position where we're vulnerable to fraud or being questioned about it, if so?

Thank you. Representative Lampton.

Through the Chair, it's the representative. It's going to be very simple. When they're suspected fraud or you're not complying with the requirements, you simply turn it off until you can prove compliance. You saw that come out of the governor's executive order, being able to turn off that funnel very quickly. Since we're talking about vendors and we're not talking about turning off an individual person's Medicaid, there's different requirements when it comes to that. There's less protections for vendors. We want them to be compliant, and it's very simple to do so. I think this is going to drive the bad actors out and make sure that the money that's being spent is spent effectively. Because there's a lot of disabled children, disabled seniors in the state of Ohio that rely on a lot of these services. But the Medicaid program has gotten way out of control. And the rate of spending, it's unsustainable. And I think those tax dollars can be better spent.

Committee? Any other questions?

I am aware that even in telemedicine today, they scan the provider's face to be sure they're compliant. So those things are already happening in health care today for those who may not realize that it's still going on. Thank you so much. I mean, at any time when the taxpayer dollar is being stolen, it is our responsibility to step forward to make sure that our people and our constituency, their dollars, their hard-earned dollars are being spent well. I thank you so much for bringing this forward. I thank you for being in this fight as we protect the dollars that are so necessary for those that are pregnant, the sickest of the sick, the poorest of the poor, for what Medicaid was made for in the first place, and that those dollars continue to meet the needs of those that the generous Ohioans provide for those that need it. And I thank you so much, and I look forward to continuing as we proceed with HB 795. Thank you so much.

now I would like to call forward Mr. Luke Rosiak of the Daily Wire to give the committee update regarding his findings in Medicaid for those who don't know Mr. Rosiak has done at least seven installments of Medicaid fraud in Ohio an investigative reporter of 20 years largely responsible for the reason we are having this discussion today I appreciate you being here, Mr. Roziak. The floor is yours.

