Ohio House Medicaid Committee - 6-2-2026

I pledge allegiance to the flag of the United States of America and to the republic for which it stands, one nation, under God, indivisible, with liberty and justice for all.

Ranking Member Baker.

Representative Dieter. Here.

Representative Hall. Representative Lampton.

Here. Representative Mullins.

Representative Romer. Representative Samani

Representative Timms and Representative Williams

Chairman Gross, record members and members of the Health and I Game Committee, Thank you very much for the opportunity to testify to strengthen Ohio's Medicaid funding system so that we could prevent fraud. I have testimony written, and I'm going to follow it as much as I can, given that we have five minutes. But I want to stress that Medicaid is really meant for vulnerable Ohioans. Every dollar spent that is stolen from people that really need it in the state of Ohio it an elderly person disabled kids with autism So it doesn just merely try and steal tax dollars it actually destroying public trust and monies that we need for people in Ohio our most vulnerable. I'm testifying because I have spent several months investigating as a taxpayer, an attorney, an Ohioan, I also work with the Daily Signal now, on Ohio fraud. Whistleblowers back in December came to me and shared that they had gone to several legislators, several offices, and the Attorney General's office because there was massive fraud in the state of Ohio. They specifically asked the Attorney General's office to please not share their names, but they wanted to share all the information because they feared to be stoned to death within that community. They identified the Somalian, Nepalese, and Bhutanese community where this fraud was occurring, and primarily there's a language barrier. Many individuals don't speak English, so they seek out certain providers that have either a common background or can speak multiple languages. I was told that individuals would sometimes, seeking home health care services, would not only be coached by home health care providers, but in many cases the applicant was actually accompanied by a home health care provider that would speak for them in terms of ailments. These providers conducted MRIs, CT scans, and then declined to actually allow for approvals because their medical need was not substantiated. Thereafter, these providers were threatened, verbally told that we are going to go back to our old provider that stamped this paperwork for us, and some health care services, one of them in particular, actually said, I'll make it worth your while, which sounds like a kickback. I provided all of this information to the Ohio Department of Medicaid, all of the providers that are potentially engaging in fraud, in addition to even the home health cares that are complicit in this, and asked them to do an investigation. I also went to the attorney general's office. They specifically first asked for the names of the whistleblowers, which I wouldn't give them attorney-client privilege. I represent them now, and they cannot protect them. They continued to push saying that they would subpoena me, and I told them they had all the information needed. But this is the type of cover-up when you're unwilling to actually work with somebody who's providing information, detailed summaries, explaining how the fraud and corruption works. At the Department of Medicaid, I spoke to several people there on a phone call and specifically said all you have to do in addition to auditing, start with anybody who closes their program starting in December. That will tell you, because they're moving to Pennsylvania, I'm not asking you to track the fraud to Pennsylvania, but if you actually stop and audit just anybody closing, that will show you fraud because their biggest concern was racism. Well, fraud is not the cost of doing business, and it's certainly not racist to look into allegations and to make sure fraud isn't occurring. During my recent visits in months, We had one home care health center that had 34 providers in there. Many people weren't even present. One or two people that we were able to speak to didn't even speak English. They didn't know how to actually explain what home health care services were. They would call somebody else, and they'd tell me to come back. On my fourth visit, three men cornered me and stated that this was, that they do not want to provide home health care services to me, which is fine, but continue to intimidate and call this racist when all we're doing is asking basic questions in our state. I have outlined a lot of potential opportunities for us to strengthen, but one of the biggest things the governor executive order does not do is if you stop new home health care services that great But what about the ones that are already existing What about auditing those And the fact that we haven done that is shocking to me There are places where individuals are billing. So an individual could come in and make $75,000 at a home health care provider. You add a parent. You add, let's just say, my parents in addition to my husband's parents. Now you're making close to $250 to a half a million dollars. Those all should be flagged within the system. We also need to inquire independent, verified medical necessity. And there's two options here. The General Assembly could actually create doctors that are approved to provide, that are approved to look at home health care services and patients. So that way you have an approved system of doctors that you have verified on a list. They need to apply. They need to be verified. They need to be in good medical standing with the board. Those are opportunities for us to strengthen this. The other way to strengthen this is also to make sure that we have an assessor that's independent, that's not tied to any agency, that's actually verifying the recipient's limited functions, the medical necessity, the hours. Also, we need unannounced site visits. I guarantee you if people had visited from the Department of Medicaid the number of times I went to these facilities, you would have known that there was something wrong. The Attorney General's office had letters underneath the door, several other mail that just wasn't opened. It's a completely vacant building. There are hundreds of these. In addition, I think we need to also look at shell company patterns. Ohio should implement automated analytics to help with shared addresses, phone numbers, e-mails, bank accounts, ownership, duplicate overlapping of business registrations. This is something that has occurred over and over again where you have one person that can own up to 50 to 60 home health care and make millions. My biggest issue right now is the Department of Medicaid, through a public records request, has refused to give us how much we're spending on home health care systems. After five months, their response to me, our tax dollars, their response was, please go talk to our vendor. That's unacceptable in the state. You made me wait five months to tell me that our tax dollars are sitting at a vendor, and we think that's okay. There needs to be a transparency checkbook for Medicaid. Every single dollar, we don't need patients' names, but every single dollar that we have going out that are our tax dollars, we want that transparency. We want that audit for everybody. It doesn't matter who the home health care service is. And lastly, I'll just tell you, whistleblowers need protection. They shouldn't have to come to attorneys like me. And yes, I did this pro bono because I believe them and I believe this work warranted a lot more from Ohioans and a lot more from our leaders. We need whistleblower protections. And if you look at the crime, I know that we are strengthening the penalties under current law. Medicaid fraud is involved. Less than $1,000 is treated as a misdemeanor. I know you're looking at penalties, but I support the idea of also using Medicaid fraud as a predicate offense under the Ohio's engaging in a pattern of corrupt activity. That way you have another way that we can bring law enforcement and the U.S. Attorney's Office in terms of enforcing our law. I think it's weak right now, and that's another area for strength. I'm happy to answer any questions. Thank you for the opportunity to testify.

Thank you so much. I appreciate you being here. One of the things that I've looked at is the number of patients that are approved by doctors. Do you think that it would be effective if we had some sort of tracking mechanism that would say these doctors approved something at 500 or 1 percent of the average versus these doctors who might do one or two approvals for home health care patients on a yearly basis?

Thank you, Chair, and thank you for being here today and for your testimony. I have a question about the complaints that you received before you represented the client. Did you reach out to the Attorney General's office? And if so, did you ask your... I can hear you. Okay. Houston, we have landed. So I ask this question because the last time we had a hearing, the Medicaid fraud unit section came and they talked to us about how many cases they had open and how they were working at this and that these units exist in every single state under federal statute.

Follow-up? Yes, please. Thank you, Chair. It seems odd based on what you're saying and how typical whistleblower complaints go. I will say that. I will move on to the next question.

I'm asking the questions. So my next question is, you mentioned that you decided to pop up at a site on your own, I'm assuming wearing your journalism hat or your investigator hat, I'm not sure which hat. But you showed up to investigate a home health care agency, so a patient's home. Where did you pop up at? I'm confused. You said that you did like a surprise visit to investigate and you encountered someone who did not speak English. That is what you just said. So I'm asking where was this? Where did it occur?

I think that was two are there any other questions for the committee yes Rep Let

Representative Gross, Representative Blatt, thank you for the question.

Follow-up? So, but you're, you are saying that there were one to two people there when you went.

Through the chair to the witness. So what you're saying is there's 34 individual provider companies, not offices where one home health provider is setting up their desk. Is that correct?