sick they can't even turn in bed. They need somebody to come do all their chores. You can see these people, they're perfectly healthy. That's the truth. A lot of it is lies. Who are all these companies? Because most of the people are actually getting paid or some large percentage are getting paid to attend to their own family members. So what are the offices? What's their role? The offices are middlemen. They're set up because they have the NPI number to bill Medicaid. And so they're able to send the receipt to Medicaid and their employees are just relatives. I mean, this is how they hire somebody. The employee comes with the patient. And so the employees are, the companies are basically middlemen that take a cut. And some of them, what they do is they knock on doors in these ethnic communities and they say, is there anybody in your house that is maybe in their 50s? We can tell them what to say. Say they have back pain, say they have mental issues. And so they actually solicit people to join the program and get these government checks for doing things that they're already doing, and by saying things, in some cases, symptoms that aren't even real. And they will direct them to certain doctors, also in the same ethnic communities. And so sitting in the middle is this group of people racking up $1 million a month, $32 million a year, $100,000 a month is common. I mean, the amount of money is shocking, and the business owners aren't taking all of it. They're paying the employees, but they're splitting it. They're siphoning it off, and they're keeping a cut. So when you look up these people, and thanks to the federal government, and Ohio obviously always had this data. They never chose to make it public, that we're not talking about releasing ever anybody's private medical information. We're talking about the big corporations that make millions of dollars. thanks to the federal government we now know who the people are that own these companies making $10 million or more and you're able to look them up in public records and you're to see that they have massive red flags. They are very, very commonly running other full-time jobs. They're running trucking companies. They have tax debts. They have criminal records. They have just, they're not oftentimes the kind of people that certainly have not dedicated their lives to this as their chosen field. You know, at best, they're people that are running a bunch of different ventures at once, often to extract money in various fields from the government. So let's go through a couple of those. One of them is a company, and these are all right in the same, basically the same two or three blocks on northeast Columbus. True Home Healthcare LLC. It's owned by a guy named Aliu Conte and his wife, Mamusu Kanu. So the man is a career criminal with numerous convictions for fraud. I think three convictions for fraud in Franklin County. He's got convictions for child endangerment. He's a bad guy who hurts people. Raging drug addict. He got his nursing license taken away by the Ohio Board of Nursing for repeatedly lying. They kept giving him chances, and he would go out and get multiple DUI. He got a DUI seven days after swearing to the nursing board that he was sober. And then he said, this time I'm really sober, and he failed a drug test. He said, all right, well, I do have a big cocaine problem, but it's fine. Can I still be a nurse? And he said, all right, you can be a nurse, but you can't manage money, and you can't do home health. Well, the Ohio Department of Medicaid said, even though you're not allowed to be a nurse doing this or manage money, we'll let you own an entire company doing that. And that's what he told me. He said, yeah, I don't do home health care. I'm not a home health care person. I own the people that, I own the company that does it. And I said, all right, well, you get $100,000 a month. That's a lot. How do you find enough customers? And he said, I don't know. And I said, I mean, but you have a long record of when you got arrested many, many times in Franklin County. You had a roster of fake names you would give to the police. And he said, oh, yeah, yeah, yeah. That was just because I knew I couldn't get arrested then if I gave them fake names. The thing is, I was just too dumb to know what is law. I mean, that is a quote from a person who currently operates a nursing home in Columbus, Ohio, who is a massive career criminal who was granted after all those arrests to open his firm. I was just too dumb to know what the law is. His wife was, you know, multiple violent assaults. She was convicted of fraud in, she was, excuse me, she was convicted of theft three times in three years in Franklin County. The Ohio Department of Medicaid, they say they disclosed all of this to the Ohio Department of Medicaid and they said, that's fine. Start your own company. You send us the invoices, you tell us who you visited and we'll just pay them. He also threatened my family, by the way, when I called him, because he's so unused to scrutiny. He feels so entitled to that money. Obviously, he doesn't feel that anybody in Ohio would ever question him, and he threatened my family. This is a bad person, and he's in charge of sending people into the homes of little old ladies. It's insane. A second company, Omega Healthcare Services, incorporated by a woman named Esther Achyapong, right after she had a daycare shut down by the government because she couldn't prove that the kids were actually attending. So like apparent attendance fraud. And then she goes and starts a home health care company where, of course, the whole point of it is you say that you went to people's houses and you can't really prove it, but the government pays. Well, she incorporated it at the address of her husband who had previously who was a multiple felon for previously running an identical scheme where he lied to the government that he was helping little old ladies when he wasn This is all he has a felony federal conviction for doing this exact scheme and then the Ohio Department of Medicaid paid his wife $6 million at the same address. And the husband, by the way, never paid his court-ordered restitution for theft of federal dollars. He still owes it, and he claims he doesn't have the money, even as we paid his wife, as you guys paid his wife, The citizens of Ohio paid his wife $6 million. He never paid what he owes in restitution. Now, the husband's name wasn't on the paperwork. You have to figure out, okay, well, this wife, that's her husband. But there was a second person in place with the husband's name. It was a teenager who lives in Canton. Okay, what is this Greek teenager from Canton doing on the LLC of a middle-aged woman from Ghana in Columbus? You might think the Ohio Department of Medicaid would ask that question before they dispersed $6 million, but they did not. You might be shocked to know that the teenager was not actually running this business. His dad was a convicted money launderer, and so you can figure out what the scheme might have been there, that he's sort of a proxy. This is the kind of thing that I found as one guy looking at public records in a matter of weeks. How many people were paid by the Ohio Department of Medicaid to do this kind of scrutiny for years? Why did I find it and they didn't? A third company was founded by a guy named Mohamed Jama, who was working full-time in another field, but casually started this company on the side that eventually billed $11 million. He was fired from his job, and he said, you know, I bet my boss thought he had me down, but he didn't know I had this secret side gig where I just passively get a massive amount of money. And so he ran for state senate as the Democrat nominee. He funded his campaign with donations from other Medicaid companies because all of his friends had their own multi-million dollar Medicaid companies or whatever. This is how common it is in some communities and within some facets. It's just like everybody has their own Medicaid company. It's like universal basic income, but we never voted on it and it's not actually universal. So the last example that I'll mention is a janitor who changed the name. She actually got a loan to open a grocery store, defaulted on the loan, and then she started a translating service. That failed. She opened a janitorial company. That seemingly failed. She just changed the name of the janitorial company. It was the same LLC, but she renamed it to something called One Community Mental Health. So now she's a mental health parent. The janitor became a mental health provider and she billed $100,000 in the very first month. Now if anybody has ever run a business, it takes a while to get clients. You have to advertise. You have to get the word of mouth out. You have to prove that you know what you're doing and eventually the clients come. Not her. $100,000 in the very first month. Rapidly rose to $650,000 a month. That wasn't her full-time job. This is $650,000 a month passive income. She's starting daycares. She's starting a residential drug treatment program, which I don't have data for because that hasn't been made public by the federal government, but you can imagine it's multiple times the $15 million that she got from just the mental health outpatient thing. so she left the country and she had AG office you know the AG office auditors they knew something was up they were looking into it but they didn stop her her house was on the market in Lewis Center as of like two weeks ago She leaving She liquidating her asset She leaving She could still be stopped. Nobody stopped her. She's got $15 million plus. She's leaving the country. And that's one of the risks of the fact that so many of these people are foreign. Virtually all the ones that I saw were foreign. They can just take off and leave with our millions. So you throw a rock on East Dublin-Granville Road and you'll find a story like this. So Governor DeWine's failures, some of it has been mentioned already. The GPS is extremely strange that you would get rid of that rule. I think that common sense should tell us that people who are 55 years old and claim they have back pain and everybody from the country of Bhutan, huge, huge percentages of the Bhutanese are claiming this, but nobody else, it doesn't make sense. I mean, this is common sense. so when my story started running the governor said there's nothing to see here this isn't fraud okay well you can call it what you want but I don't think you should be doing it I think you're going to bankrupt the state and he said well it couldn't be fraud anyway because we have electronic visit verification and as we've all seen since that is misleading at best he wanted to have it both ways and be able to say he had EVV without actually doing the EVV. It was completely meaningless. You guys paid $146 million for a contract to SanData. That's a lot of money. You can make an app nowadays with AI pretty cheaply. I've never heard of an app that costs $146 million. I understand SanData sells devices. Like instead of a phone, it's a physical device that could have whatever security you needed, some of which Representative Williams mentioned earlier. I don't know that they're using that. I do know that Ohio allowed, they paid for this one particular app, but then they allowed you to use your other app on a different app instead. And that negated the whole thing. Because I looked at the code. I do computer programming. The code, they let you submit arbitrary GPS coordinates. Any software can submit any GPS coordinate. So this whole thing was absurd. It was to tell people like you, don't worry, there's nothing to see here. We have software. But the scammers all know there's loopholes a mile wide in this thing. It's trivial to fake. And so you can close some of those loopholes. All the ideas we heard earlier sound good, but the problem is the scammers, there's so many of them, and they will quickly find the next loophole and the next and the next. Half of the clients turned off GPS after Governor DeWine inexplicably made it optional. And I think that says a lot right there. I think it's not unfair to infer that that may be an admission that half of these home health care visits are fake. So why is this in Northeast Columbus in particular? I asked one owner when there was almost nobody was in these buildings. They trick you. They lie. They have signs on the door that say we stepped out to lunch. Well, it's 4 p.m. or