I just want to make sure that we are understanding what we're talking about here so that it's correct for the record. Thank you for clarifying. Thank you.

Thank you, Chair. Through the chair to the witness, my apologies for coming in late, first off, so I didn't catch everything I was trying to read as you were going through, but first let me just say that I work in healthcare in my day job, right, so I find fraud, waste, abuse, abhorrent in all its forms. So, again, appreciate the things that you've come to talk about today. My question was going to be you know, there's sort of the bucket and we talked about it in the last committee meeting around MFUQ. I can never say it right, but the unit that does the investigating from the AG's office. And I asked them in committee, I said, hey, do you have enough in the way of resources? And the answer was like, yeah, we have 900 cases, but I don't want to say no to more resources, but I think we all know he was trying to say, I need more resource. That's just one bucket. So my question, though, is you mentioned the site visits, and I think last count there's over 850 home health agencies in Ohio. I think it's closer to 1,000 now. I'm all for site visits. Like if I had my brother's date, all would have a site visit unannounced multiple times a year. My concern, though, and this is my question for you, is it doesn't appear, though, that either ODM or ODH are appropriately staffed to be able to carry out that level and that number of inspections. We all talk about fraud, waste, and abuse and how it's just a portable thing, but if we're not going to fund additional resources to root it out, I mean fund, I don't just mean saying let's require ODH to do 1,000 visits without giving them more manpower and more funding, sorry, womanpower too, by the way. What are your thoughts on the resource allocation to actually rooting out fraud waste? Do you have any suggestions or thoughts on that?

Thank you, Chair. Through the chair to the witness. I said one more follow-up question, which was, listen, you know, there was a famous nurse that once said that sunlight is the best disinfectant, right? So, but with regard to transparency, not but and, do you think that there's a role in AI to basically, you know, sort of go through? Because, I mean, you know, the data is, it's a ton of data, right? And so what are your thoughts around the use of AI to look for patterns in data with regard to detecting fraud, for example?

Yeah, so I have an address in here. It's 2700 East Dublin Granville Road. The nice thing is there's also a bank there if you need to do banking, but you could easily stroll in there. There are 34 empty individual home health care centers. A couple people have staffed in the past, and then also trucking companies with nobody in there. And I believe, if I'm not mistaken, that was the same building that billed almost $66 million to Ohio Medicaid. Yes, and this was flagged in December to office holders. I think it's a national embarrassment for me to have to go on live television and talk about our state like this. When you have Daily Wire coming in to actually talk about what we could have done together as a state, as a group of individuals, to correct this. Thank you so much.

Correct me.

Thanks for having me. Chair Gross, Vice Chair Barhorst, Ranking Member Baker, and members of the House Medicaid Committee, thank you for the opportunity to provide testimony today on behalf of the Ohio Council for Home Care and Hospice. My name is Lisa Von Linden, and I'm honored to represent Ohio's licensed home care agencies that serve thousands of elderly disabled Ohioans each day. I have submitted written testimony as well. This will be a modified lesser version. The Ohio Council supports many of the goals contained within House Bill 795 and appreciates the legislature's commitment to strengthening accountability, oversight and integrity within Ohio's Medicaid funded home and community based service system. Our agency providers operate within one of the most regulated health care environments in Ohio. Agencies provide nursing oversight, workforce supervision, competency validation, quality assurance, infection prevention, payroll compliance, incident reporting, backup staffing, and continuous readiness for state and federal review. It is important to recognize as not all home and community-based service providers operate under the same level of oversight. Ohio's HCBS system is generally comprised of three primary provider models, agency providers, independent providers, and self-directed care arrangements. The Ohio Council represents licensed and certified home care agencies and advocates on behalf of providers operating under comprehensive state and federal regulatory requirements. We support many of the substitute bill's program integrity provisions, including expanded EVV requirements, strengthened claim validation, enhanced provider recredentialing, impossible claim detection, fraud analytics, and increased transparency measures. We do, however, encourage a reasonable implementation timeline to ensure providers can successfully adapt systems, train staff, and manage patient transitions. We also encourage the legislature to ensure accountability standards are applied consistently across all Medicaid-funded care delivery models. Ohio has created parallel systems that operate under significantly different levels of supervision, accountability, and operational oversight. While self-directed and independent caregivers often provide valuable services, those models do not consistently require the same supervisory infrastructure, training, quality assurance, human resources support, and compliance oversight required by the license agencies. Our position is not that caregivers should lose the opportunity to provide care. In fact, Ohio desperately needs caregivers. Our position is that caregivers deserve stronger systems of support around them. Patients, families, and taxpayers deserve consistent accountability standards, regardless of who provides the services. We've also witnessed firsthand the challenges associated with Ohio's current oversight structure. Some agencies have gone years without receiving state surveys necessary to support payer credentialing and contract renewals. In one case, an agency had not received a survey in more than eight years. These delays create operational challenges for providers attempting to remain compliant and continue servicing patients. For that reason, the Ohio Council has developed the Accountable State Accreditation Program, ASAP, which would partner with nationally recognized accrediting organizations such as CHAP to assist Ohio in modernizing provider oversight and survey activities. However, we believe the cost of addressing these state oversight challenges should not be borne solely by the providers. State investments should accompany any statewide accreditation initiative. Finally, the Ohio Council supports six proposed amendments before the committee. These amendments do not weaken program integrity. They strengthen it by ensuring enforcement actions are based on evidence that providers have appropriate due process protections and that technology failures are not automatically treated as fraud. House Bill 795 represents an important opportunity to strengthen accountability, improve transparency, protects taxpayer dollars, and restore confidence in Ohio Medicaid home care system. We look forward to partnering with the legislature, state agencies, and stakeholders to move these reforms forward. Thank you for your time and consideration. I would be happy to answer any questions.

Through the chair to the representative. We love that idea. We've been attempting to position the Ohio Council as a safe zone for agencies that right now are questioning what's happening, how is this going to affect day-to-day business, what's the strategic move, what do we need to know. I believe our agency members want to follow the rules. They want to be good stewards of care. To your point, that's why they pay the money to be a part of the association, to be able to get immediate responses to what's happening or updates in regards to what's going on. I'm not sure exactly what that looks like, but when we developed the ASAP program and spoke with the leaders at CHAP, which is the Community Health Accreditation Partnership, we had talked a lot about being able to advertise that if an agency was willing to come into the association, perhaps they could get reduced costs for accreditation. Accreditation services through CHAP costs around $9,000 to $12,000, depending on the size of the agency. But from an oversight standpoint, being an owner-operator myself that has partnered with CHAP for my own agency, it is an incredibly thorough, I would call it, learning experience. They come in, they do site visits in the home, They review 10 to 15 employee charts to make sure that the background checks are being done, that licenses are up to date. They interview families, look at infection control. It's an investment, but I believe that it makes agencies better and more accountable. And to me, it's the ABCs of oversight. oversight. We have to have either Ohio Department of Health or someone coming out to ensure that we are doing business appropriately and providing the right

testify. I think your testimony is very important. It's an issue that we've been

Remind me what portion you'd like me to address.