it's 10 a.m. or there's a pile of mail on the door showing that they haven't been there in months. These are the kind of people we're dealing with. They're manipulators. But I did find one business where somebody was there, and I said, well, why would you charge to take care of your own family members? I mean, your mom raises you when you're young, and when your mom gets up there in age, if you need to repay the favor by cooking or cleaning for her once in a while, that's human nature. That's what we've all done. It's something we should be proud of. It's something we should encourage, but it's not something you do simply because you get paid by the government. In fact, that's never happened throughout all of history. And his answer was, well, if the government will pay you, why wouldn't we do it? Which is reasonable enough I suppose but it not fulfilling a need At best it paying people for doing something that they would already do And by the way if they would not help their own mother unless they were paid I do not want to help that person. That person is essentially a bad person. Can you imagine? This is the kind of person we want to reward? When I knocked on the door of another home health care operator to get his thoughts on the tradeoffs here, that this has become very expensive. Way more people have claimed to need help at home than we ever imagined, and now the budget for Medicaid, spending on Medicaid has increased by $20 billion over the last decade. It's basically doubled, despite enrollment being essentially flat. How do we balance that? How do we keep Ohio solvent? And he said, and I quote, this is an exact quote, blah, blah, blah. Journalists, who cares? Do you pay my bills? I'll just tell everybody you're racist. So I can tell you he did not feel invested in Ohio. He doesn't care if the state goes bankrupt, and he knows how to manipulate the most gullible among us with fake claims of racism, who these people are so naive that they are tricked into thinking millionaires who hate them are sob stories. He had nothing but contempt and open... He articulated a plan to manipulate you to keep his millions of dollars going. I was simply following a database. I didn't know who was behind these doors. I was knocking on the doors of the people that got the money. But there's a reason he claimed it would be racist. Actually, he didn't claim it would be racist. He claimed he would tell people it was racist. And there's a difference. But they are all foreign, 99%. I mean, you can never say the word all, but essentially all. I'm talking 99%, and I can't speak to elsewhere in the state, but in northeast Columbus. and you can see this, you don't have to go to the buildings, you can look at the database that HHS released, you will almost never see a traditional American name. So it has somehow been extremely tightly intertwined with certain ethnic factions. And you can see this in the data from places like the Committee on Aging, that the percentages of people actually who are using these services as opposed to providing them is the same. It's a tiny sliver of a particular ethnicity, as Bhutanese and Somalian primarily, who are eating up massive portions of this program, which in itself is eating up massive portions of the state budget in terms of Medicaid as a whole. So what are the implications? Because we shouldn't beat around the bush. It very much is foreign people, almost entirely. The first is they're harder to track, and I saw that in my own research. You have a few common names like Mohammed, and their names are variations of that. The traditional mechanism of looking up somebody with an American name fails. It's harder to keep track of these people for auditors, investigators, people doing background checks. And maybe that's part of why they let those criminals that I mentioned start those companies. They also don't have birthdays oftentimes. It shows up as January 1st for a huge percentage of the Somalis in the government records because they say they don't know when they were born, so we just write down that it's January 1st. they also have the ability to send money abroad where we can't get it back and to flee the country if it comes to that. Traditionally, American criminals, who certainly exist, they have had a harder time getting away with it because they don't have all the advantages I just mentioned. Second, the fact that they are from insulated communities, oftentimes from clan-based cultures, they are unassimilated in America, which happened in part because there are such large numbers of them that they don't have to be assimilated. they have their own crews that roll These kickback schemes where you've got the doctors in on it. You've got the old ladies, if you want to call a 53-year-old old, who get the doctor's notes from the doctors. And you've got the people who run these businesses that will knock on the door and encourage you to sign up, tell you what to say, and send you to the doctor. And they know that nobody in these communities is going to tell. And they have translators who will show up, and if they're ever talking to a government person or talking to a doctor that maybe isn't doing on it, they have a translator that pretends to speak for the old person, and the translator doesn't have to actually translate what the person is saying. They know the magic words to make the government people go away. So I know this is a lot of information. It just scratches the surface of what I found, but I appreciate the work. I know that it's hard. This is the hard work of oversight is doing what you guys are doing and really getting into the weeds. Because any time you insert a loophole, because it seems like it's addressing some edge case, like lack of internet, they instantly will exploit that loophole and suddenly you're back where you started. So that's a summary of the facts that I found. I do also have some thoughts on proposed reforms, if there's any interest in hearing that. But I'd be honored if there's any, and happy to answer any questions either on my facts or ideas for fixing this, if anyone has questions. Thank you so much. I'll leave my questions to the end, but this is quite informative. So thank you. Representative Simani.