Okay, so independent providers and self-directed caregivers are held under two different rules in the Ohio Administrative Code. Independent providers have less supervisory requirements than any agency provider ever does. It's very simple. The first three years an independent provider is providing service, they get an annual evaluation. And after that, it's every three years. They're allowed to keep the records in the home and the time slips in the home. The deficiencies are typically handled when they have a survey of sorts with no public findings and with no punitive sanctions of any sort. It's more like, let's educate. Let's see what we can do a little differently. Daily, they have no direct line of supervision. If an independent provider calls off sick or there's a problem like that, the patient has no way to go anyplace else. There's nowhere to call. There's no way to get additional help unless the individual has two or three or four independent providers that they can go on to the next and attempt to get help that way. And there's no direct oversight. So typically the patient's responsible to understand what the independent provider is doing, how well it's working or not, and moves on from there. This model works to some degree with medically fragile children where the parents can kind of get help so that they can go to work and things like that. That can be very helpful in that particular setting but there still an issue with how do you deal with EVV and timesheets and the 15 billing requirements things like that So an independent provider as one individual they have a really hard time having all of the tools that many of the agencies have that they need to run their businesses. So that's the IP portion. That's all about supervision, and you can find that in the administrative code under 5160-4506. that's one of the places you can find the independent provider supervision. Self-directed caregivers, that was the other question. Initially, in the first 12 to 24 months, they have a survey of sorts, and after that, it's every three years is how it's supposed to be. That doesn't mean that's what's working. Home Care Network is Medicare certified across all of our agencies, and we're supposed to be surveyed every three years, and I've got some agencies that haven't been surveyed for over six. So there's that. They keep the records in the patient's residence, typically noncompliance for any of the standards that Ohio has set out, and their rule, and their rules in 5160-4503.2, is typically handled as opportunities for improvement, some type of education. And the supervision is handled by the waiver participant, period. That's how supervision goes for self-directed caregivers. And there's a simple timesheet, and there's a low level of scrutiny. There's no EVV involved. It's very different. Who was the question from?

Thank you. I appreciate that oversight of, you know, when they're being surveyed and things. So my understanding is, you know, the agencies, they get ODH certification. But are the independents and the self-directed, are they getting that same type of certification?

What type of certifications are they are? What's the minimum requirements? You know, when I hear the self-directed and we're saying the patient gets to pick the provider and the money is essentially funneled through the patient. In those instances, if grandmother is having their daughter take care of them, I don't think they're going to report it when granddaughter doesn't show up to work, but they're still going to bill it. I don't think they're going to turn their own daughter or granddaughter over for fraud. But when an agency fails to show up, that patient who is expecting to get care from you guys that day, they have someone to call. They're going to report you for not showing up, and if they see that there's a bill that comes through where you were supposed to be providing services, you're going to get flagged for it. So can you just talk about, like, the requirements of licensure? Are they ODH certified, like the agencies, or what type of certifications do they have to have, the independence and the self-directed?

Thank you. Representative Baker.

Sorry, Ranking Member Baker.

Through the chair to the representative. Great question. As she was testifying, I was thinking to myself, you know, primary care physicians that have a very large aging population are inherently going to have more of their patients receiving Medicaid services. Same with DD. So when I look at utilizing AI or some type of technology to be able to cycle through and pick out trends, my ask would be that there's a subcommittee developed to be able to analyze those trends appropriately. And then as we make the choices to investigate, let's go ahead and give the agency some time to be able to talk about why these trends are showing up. We're all for that level of oversight. We're okay with technology coming in, scrubbing things, looking at trends, identifying potential issues. But before we go to stop payment, stop services, let clients know that this agency is on hold, let's actually have a conversation with the agency and see if there's any logical reasons as to why these trends are flagging.

Through the chair to the representative, I believe a reasonable timeline would be somewhere between 6 and 12 months. If we are given the proper tools to prepare our agencies, certainly I believe that we could get there, and everybody is extremely motivated to get there, especially the agencies that are performing above board. I would only caution that we've had several issues with our vendor EVV over the years, that of which you have heard about in the past, and I would just ask that we ensure that Medicaid has their EVV vendor, Sandata, working properly so that we can go ahead and meet these timelines.

The ODH was largely responsible to do on-site visits, and I've heard from you as well as your colleague who will be up here shortly that those should have been done within the first year. My understanding is that these agencies, when doors were knocked on, there was no one there. So in your humble opinion, what do you believe has happened that they slipped through with no or did they get inspections?

I believe you referenced independent providers on the first portion of the question, but then referenced offices maybe being unmanned. An independent provider would not have an office. They would not report to an office. That's part of what we're talking about, right? The agencies that do have physical offices, by law, we are required to have an office with our hours, with our contact information, and a sign on the door. And whatever our signage says, we should be adherent to. So case in point, if my offices are open from Monday, Wednesday, and Friday from 9 o'clock until 3 o'clock, I have to have somebody in that office. because although we are home health providers and we are deployed out into the field, we do still have the opportunity to be able to have people coming in off the street asking questions and whatnot. I can't speak to what happened with the independent providers or how often they're being certified or audited, but what I will say is that when we had a meeting with the Ohio Department of Health several months ago to talk about some of the issues that we're having with revalidation and agencies being able to recredential with payers and continue doing business. We were told that complaint surveys will rise to the top and that they will get to the annual surveys when they can. And that, quite frankly, is why we're kind of taking the stance and saying, well, okay, then somebody has to come in and provide that audit and that oversight. We are opening our doors. Come on in. Look at what we're doing because we are doing the right things. And we're proud of what we do. We love serving Ohioans in their home. So I hope that answered your question.

Chair, the average agency is staffed. Definitely staffing has gone down significantly since the pandemic. The ability to allow your employees to work from home has become very popular. And quite honestly, we're also able to recruit top talent all over the state and even sometimes outside of the state for some of our critical key roles. However, we do still have agencies. We do still have offices. And we are still required to state our hours. and if our hours are from 1 to 4, somebody needs to be in the office between 1 and 4.

Good evening, Chair Gross and Vice Chair Barhorst and members of the Ohio House Medicaid Committee. The question I'm here to address is, how can Ohio operationalize House Bill 795 by identifying known and emerging Medicaid fraudsters before they take millions of dollars for the people who need it most? And how can AI, artificial intelligence, when used strategically, securely, and with proper human oversight, deliver both a return on investment and a return on purpose for this program? There is a visual aid in front of you. I will try to prompt you when to go to the next slide. So, next slide. these projects have included working with Department of Homeland Security, the Internal Revenue Service, the Department of Defense, and counties, cities, and townships throughout Ohio. They've ranged from pilot programs to full-scale implementations to training stakeholders on where AI can be used strategically, how to use it, and how to govern it effectively. So while Medicaid fraud is unique, the underlying challenge is familiar. How do you uncover meaningful patterns hidden within massive amounts of data and get the right information to the right people quickly and securely so they can take action? Next slide, please. So let's say we have Ohio Medicaid data claims data, and we want to compare it against known fraud indicators. If investigators need additional context, agentic AI can help connect information across agencies as needed. So for example, Medicaid data may raise a question, while tax records, business registrations, or licensing data may help answer it. Instead of spending weeks searching for connections, investigators can focus on evaluating the most promising leads. So today investigators often work with enormous amounts of information manually. This is where machine learning AI, so machine learning AI, can rapidly identify patterns. For example, billing codes that suddenly increase by 1500% in a single year. Or a provider operating from a neighborhood home that also has a second business registered that's already generating hundreds of thousands of dollars while billing hundreds of thousands through Medicaid. Separate businesses, but the data can overlay. Or a chain of businesses, a network opened by relatives that appear separate on paper but moves money through the same networks. AI does not determine guilt It identifies where human investigators should focus their attention So once potential fraudsters are identified generative AI can automatically create reports tailored to different audiences. So investigators may need detailed reports. Leadership may need financial exposure information. This committee and the public may need simply just trends and outcomes. The same information can be presented to each audience while maintaining compliance and security requirements. Now, I want to be very clear. AI should not replace investigators. It cannot. AI should augment investigators. The goal is to prioritize where human judgment is needed most. As investigators review findings, the system learns from those decisions. False positives can be reduced. New fraud patterns can be identified more quickly. And the result is a system that becomes more effective over time while keeping people responsible for every meaningful decision. AI technology alone is not enough. helping people learn how to use AI effectively and govern it well is just as important. So success requires the right people, process, data, technology, and governance. And that is why if the state chooses to use AI to support Medicaid fraud prevention, a phased approach is recommended. So we started with this question, how can Ohio operationalize HB 795 by identifying known and emerging Medicaid fraudsters before they take millions of dollars from the people that need it most? So AI-powered Medicaid fraud prevention can help investigators focus on the cases that matter most so the state can fulfill a key part of its purpose, ensuring the right resources reach the right people at the right time and not fraudsters. AI done right can identify suspicious patterns known and emerging. Two, getting the right information to the right people at the right time so they can act. And three, maintaining human oversight and governance. So AI is not a silver bullet. But when you strategically, securely, and with the proper human oversight, it can be a powerful tool in the fight against fraud. Thank you.