I do ask, Representative, that you show proper decorum to our witness. Thank you.

We are when you look at the numbers of people that are in Ohio the white population versus people of color you implying that most of the fraud is happening in communities of color I not implying it I stating it

Just please, through the chair, with your back and forth.

Your question doesn't even make sense. I mean, you're acting like it's either or through the chair. Of course, it is true what you said. There are these minimal statements. That does not imply that there was not additional fraud, which they failed to detect. They very much did fail to detect that. You mentioned the AG. Well, the AG also told this committee months ago that Ohio law caps Medicaid fraud as a low-level felony. So you could steal $15 million from a person. You're going to jail for a long time. you steal $15 million from Medicaid under Ohio law, it's not even possible to prosecute it as a high-level felony. You can also see how these exist, the discretion of prosecutors in jurisdictions like Franklin County, how they plead it down. There is a guy named Ali Uconte, one of the most recent Medicaid fraud prosecutions. What did Franklin County do? They let him plead down to a misdemeanor, and then they expunged his record. And as a result, then the Ohio Nursing Board lets him keep his license, and he's still out there, and he's able to do this again. There is very little chance of getting caught doing Medicaid fraud, and in the tiny chance that you do get caught, there is very little consequence. People need to go to jail to send a deterrent here, and there has been far too little of that. If you look at the prosecutions from the AG's office, they are piddly. They are low-level stuff, and you have to get at the head of the monster. These are millionaires. They're often tax cheats. If you want people to pay taxes, you should not like these home health operators, many of whom have tax debts to the federal government or to Ohio. They're getting their money from taxpayer money, and they don't even pay into the system. And our government continues paying them, people with active tax liens. So it's very bizarre, and, you know, I think that you look at the audits. They will catch people billing for doing home health care at the same time that the person was also in the hospital, billing Medicaid as an inpatient or at adult daycare. And the home health care operators will fill out these detailed reports. I went to their house. They were wearing a purple shirt. I turned them to their left. We talked about sports. All that was made up. The person was in the hospital, and they were caught. You know what happens when you get caught? Nothing. You only have to pay back money for the visits where the person was proven not to have been there. But they continue to believe your story. All the other times you said you went to their house, and they were wearing a purple shirt, and you turned them over. They just assume all that's true. And so this is, I mean, to walk out of the hearing, we need people who are actually dedicated to, this is the biggest, this is half of Ohio's budget and they can't even stay for the hearing? I mean, this is a big deal. We're going to go bankrupt if we don't fix this. And unless there's some plague that I've never heard of, there's no reason why so many people who are in their 50s suddenly need people to come to their house. Thank you. Representative Baker.

100%. So first of all, I've heard the same thing. Through the chair, both of you, please. Thank you. Yeah, through the chair. It is hard because when we hear from people, we're typically hearing from good people, people that are involved in society that play by the rules. and they have these experiences that it's difficult because they play by the rules and when they encounter a problem they come to their elected representative. We're dealing with a whole different ballgame. We're dealing with people that live in a parallel society. They don't speak English. They don't play by our rules. They don't even interact with anybody that speaks English and they have their own doctors who are absolutely the head of this monster. And I don't think we should even bother going after the low-level people because we don't have time. And I haven't seen many prosecutions from the AG's office of the people at the top. The doctors are absolutely in on this, and one of the things the committee can do is publish data of doctors who have signed the most forms, and that doesn't prove that none of those people actually are sick, but if you have a doctor who claims to have seen 100 people a day and that they're all sick, that indicates that that doctor needs, we need to look into that doctor further. I have some real, I think that the, if we are going to have a government program that pays people to go to people's homes. The doctors need to be government employees. I want to deprivatize some of this. I want to have more government employees, less private actors. We cannot have people going to private doctors and doctor shop until they find one that has a different standard of what it means to be sick. Veterans go to the Department of Veterans Affairs and they see somebody who works for the Veterans Department. And Social Security Disability, same thing. There may be only a couple offices in the state. You may have to drive a couple hours at one time to get your initial disability determination. But we want this to be a fair, equally administered program that provides one standard for what it means to be disabled. And it's likely that the people who are contacting you are going to doctors that are fair and don't want to waste money. There are other doctors who don't feel like they have skin in the game. That's the most charitable way to put it, is what do they care? It doesn't take anything out of their pocket. if they give in to the pressure and they say that everybody is disabled. So I would strongly urge this committee to kick everyone off this program at a minimum, restart it with doctors that work for the state, have several doctors who are the only people who can approve this, and they're applying the same standard to everybody. You have to go to them to get that initial determination. The number of hours should not be able to be modified later by case managers, and there should be basically, you know, probably even a quota for the number of people that the doctors can say are disabled in a given year that would force the prioritization of the most severe cases so that if you do have suddenly a massive number of people who all claim to have memory loss or back pain, we make sure that we're prioritizing the people with these really rare and terribly sad and debilitating illnesses.