Thank you. Are we good? I wasn't sure. Through the chair.

Thank you. Follow-up? Thank you so much.

Thank you, Chair, and thank you for being here today. You sort of touched on the answer to my question at the end there. You talked about the proper human oversight being a powerful tool. When you're talking about these types of programs, what does proper human oversight look like?

Thank you. No follow-up.

Representative Mullins. Thank you but I think my question has been answered two or three times Thank you And vice ranking member Baker Thank you Chair Thank you for being here

So from the Chair to the Representative, we have not used AI in other states for Medicaid fraud. This is much more an emerging issue. However, we have used AI for fraud detection and finding bad actors in other ways. So, for example, Department of Homeland Security and the Department of Defense and the Internal Revenue Service, where those were like counterinsurgency, counterterrorism, or even financial fraud or cyber threat defense. So very similarly, bad actors either will follow common patterns, and you can find those patterns, or they specifically try to get around those patterns. Those are called asymmetric patterns. You can almost measure where they try to disrupt the patterns and use those to actually find the more and more difficult fraudsters. So even though, again, Medicaid has its own specific elements of it, we also personally, we believe that the folks that are defrauding Medicaid are domestic terrorists. And they follow kind of similar patterns in some ways, too. And so taking from those other high-stakes challenges use cases, applying that knowledge specifically to Ohio's Medicaid fraud.

question, are you talking about how you protect data around those things? Could you clarify?

Thank you. From the chair to the representative, yes. So making sure things like HIPAA compliance or if there is also any law enforcement data that's involved with this, CIGES compliance is a really important part of this. There are ways to anonymize the data. That's one way to do it. Another way is to make sure you have a fully secure platform that meets all of the security and compliance requirements so that you can reference that particular information and making sure you have that in place. Make sure that only the people that are allowed to have access to that information have that. One part talking about the reporting side of things. So being able to use generative AI to provide a level of detail to investigators. An investigator probably needs to know everything. Someone who's on this committee does not need to know someone's social security number or particular health challenge, right? But they might need to know the overarching trends involved with that process. So you can actually use AI to redact that and make sure that there security and compliance in place and make sure that the data is processed in a place that has a security and compliance inherently as part of it Follow up Thank you very much Vice Chair Barhorst Thank you Chair Through the Chair to the witness thank you for your testimony today

Just curious, your presentation was intriguing to me, and could you just share with the committee your experience, the qualifications to advise and or consult on these medical fraud prevention issues, kind of where do you come from and what's your past experience in this arena per se? From the chair to the representative, sure, happy to. So as I mentioned, from the Department of

Follow-up? Yes, please. So basically, we've got to flag it, then we've got to be able to use it and make it accountable to whoever's going to enforce this, right, so that we can design a system that can have a two- and three-step process, or where does it start and where does it end, per se if we go down this road?

Maybe some of it we've got to look at the state tax records or the business registrations or the license information, run that over the data and find some of those unique patterns. Then let's look at who actually needs to have access to what type of information, what level of security or compliance, what level of detail do they need, what questions they actually need answered, and how can that system then either automatically generate those reports and send it to those right people so they can make decisions. The key, though, is always making sure that, again, you have that subject matter experts, and you're also training people along the way. I find a lot of people are still wondering, what is AI? I'm trying to understand it. This is a really good way to help those who are doing the auditing or those who are in these industries to actually understand how AI can help and also what it cannot do. That is just as important through this process so that humans preserve their judgment and AI can focus on what it helps in the best way Thank you Thank you Representative Hall Thank you Chair Through the Chair to the Witness thanks for being here today

That's a very good question. How do we measure to make sure the return on investment is worth the process, right? So I have with me actually our CEO, Steve Dong, who would be, I think, an expert on this part, especially when it's, you know, AI is kind of new. It's how do you make sure that the value is there while also the costs are covered. Steve, would you mind? joining us.

To the chair, to the representative. We hone into a phase one of our factor. It's somewhere between three to six months. Three months if all the pieces are together. Our modelings are extremely advanced. We build data lake on orchestrating layer. and those models are already there to use, so we don't have the stuff from the scratch. Our main thing is called bringing the data into the lake, the data lake. And basically, for layman terms, we build lake house on the lake, and then the lake house would govern the lake. We do not allow any junk data coming into the data lake. We only allow orchestrated data based on our data scientific and engineers and AI engineer and science. They work together, say that data can come in the lake, and we orchestrate that data in such a way that it will be proper context. So when the representative or the administrative officials want to engage anything, they will already have the privilege to directly engage that lake. but other people can't. So that's the automation probably would then come to more phase two. Phase one is to prove the capability that, wow, this is amazing. Did I answer your question, Chair, to the representative?

Yeah, that's a really good question to the chair, to the representative. So think of CHET-GBT as a public agent. It's very powerful. So let's say if we want to go to Florida, we probably want to take an airplane, right? And that is through a public transit to Florida. But let's say if you go to Florida and you stop by visiting a friend or go to a hotel, you probably need to change vehicles because it would be hard to drive an airplane directly to the neighborhood. So when you take a look at that, a private agent would become much more important because you really do not want to share where you stay at the hotel, you're visiting friends, you have private conversations with your family and friends. That becomes a different reason for what we call the agentic AI So a public agent chat GPT or a genetic AI agent for the Medicaid applications and usage will be we need airplanes ChatGPT We also need cars maybe Uber We also need hotels. So different reasons for different agents, and Serena basically brings out from the public agent, which is the generative AI. Overusing generative AI typically would get bias, hallucination, and many other unwelcome type of people-pleasing results. It's not built for that. So agentic AI is built for exactly to personalize yourself. In turn, it can be a digital twin for yourself or for the agency like Medicaid. So there's a lot of things we can do in that area. It's very proven technology. It's just we need to apply in the new arena like Medicaid fraud prevention. Thank you.

So from the chair to the chair, actually. Yeah, so regarding how the DOGE data could be used or would be used within this process. So the DOGE data is just one of the data sets that might be helpful in identifying fraud indicators, just like the Medicaid billing data or the state tax data. So it would be combining those different data sets, laying them on top of each other, and then seeing where the patterns emerge through that process. Because some of that data has already been identified and prioritized, that's a really good place to start because we don't have to boil the ocean, right? That's actually what makes this process already, I'd say, easier and simpler is because actually being given to us to use. It's just having the right people that can interpret that and then make it into actionable recommendations for investigators, for the committee, and for the public to be able to understand. One note on Doge. So I know when a lot of people hear Doge, they hear, oh boy, what does that mean exactly so one thing i appreciate about doge is that their ability to very quickly identify the fraud and i'm very grateful for that one thing i don't appreciate as much about doge is how they took a very draconian approach of say let just cut here cut there you know shoot fire aim shoot right Or shoot it whatever But instead, I think what's important for Ohio is use the data, but make sure that the right people are involved, the right processes involved, and the right governance. So it's not just let's cut everything out and see what sticks, but actually bring people along the process. We believe in AI, but we mostly believe in human flourishing. That's really what's so important to us. That's why this use case is interesting to us. And I think if you're going to use AI to help detect and prevent Medicaid fraud, it needs to be done that way. Thank you.

So obviously it depends, right? So let's say, just for the sake of example, maybe we help identify the top 25 for Rodsters, or maybe the top 50 or the top 100. I don't even know if there's 25 or 50 or 100, right? I'm not into the data. But if there was, being able to ideally say, here's a suspicious activity, and here is a dollar amount that they have received over time, right? If those investigations go through, they find out that's fraud, that is money that's going directly back into being able to serve the people that need it the most. I don't know how much that would be. I kind of leave it up to the committee to decide, based on what you're seeing, what those numbers could be. But then comparing that to the figures that our CEO Steve mentioned versus the potential fraud that's not just this year, but over time going on could be saved to be able to focus on. Anything to add? So if I look at the very raw data, I think between the state and the federal budget for Medicaid in the annual basis is for Ohio is $45 billion. Not million, but billion. So that's $45,000 billion. That's the number. $45,000 million. $1 million. That's a significant amount. Let's just say, through this, I apologize for the numbers, but $45,000 million. If we can save 10 of that that million And investing let say whatever the sixth figure let say million that seventh figure That's a return of a very high return. I think we can do that calculation pretty quickly. So we are actually not asking for business. We just concern citizens, knowing that what we know, it's going to be significantly return on investment. 100x, 1,000x, not 100%, 100 times, 1,000 times of the return. And that's based on a very conservative calculation, just based on the numbers. Thank you, Chair.

Thank you, Chair.

Chair Gross and members of the committee, thank you very much for this opportunity to testify. I'm a parent of twins with profound intellectual and developmental disabilities. They reside at Heiserling Foundation, which is here in Columbus, that cares for about 200 profoundly disabled individuals. I'm here today to talk really more about the big picture issues that I think this committee could benefit from thinking about, and these longer-term issues that I think have gone unnoticed. First of all, I just want to say that I support HB 795. Requiring electronic visit verification is just common sense. And just to give you kind of an idea as to the type of data that is taken down in the facility-based setting, the intermediate care facilities, and I would assume as well like the nursing homes, because people might say to me, Caroline, your kids are in an ICF. What do you know about electronic visit verification? I would say that in an ICF, every bit of care that is provided to residents, changing diapers, giving medication, providing meals, going out on community outings, turning them in their beds to make sure they don't get bed sores, every time any care is provided at the smallest level is recorded. and those records are kept and they're provided to the state of Ohio that comes in and surveys on a regular basis. So that is the type of hands-on oversight that is happening in these facilities. In addition to professionals that work there that have eyes and ears on the facility, as well as family members that go in and visit their loved ones, we are all providing oversight constantly in those facilities. So I support electronic visit verification. That's just common sense if ICFs can do the others. Also, I want to say that cleaning up the provider roles, cleaning up the Medicaid recipient roles is very important. However, I think we need to make sure that the providers that get on the roles in the first place and the Medicaid recipients that are on the roles, before they start getting payments, that we vet them and we make sure that they're legitimate. You know, I'm hearing about AI, which I understand why that's important, but if we have good, you know, providers and eligible recipients to begin with, the AI becomes less important because they're not going to have the fraud. So I hope this committee is looking at how we had fraudulent providers added to the rules and how ineligible Medicaid recipients based on Auditor Faber's testimony, how those were added to the rules, and fix that because that's going to go a long way to making sure this fraud is not endemic in the system. Okay, as far as the more macro level, I really urge this committee to look at the macro level. and the state policy conditions, or the state policy that I believe set the conditions for this fraud to fester and grow here in Ohio. It seems to me, based on attending two of these hearings, that the fraud is really based in the community-based settings. And I think that's because there's a lot of vulnerabilities there. There's, you know, they're happening in thousands of homes all over the state. How do you monitor that? It's been state policy for years now to push families away from institutional settings, even when families have indicated a preference to it. And I think that this is something that we all need to consider. If individuals prefer institutional settings that we all know are highly structured and, you know, there's less fraud in them, why are we pushing people away from these settings? We hear, which I am going to dispel later, that facility-based care is more expensive, but we've got $4 billion of fraud potentially here in Ohio. That's not making community care less expensive. That's making it more expensive, and we need to consider that because this community care is harder to monitor. So I think that by pushing people away from institutional settings into the community settings, we have increased the risk of fraud in the state because community services are harder to monitor and that's just a fact that we have to accept. In 2015, the state closed 1,200 ICF beds and two developmental centers against the objections of families. This policy killed all the economies of scale in the system not all of them, but a large part of them because, for instance, one nurse can serve 20 patients in an ICF on one shift. So when they close all these settings, they put tremendous pressure on the community system, and they make it harder for people to find care because there's more people trying to access the community care. This also made the state rely heavily then on paid family caregivers rather than providers because they didn't have the labor market anymore for them because there were too many people accessing the system. To understand the dramatic change, I would urge you all to look at the graphs that are attached to my testimony that were prepared by the state of Ohio in 2016. It shows the dramatic rise in community services. Between 2010 and 2016 alone, there was a 37% increase in community care. I think it's fair to question whether the state expanded community services so greatly before they had the appropriate procedures in place to make sure that there was proper monitoring and onboarding of these community services. And I think it may be expanded so quickly that it exposed Ohio to fraud. This is not to say that every Medicaid recipient should be able to do that be in an institutional setting I believe it should be driven by individual choice but by closing settings against families objections is not allowing individual choice and is harming the system Lastly, I just want to say that as far as I heard Representative Williams indicate earlier that it's cheaper to be in the community. That is not the case. If you look at the numbers provided by the Department of Medicaid, in 2016 the average annualized cost of a private ICF was $103,400. The average annualized cost of someone in the waiver that was kicked out of those ICFs was $95,800. Now that waiver cost doesn't include room and board, case management, or nursing, which is all included in the ICF. So when you add those numbers in, the community care is actually more expensive. One final point, Ohio taxes bed tax, imposes bed tax on ICFs and institutional care. ICF bed tax is $50 million a year. Institutional care is $389 million a year Ohio is getting in these bed taxes. You have to consider that money as well that's going back into the Medicaid system and helping to fund the community system. Thank you so much.

Thank you, Chair. Thank you for coming to testify today. I'm going to go in reverse order. So your last comment was about the bed tax, right? So if we're going to have a conversation about what it costs to have somebody in an ICF and saying that it's going to be cheaper to put them in community-based resources, I think we have to consider the fact that part of the cost for ICFs is the fact that you have a bed tax. So you're technically driving up the cost of each one of those beds by having a tax on those services. But I think what you highlighted here is something that we're starting to finally maybe catch up on is when we have this sudden shift away from institutional care and there's not enough providers in the state of Ohio, what we do is we kind of inundate the system with low-level providers that are prone to fraud. It both happens in the developmental disability space, but also in the home care space. Can you talk about that just a little bit? The level of care that you think people are getting compared to being in an ICF, where they're kind of specialists, compared to going into the community base, where I know individuals now that are working with people with developmental disabilities that have no prior training, no specialty, and they're essentially occupying that person's daytime hours. Okay. Yes, Representative Gross.

Representative, follow-up? Thank you so much. committee. Are there any other questions? Representative

this is a family decision. It's an individual decision. If you look at the federal Medicaid law. Families are to be given the option between an ICF and a waiver. The ICF is the entitlement, and they're supposed to be informed of both options and then choose what is best for their family. So this isn't a state of Ohio policy, as far as I'm concerned. This is a family-driven policy. That's how the Medicaid regulations work. It's the individual's choice. It's a freedom of

Follow-up?