The issue is that a waiver is given to the state. A waiver is an agreement between the state and the federal government to do something that isn't a core function of Medicaid. Most states do not have, I don't know the exact number of states that have waivers that include personal services, but I can say that most states do not have active in large personal services programs. And so it's not that there is a lot of states out there that do this but have a better job of policing fraud. They just don't allow you to bill the government for hanging out with your own family. We're talking about California, New York, Massachusetts, Missouri, and then Ohio. Those are the big states that do personal services. And so I would strongly encourage the state at this point to terminate the waiver, to pass a law that requires the governor to terminate immediately that personal services waiver. This would restore parity with the bulk of states. There's not really any reason why Ohio should be paying for something that, which Ohio is not paying for, 70% of it is from the feds, but it makes sense to just take Ohio back to what most states are doing. Now, we're only talking about Medicaid here, so if you're on Medicare, you would still have, potentially, depending on what your plan covers, the ability to have a non-medical staff come. We're also only talking about personal services. So if you're on Medicaid, you still would have a nurse come to your house if you had a medical illness. But we can't pay your mom, we can't pay your daughter or whoever to vacuum your house. I don't think that's a terribly radical position because it is just restoring Ohio to be the same as, you know, most other similarly situated states. So that's my recommendation, is terminate the waiver. I think that it would be easy to say that you will crack down on fraud, but ultimately I think it would be pretty meaningless. They're just going to find the next set of loopholes to jump through. I think that also the distinction between fraud and waste, these are certainly two separate words, but in this program they start to blend together, and the distinction I think is not all that terribly important because we shouldn't be paying for either. I think you have a program that at best is full of waste, where we're paying people to cook and clean for their own mother when they would do that anyway. And at worst, you are paying criminal masterminds who are sending the money abroad. I think that no state can afford to provide to pay people to hang out with their own family. This is the kind of thing that destroys the government. I mean, we just can't do it. It's not possible. so yeah I think that this is not a radical position I think the legislature should be wary of authorizing any program where if there was fraud it would be difficult to prove and that's what you hear by the pro-fraud lobbyists including the woman that left these are people that say well you can't prove that such and such was not at his cousin's house a year ago on Tuesday at 2pm that's true you can't Why should we have a program where they can bill for saying, I was at my cousin's house last Tuesday at 2 p.m., It's impossible to prove whether they were there or not. I think the government should never have a billion-dollar program where fraud does occur, but when it does occur, we can't always prove it, and proving it would involve following people around, doing cameras, doing crazy stuff that nobody's going to do for $28 an hour. It's just not possible to enforce. It's not possible to administer in a way that isn't going to be eventually subsumed by fraud, and it may be that this worked 20 years ago because we had people that are less willing to lie and manipulate and try to bankrupt our country. But that's not the situation that Columbus is in now due to decisions that various people have made. And I do want to reiterate, because I saw it again and again in my research, a lot of these people do not pay their taxes. They have $10 million in income, $32 million in income, $1 million a month, and they have tax liens. In my opinion, some of these people are trying to destroy Ohio and trying to destroy America. They are doing this maliciously. They're rubbing it in your face. They're not trying to hide it. When they don't have enforcement actions taken against them, it makes them feel, look how stupid these Americans are. They didn't even catch me. I couldn't be more blatant. I don't know how you get $10 million from the taxpayer and you don't pay your own taxes as just a portion of that income, and I see it again and again. And it just speaks to how lawless this entire system has been, that the Ohio Department of Medicaid has paid these people without even checking that kind of thing. I do not believe it can be reformed. I do not believe that the same bureaucrats who oversaw this, and even the people at the top change, it's mostly going to be the same people doing the day-to-day jobs. I do not believe that the people who thought it was a good idea to take away GPS verification, the people who couldn't figure out what I figured out in two weeks, and if anybody can quibble with my facts there, I welcome anybody to go try to disprove the people. I mentioned their names. Go look it up. They're criminals, and they got the record. They opened the companies afterwards, and nobody stopped them. Talk to them yourself. See if they threaten your family, too. These are not sympathetic characters. All the levels of government failed, and I do not believe it'll be possible to rearrange the deck chairs on the Titanic to make this work. So I would just say it's not a radical position to terminate the personal services waiver. Ohio will be just fine, and it'll just be the same as most other states are.