Representative Lett.

issue because you require people to provide credentials, then you make it more costly for them, and then you hurt the labor force again. So it's really a difficult issue, and I would really hate to, I would really be talking too far out of my comfort zone to even provide that. I can just tell you that there needs to be training involved in the care, I would say, for people with behavioral, like your son, how to best handle those. I mean, there has to be training, or you could be doing more damage. Same thing with high needs, complex needs people. There needs to be training. And I just, you know, you could have conferences where people come in and come to conferences, try to keep the membership, the entry fees low so people can get some basic training. I also think there needs to be some sort of hands-on interview process happening. You know, maybe that's impossible, but it seems like people are being added to the provider roles without anyone even meeting them first. And even, because you, like the first witness said, you get a lot from meeting somebody. And just taking a look at their resume, seeing if they've, you know, a lot of the aides do go and get certain certifications. I can't think of the names of them, but I've talked to a lot of the aides, and they've told me different certifications they've gotten before they took these jobs. So, you know, requiring a certain level of training on their own first, having conferences, those type of things may help, but you've got to make sure that those certifications are not too costly or you're going to affect the labor market again. Through the chair to the witness, just agree and want to just point out the intersectionality of what we are paying people and the credentialing that we're expecting of them. And if we're going to kind of bring up this workforce, we have to keep in mind that we're asking them to do the most and make the very little. So I agree with your point, and thank you for bringing it to the committee's attention. Yeah, you're also putting people in very risky situations for themselves because someone could die on their watch. Someone could get hurt if the behaviors aren't handled. So you're giving people a lot of responsibility. So it has to be taken seriously who's watching these individuals. Thank you. Thank you so much. Thank you very much for your time today and your wisdom in this and also your life lived experience. So thank you very much. Thank you. I appreciate it. Thank you.

I would like to now call Ms. Tara Dunn to provide proponent testimony.

Thank you so much. I mean, you have such a wealth of information for us. Committee, are there any questions? I have some. You have so much information. You are able, you would jump through all the hoops to be able to do everything we want you to be able to do. What are we doing wrong? What advice can you give us so that we keep you and we keep people like you, but we get rid of the fraudsters? Tell me, what would you recommend to this committee?

Thank you. Committee, are there any other questions? Thank you so much for your input and view of this.

Have a wonderful day. All right. Next, I would like to call up Ms. Kimberly King for proponent testimony.

Thank you so much, Ms. King. Committee, are there any questions?

And Vice Chair Barhorst. Through the chair, thank you. Thank you for your testimony, Ms. King. Could you give me a historical perspective on your recommendation on the line items changes and separating them out? Or is this a new idea, or has there been past proposals you've been involved in or know of?

Follow-up, Vice Chair? Look forward to hearing some proposals on separating these out. I have them written down. I will happily supply those. Thank you. Thank you. Representative Stevens. Thank you, Chair. And I know we're getting late in the day, and not to be from the Department of Redundancy Department, but I definitely want to emphasize how important the budgetary transparency is. And I will speak to it a little bit and let you expand on it. Medicaid is obviously a huge part of our budget at the state. And, you know, we have different conversations or discussions about, you know, our capital budget, for example, right, that we just came out with this week. And there are budgets that go down to, you know, $50,000 or $40,000 for a specific line item for a specific thing. And sometimes, you know, you'll have a bigger program. but can you speak to what we would be able to get the information from a budgeting standpoint, how the legislature, who is the appropriating authority, how that gives us as the appropriating authority the true responsibility to the taxpayer by having those divided out? Maybe an example of how that would be. Please. Thank you. Say we know we have a fraud, waste, and abuse problem, and we're trying to figure out what programs are we having problems with, what service lines are we having problems with you could see if you had the budget separated out which aid services were provided without oversight and what those dollars looked like You could tell how many units of service were provided and you could tell how many dollars were spent. You could see how many nursing hours of service were spent and what they were spent on and in which counties they are spent. So it gives you a way to see program by program, whether it's state plan or waiver programs. And I would pull it out by service type. So you know aid services, daily rate services, hourly rate, or per unit services, fee for service kind of things. You want to know all of those things separated out because fraud is going to be more inherent in some services than others. And we don't really know that until we start digging in and looking. So that's how I would separate that out. And I can provide you that information. Follow-up? I'll go ahead and ask another question. So I look at it as, and we've talked about fraud from the front end and the back end, and when we look at the budget, I would also see it as a front end issue, which with the appropriation process, but also on the back end issue, kind of like the Ohio checkbook is for local governments. Okay. I don't know if you're familiar with that program or not, but it's basically a searchable thing. You can see where everybody is. Why wouldn't, let me be a positive question, would it be helpful on the back end if we had a, instead of an Ohio checkbook, Ohio Medicaid checkbook as to where these funds are going so people could do searches on their own? likely yes, it would be helpful. And the reason I believe that it could be helpful is that transparency gives insight. So I can't tell you that it's helpful to find out that a particular agency has X amount of dollars in top-line revenue. That's not going to help nearly as much as understanding what services are actually provided during that, you know, during the time period that they're in the home. So you're going to have to be able to balance that to some degree, because people don't necessarily understand how our businesses are run. And when they look at a particular number and take it out of context, that's going to be problematic. Let me give you an example. We're very focused at Home Care Network on electronic visit verification, and we've just built ourselves a dashboard that was hot off of the presses on Monday this week. and I find out that for the 1,824 visits that we did in the time period that we selected, 76% of our claims were edited. That does not make me feel good at all, and I thought, 76? Well, at 85, you've got a problem, but in my mind, 76 is awful, right? Because we've been doing this since 2008. Why are we that bad is how it felt to me. So I went to my data analyst and I said, really, we're really editing that much? So I want to know, are those edits editing up, like expanding the shift, or editing down? I want to know what that total is. That 76% was a minus 148,624 minutes of service. So yes, it was a lot as a percentage of edited claims, but those claims were edited down in net not up so if you don't understand the data you don't really know because the first time I saw it I was like oh crap now what Monday you know and we dig in a little bit further and I find out okay So now I want to separate. I want to see the ones that got expanded up. How many of those were there? There were 210 of them, right? And we're already starting to dig in. Why was it expanded? What happened? Where did we go? So you have to kind of be able to take that data and do something with it, as opposed to just freak out, because that's kind of what we do. Follow-up? All right. Thank you so much. We did put an amendment in the budget, and my health policy person, Joella, just showed me, We do have itemized expenses on that. So we have already, see how fast we are? We already took care of that, and you're still on the stand. So we, I don't mean to make light of a serious topic, but we do take this extremely seriously, and we do appreciate so much your wisdom and knowledge. I know you've been in this business for many, many years. So thank you for taking your time to be here with us today. Committee, are there any other questions? Thank you so much, Ms. King. It's my honor to have you in committee today. Next, I would like to call on Michael Vallee to provide proponent testimony. Good evening. Chair Gross, Vice Chair Barhorst, Ranking Member Baker. Members of the committee, my name is Michael Vallee. I'm with Your Choice Healthcare Group. We operate home health and medical equipment companies across southeast and south central Ohio. I also serve on the board of the Ohio Council for Home Care and Hospice. I participate in the Medicaid ecosystem daily, and I'm here to support House Bill 795. To that end, I'd like to make four points. One, Ohio spent $2.5 billion on home health personal services between 2018 and 2024. The documented fraud findings are not theoretical. Hundreds of companies across very few addresses billing hundreds of millions of dollars. 38% of all Ohio home health spending concentrated in one county. The 2024 state auditor found over a billion dollars in claims with no EVV record at all. Every dollar flowing to a fictitious service is a dollar unavailable to a needy individual across the state. Two, GPS electronic visit verification is the right fix, but the data must be cleaned up as well. House Bill 795 restores EVV GPS as a condition of payment and codifies it in statute so that no administrator can remove it again. But I want to flag data quality issues that every day we deal with. Under the current SAN data system, every manual adjustment to an electronic visit verification record, regardless of reason, gets the same code and looks like a fraud, looks like a fraud item. So if a patient changes payer from care source to Buckeye, that looks exactly the same as if somebody is inflating their hours that they're billing. It looks identical. So the result is that Ohio's fraud detection data is polluted with false positives. Investigators waste resources on legitimate corrections and the actual fraud signal is buried in the noise. The fix is straightforward. SanData has done this in other states. Ohio should work with SanData to implement differentiated change reason codes that separate administrative corrections from substantive record modifications I urge the committee to include that directive in the bill or in its implementation guidance Three legislation is absolutely necessary Administrative fixes have already failed. This needs to be in statute rather than left to administrative action. GPS verification was in the system. It was absolutely required and everybody was doing it. Somebody somewhere in 2024 removed that requirement. Now GPS is only in just a little bit over 50% of the records, and over a billion in claims, as I said, have no EVV record at all. Medicaid fraud penalties as well, Medicaid fraud penalties have historically been capped below comparable theft offenses. This bill addresses this directly with a tiered felony structure. And while the bill now grants subpoena authority to the auditor of state, the Attorney General's Fraud Unit still lacks that, a remaining gap that's worth noting. Each of these is an administrative or legislative gap that was left wide open even while the program was expanding rapidly. House Bill 795 closes the door. By enshrining GPS verification, fraud referral obligations, annual reporting to this General Assembly directly in statute, It removes the ability of any future administrator to quietly opt Ohio out again. As a provider, I can tell you legitimate operators do not benefit from regulatory ambiguity. We benefit from clear, stable, consistently enforced rules. Codification in statute provides that. Point four, vetting helps, but payment level verification is the most important thing. I strongly support provider credentialing, but the record shows that fraud has repeatedly penetrated the enrollment process. You have convicted felons. You have professionals losing their licenses. You have individuals who have been taken from the roles of being able to bill home health, still billing hundreds of thousands of dollars. No background check catches all of that. This bill addresses it at the point of payment where GPS timestamps, location-consistent data, create a floor of accountability that falsified paperwork cannot circumvent. Vetting determines who enters the program, but verified billing data determines who gets paid. In closing, House Bill 795 restores verification mechanisms that were already in place, codifies them against future erosion, and creates the evidentiary infrastructure needed to prosecute fraud. It does not burden providers operating in good faith. We have nothing to hide from a GPS time stamp. I urge the committee to strongly support this bill favorably. I'm happy to answer any questions. Thank you, sir, so much for your time today. Committee, are there any questions? Wow, you get off easy today. Thank you so much for your time and your support of sub-HB 795. Thank you. And last but not least, Mr. Donovan O'Neill for proponent testimony. Thank you, sir, for being here today. Absolutely. Chairwoman Gross, Vice Chair Barhorst, Ranking Member Baker, and members of the House Medicaid Committee, thank you for the opportunity to testify today in support of House Bill 795. My name is Donovan O'Neill. I serve as state director with Americans for Prosperity Ohio. At AFP Ohio, we put a megaphone to the voices of Ohioans who want to see a government accountable to the people. And I'm proud to testify in support of this legislation and to commend representatives Josh Williams and Mike Davila as Buckeye Blueprint champions leading on this issue This is not a new issue for us at AFP Ohio In fact in February 2025 over a year before the fraud on Ohio Medicaid program became front page news, courtesy of the chair, we delivered testimony at the request of Chair Gross to this committee warning about explosive spending growth, structural vulnerabilities capabilities in provider enrollment in the absence of meaningful verification tools. Ohio Medicaid has grown from about $16.99 billion in fiscal year 2016 to over $22.3 billion appropriated in fiscal year 2026, now consuming over half of the state's total GRF budget. We have long opposed the Medicaid expansions of the prior administration, the KSK administration, because we understood that a program expanded without the accountability infrastructure to match was a program set up to fail the people. Most importantly, it was meant to serve. The fraud crisis playing out now is exactly what we were cautioning against. AFP Ohio believes Ohio's Medicaid program must be built around a few core accountability principles, as you folks have the opportunity to evaluate reform opportunities here. One is front-end integrity before dollars go out, not just prosecution after the fact. Meaningful provider vetting, real-time claims analysis, and verified visit data must be the default, not the exception. Transparency and oversight has been talked about quite a bit this afternoon in the last several committees, hearings this committee has met for. But the legislature, the auditor of state, and the public deserve access to the data needed to assess how this program is operating. Accountability requires information. Protecting those Medicaid was built to serve. Every dollar lost to fraud is a dollar that cannot serve Ohio's elderly, disabled, children in poverty. The population the program was originally designed to support. One of the best ways advocates of this program can help support it is through reform. The substitute version of House Bill 795 represents a meaningful step forward on many of these fronts, from the electronic visit verification, provider enrollment reform, auditor of state authority, and data and transparency. I won't go into depth on each one of those necessarily as a courtesy of time, but it's all within our testimony of those particular areas we would highlight within the substitute version of this bill. House Bill 795 is the kind of structural reform AFP Ohio has advocated for since before this crisis