to find the things that I found for free. I think that throwing money at the, I think that losing millions of dollars to scammers and then paying millions of dollars to consultants to fix it is not the problem here. is kind of like driving your car down the road and turning on the heat, and then it gets hot, so you also turn on the air conditioning, and you keep going, but it doesn't make any sense. Maybe just turn them both off. I think that, obviously, there are ways to mitigate if you want to try to do oversight and create more committees. I think at the end of the day, the people running this program are the Ohio Department of Medicaid. You don't want to chase the money. You don't want to pay it and then chase it. You don't want to pay it at all if it shouldn't be going to those people, and anything the AG is doing is really on the back end. The auditor inherently doesn't have the ability to go after these people. So it's not my place to tell you how to organize your committees, but I'm skeptical. I think that at a minimum, if for some reason you guys can't get rid of this program, you should report to the public, disclose data. You can never go wrong with transparency. We should know the number of people who are qualifying for home health care based on their medical condition. So what is it? Is it old age? Is it, you know, are they amputees? They don't have any limbs. Is it they have fatigue? Do they have migraines? What is the diagnosis? Because we know that in states like Minnesota, but also states like South Carolina, when there becomes an incentive to have an autistic child, the number of autistic children increases 100-fold or more. It's remarkable. And so we need to be able to track that. We can't expect to see some increase in the number of old people that need help because of baby boomers. But that's not in any way what we're talking about here. It's orders of magnitude different, the increases that we've had. But we don't even know how that's broken down. I mean, what are they actually claiming? Because some of them very much are in their 50s, and they're doing this thing that was supposed to be for nursing homes. So we need to publish the condition that led to the eligibility for home health care, how many hours they received. We need to know their ethnicity. We need to know their county. and ideally we need to know this can be a separate data table but the doctors that approved it and obviously if the data will be suppressed if there's any risk of disclosing the identities of making specific individuals identifiable but these are broad buckets that we deserve to know so that we can see oh well you guys tried to close some of the holes but you preserved an exemption for say ALS something that really is very legitimate and tugs at our heartstrings Well, then we can know, well, the next year, what do you know? There was an epidemic of ALS or, you know, polio made a comeback, and suddenly 1,000 people have polio. We need to be able to track that kind of thing because the whole thing right now is a total black box, and it's just not sustainable. I mean, you guys know this better than anybody. The dollars just don't work. We can't afford to keep doing things the way we've been doing things. Thank you.

Representative Ferguson. No?

No.

Thank you. So I want to go back to your proposal that we stop the program. So right now we have 112,000 Ohioans using home care. I'm assuming by personal services waiver you're talking about the home and community-based waiver? So when I speak about personal services, the distinction is that these are not people with nursing degrees and they're not performing medical tasks. They're doing cooking and cleaning and companionship and conversation. Okay, through the chair. So you want to stop all aid services to those 112,000 people? I'm not sure if the 112 refers to nurses as well who visit the homes or just the non-medical. But, yes, I would advocate at this point for stopping any non-medical providers from being paid by the government to hang out with their own family or to go to private clients and provide cooking and cleaning and so on.

So one more follow-up. So when we look at the cost of providing services, the whole idea with this home care waiver was that if we can bring people into their home and a few things. One, it would save money. It's much more expensive to send people to long-term care facilities. But two, the dignity of life and being able to live and grow old in your home. Do you think that there is a more scalpel approach to this versus kick everybody off that we've thought because there's some doctors in some places that are overdoing this? or do we look specifically at the doctors that we're worried about, at the folks that we're worried about, versus closing the whole program?

Thank you. So the home care waiver is zero to 59, I think, right? So I misspoke, not aging at home, but living at home. So I work with a lot of children with medical complexity who are trached, are vented, would much rather live their childhood at home with home health care than living in a facility. So I think we need to be careful that we are continuing to provide important care to people who need it and that we can do both. We can look at people committing fraud, and we can make sure that we are sustaining good care for people who need it to live in their homes. But if I might ask, would you be willing to limit the medical conditions that resulted in home health to a certain enumerated and narrow list of medical conditions, like being on a vent, like being an amputee or things like that? Through the chair.

that are doing vacuuming and meal prep and companionship and changing addressing for a central line. The people in the personal care services are typically not licensed, and this is the distinction between those two. Lastly, sir, and finally, have you seen a hesitation in providers or the communities at large? Because we haven't heard a lot, but I think that I'm hearing under a rumbling, a low-level rumbling of people afraid to report fraud to the state because they are in such isolated communities. They know each other so well that they have been afraid to report. Do you know anything about that, and can you talk to that at all, about fear in reporting and why perhaps partially we are in this situation when communities have known this is going on, but we are just now finding out?