became a public scandal. Representative Williams and Davila deserve credit for carrying this legislation, and this committee deserves credit for the numerous hearings it has held addressing this issue and moving this legislation forward. Ohio taxpayers and the vulnerable Ohioans who depend on a functioning Medicaid program cannot afford the status quo. AFP Ohio urges this committee's support and passage for HB 795. Thank you for your time and consideration. I'm happy to answer any questions the committee may have. Wow. You did that in less than five minutes. Thank you so much. Committee, are there any questions? Representative Ferguson. Thank you, Chair. Thank you for coming in, Mr. O'Neill. The first thing I'd just ask, where does your organization see Medicaid fraud ranking in the problems it's facing Ohio? Through the chair to the representative, as a grassroots advocacy organization, when the Daywire report came out, this was naturally something that was talked about across the state. And while we have our priority issue areas that many of you have heard us come to the committees across the General Assembly and testify in support of being responsive to the grassroots call this is something that again going back to february 2025 was the top priority for an early piece of an opportunity to testify And then with the Daily Wire reporting and the new sort of attention in the public arena around this issue we've, you know, naturally begun to drive where we can on conversations and support this. So I would say it ranks fairly high as a priority for us. Follow up. Yeah, thank you, Chair. And, you know, one thing last year that we saw happen here in the legislature is JMOC, the Joint Medicaid Oversight Committee, was abolished. And that was in House Bill 96. And I know your organization key voted that. Can you walk us through the decision-making philosophy? Yeah. So through the chair of the representative, there were a number of provisions in House Bill 96, the state operating budget, that we were very proud to be supportive of. Any large budget bill doesn't always work for everybody, but that's just, as you all know, how the process sort of works. In terms of the JMOC process, I think the intent in moving that to these committees was to actually empower the legislative committees to do the work that they need to do. And I think we're seeing that, quite frankly, play out through the light that's been shown on this issue, where this committee has called several meetings through the holiday season, Memorial Day, And even as the rigorous capital budget process is developing right now, there are members in this committee room taking this issue very seriously. And so I would say, you know, there's always the opportunity to evaluate what sort of committees need to be there. But my understanding is the process for eliminating JMOC and moving it back to the standing committees that exist, like this one shared by Rep Gross and staffed by members here today, was designed to put it where it belongs in the standing committee so it can have the attention these issues need. Just one more. Follow up. Thank you, Chair. And then so from your perspective, looking at, you know, JMOC going away, what we've set up now, are there ways that you see this being a better process or you think there's things that maybe were missing from JMOC that need to be brought back and maybe it was a bad decision to do that? Yeah, through the Chair to the Representative. But again, like I said, I think the process, as this issue had developed, this committee quickly jumped into action and began to take those investigative reporting findings very seriously. I think that's a testament to the process of the standing committees. Beyond that, I think the legislature has, you know, you kind of go back through both this most recent budget bill and prior budget bills. The legislature has been very clear about protecting the integrity of the Medicaid program, putting the kind of processes and rules into place to provide the oversight. It's unfortunately been the DeWine administration and the governor himself, who has that red line veto pen, who has gone through and vetoed many of the provisions that this body, the General Assembly, has put forward as they should as the legislative branch. And so I think the legislature has done a lot. There's certainly more to be done. But at the end of the day, the executive is the one who signs these bills into law, and many of the things that you folks voted for as recently as House Bill 96, the administration saw fit to veto, which has proven to be maybe not the wisest of actions. Thank you. Representative Stevens. Thank you, Chair. Thank you for coming in. Last week we heard from Auditor Faber talking about the rehab facilities in my area. And as you well know, your organization spent a lot of time this spring in my area, to no avail, I might add. But have you – I didn't see any comment about that situation in your testimony. Have you had a chance to look at that issue? Thank you. The chair to Representative Stevens. Yeah, I saw that within Auditor Faber's testimony and kind of reviewing it. Again, I would kind of point to where the state auditor has consistently been exposing and surfacing these issues that exist within the fraud, waste, and abuse within the state of Ohio, specifically within the Medicaid program. and I believe the substance of the auditor's testimony was to ask for more authority, to be able to go and subpoena the things that they need to get, to be able to do the job they need to do to expose and surface these issues so that the good actors in the administration or if they fail to act, the members of the legislature like yourselves can actually strengthen and affirm the oversight that's necessary for these precious tax dollars. Follow up? No, thanks. All right. Committee, any questions? Representative Samani. Through the chair. We've been hearing testimony about all of this, and one of the concerns that came up was GPS tracking, that it's hard to follow that, that sometimes the tracking isn't accurate. Are there potential concerns that you see around privacy and surveillance with this bill, and do you think that it could be misused or used inappropriately, and how would you put safeguards around that? Through the chair to Representative Samani. You know us as an organization that also appreciates individual privacy, so I appreciate you asking that question. I think I understand and hear the concerns there. I think at the end of the day, the transparency and the accountability should be present for these individuals who are providing services that are directly funded by state dollars, right, by taxpayer dollars through the Medicaid funding. And so I think you want to have those protections, but at the end of the day, if those folks exist, those organizations, those entities, those health care providers exist to provide that service, the oversight's necessary. I'm talking in circles there. Let me put it this way. Think about ODOT and road paving. It might be an example that works or doesn't, right? but we have a very clear verification mechanism to know that the work that ODOT or that contractors paving our streets building our highways in the state are getting the job done We can see the fruits of that labor and can validate it We have folks who go out and verify and inspect the asphalt right to make sure that it's the right grade and that we're getting the type of product the taxpayers of the state of Ohio are paying for with their gas taxes. I think this electronic verification, this GPS tracking, it's a similar type of mechanism, right? We need to know if we're going to provide personal care services for individuals in the state of Ohio with Medicaid dollars, that those people are actually at the house they say they're at when they say they're delivering those services. Short of that, you know, that's the mechanism for making sure that we're getting the services and the people are where they say they are when they are filing to be reimbursed. Follow-up? Yes, thank you. Through the Chair. The other concern, you mentioned, you know, we don't want to disrupt services to people who actually need these services. with all of these guidelines and with all of these, all this technology and things, how do we support that or how do we prevent people from, how do we make sure that people get the care that they need? Through the chair to the representative. So I'm going to try to answer your question in this way. I asked one of our national policy folks, I said, I'm going to go to the committee, I'm going to testify today, and I'm going to maybe even ask the question of how do we, what states are doing things well? How do we actually reform the system so it works for the people it's intended to serve? And the response to the answer I got was the reality is with states and the way that the Medicaid program is set up between state and federal government is legislatures, states, will only ever be able to really nibble around the edges of reform. The partnership between the state and federal government on this inhibits the ability for states that really want to be bold and create a program that's going to function for the people that it's designed to function for is very difficult to do. And so while we support this legislation and don't want to minimize it, I think the reality, Representative Samani, is that the nature of the program and the fact that it is driven by the state government. Now, we proposed, Sophia Hamilton from our team who came here and testified in February, some of her recommendations were around ways to empower states to have more control over that program so that they could have the flexibility to provide the oversight where they need it also make sure the services are directed to the people that the state believes are most in need Happy to bring that testimony back forward through the chair but I think the challenge really is quite frankly as unsatisfactory as that might be the nature of the structure of the program inhibits the ability to really guarantee that folks on the front lines of it, like the members of this committee, are able to do the kind of bold reforms that you all may see fit to do that would actually better serve the people of Ohio. Thank you. Representative Bake, uh, um, Representative Thames. Thank you, Chair, and thank you for being here today to testify about this bill. I agree with you that we should make sure that the system works for the people who need it. That being said, there are some concerns about the bill in relation to the immediate suspension without proof of a violation would you support or your organization support an amendment that would essentially require proof in order to support due process of law? Through the chair of the representative. I'm not entirely familiar with that particular aspect, so I wouldn't be able to speak to support an amendment to that nature or not. I apologize. No, that's okay. I can send it over to you. Follow up? Ranking Member Baker. Thank you, Chair, and thank you for being here. So I want to pivot a little bit. Sorry to off-script you. But part of this bill also has added in removing categorical eligibility for SNAP benefits. According to new federal law in H.R. 1, if our state needs to get our SNAP benefit error rate down below 6%, or else SNAP becomes a shared federal and state program. And estimates, if we can't get our state error rate below 6%, are that $160 million to $480 million would be on the state to pay for SNAP. My question is, considering all of that, What are your thoughts on spending on creating part of this I guess I just having trouble connecting that part So in order to get rid of categorical eligibility we going to put more work on the county JFS workers to check all the eligibility That increased work and removal of categorical eligibility is undoubtedly going to increase our payment rate. so actually cost the state more. What are your thoughts on the SNAP provision and how that's related to Medicaid fraud? Thank you. Yeah, through the chair to Representative Baker, we're prepared to look at this specifically from the Medicaid spending elements. And I think I'd seen some reporting and coverage on that SNAP piece too, and there's a bit of maybe a disconnect in terms of how that fits in with the larger picture here. I'm not really prepared to provide any insight opinion from our organization on that particular issue but I think it's the important immediate element is certainly the the the Medicaid fraud waste and abuse potential and making sure that the legislature to me largely what this legislation does especially through the electronic visit verification is just a firm its intent that was included in House Bill 96 that the governor vetoed and make sure that we have good oversight of those taxpayer dollars and make sure that the folks who are using these programs are getting the services that the taxpayers are paying for through Medicaid dollars. Thank you.

Happy to. Members, are there any other questions today? Well, thank you so much. Sir, for being here. We really appreciate you, Mr. O'Neill, for all that you do for Ohio, and thank you for being here before our committee today.

Committee, I would like to direct your attention to the written testimony for House Bill 7, sub-House Bill 795. Please note that on your iPads. And with no further business to come before this committee, the House Medicaid Committee does stand adjourned until tomorrow after session. Thank you so much.