Thank you so much.

yes ma'am yes ma'am you may and please tell us your name and where you live and um and if we could all right and um if you could um keep it to five minutes would that be okay all right thank you so

Thank you.

Thank you. So committee, are there any questions for the witness?

I don't have any family that can pay for services for me. I don't have family that could pay private caregivers to come into my home. My life would be over. I'd have to lose my apartment. I'd have to lose everything that I work for because I wouldn't be able to have a job. I would have to go into an institution. And like I said, I would rather die. So it's either suicide or go to live in an institution. And I don't know. Suicide looks a lot better because I been in one of them It horrible I was on the governor appointed task force to look at nursing home reform and I was able to suggest some changes to our nursing homes but they will never, ever be better than living in your own place, having people that you either know or are paid to provide services that are better than being in a nursing facility. So it would be over. My life would be over. I wouldn't be able to work. I would lose everything. Everything. Thank you for your question.

Thank you, Tierra, and thank you for telling us your story, and please know that I think the majority of us understand that and understand the benefits of the program, and I hope that we can work together to figure out a way to reduce fraud, which would give more resources to folks that really need it, but make sure that we don't take those resources away while we figure it out. Thank you. Absolutely. Thank you.

Representative Craig. Thank you so much for coming forward and speaking. It's great to hear from you, and thank you for coming to the committee. Not everyone clearly does that, so thank you. I do want to point out, I mean, I share some of the sentiments from our ranking member. 49 states do have home community-based waivers for their developmental disabilities population. And I think that's what we have to be very mindful of moving forward with any types of these reforms is making sure that we are, to the chair's comments earlier, taking care of those that can't take care of themselves. So again, just appreciate you being here. Thank you.

And it's not, I just want to thank you so much for your comment. I just, it's not just people with developmental disabilities, because that cutoff for being on one of those waivers is at age 22. And if you can't prove that you've had a disability, you know, 22 or under, then you can't get on one of those waivers. So that's why the other nursing home level of care waivers are available for people that maybe have, you know, gotten a disability later in their life or they're aging into disability. But again the level of care needs it not just somebody like you couldn represent a chair gross You couldn just sit in a wheelchair and then call up the area agency on aging tomorrow and say I want a waiver and then be granted one. It's it there there's a lot more regulation around it than that. So please just open up your hearts, your minds, and listen to multiple sides as you consider this daunting, very hard task that is before all of you. And I represent, I mean, I understand that there's fraud, waste, and abuse in the system, but just please keep an open mind about things. Thank you.

Thank you, Chair. Thank you for coming in. Thank you for your story. And I appreciate the ranking member and Representative Craig's comments and reiterate those. So I will kind of ask you the same question that I was asking others. You know, what would you do, and you understand it better than a lot of us, the system, what would you suggest be done from the legislative side of things that we can make sure that people aren't taking advantage of the programs because clearly there's folks who desperately need them? What would you suggest that we would do that would say, okay, that should keep some things from happening?

If I may follow up.

I will just say thank you very much, and you're probably correct. I'm sure we'll have some more conversations.

Thank you.

Representative Ferguson. Thank you, Chair. I just want to make a comment, and I think that we're – well, I know. I've heard what people have said. We're in agreement. We're trying to tackle fraud, waste, and abuse, and just as you pointed out, you get 56 hours a week. I sense that you would like to get more than 56 hours a week. one of the things standing in the way of giving you 60, 65, or 70 hours a week is people that are abusing the systems. And so that's what we want to do is we want to make sure that we get in there and we address it. But everything that you've testified to, I really appreciate you coming in.

other questions for the witness? With no further business to come before the committee, the House Medicaid Committee stands adjourned.