A Springfield News-Sun and Dayton Daily News file photo of the Mental Health Services’ building on East High Street in Springfield taken on Aug. 1, 2024. The facility houses primary care services for patients and behavioral health services.
Behavioral health providers in Ohio will be seeing more scrutiny after the state regulator announced enhanced oversight and accountability measures to prevent fraud and misuse, particularly as it relates to providers for Medicaid members.
The Ohio Department of Behavioral Health will be implementing new safeguards to strengthen oversight of providers, grantees and publicly-funded behavioral health programs across the state, according to a press release from the department.
“The overwhelming majority of Ohio’s behavioral health providers and community partners are dedicated professionals who deliver life-saving services every day,” Director Tia Marcel Moretti said in the release. “At the same time, we have a responsibility to ensure public resources are being used appropriately, effectively, and in a manner that maintains the trust of Ohio taxpayers.”
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The department’s enhanced accountability measures include:
An enhanced review process for new behavioral health provider licensure and certification applications.
Reinforced provider renewal requirements, including timely submission of licensure and certification applications to maintain compliance.
Increased coordination with the Ohio Department of Medicaid, managed care organizations and the Ohio Attorney General to identify and address potential fraud, waste and abuse.
Enhanced verification and monitoring of service delivery and program performance.
Implementation of a standardized statewide grantee monitoring and reporting framework for programs and partners that receive grants or funds from the Ohio Department of Behavioral Health.
The new grantee monitoring process establishes consistent reporting requirements, standardized monitoring tools, corrective action procedures, and enhanced documentation practices across department-funded programs, according to the state.
The framework is intended to support earlier identification of risks of fraud or misuse, leading to improved accountability for finances and programming, according to the department, which also stated this would strengthen the department’s ability to measure outcomes and system impact.
“Protecting access to care and taxpayer dollars go hand in hand,” said Moretti. “These efforts are designed to maintain public confidence, support responsible stewardship of public resources, and ensure that Ohioans receive the quality behavioral health services they deserve.”
Implementation of the department’s standardized monitoring and reporting framework is now underway, with program areas working directly with funded partners, vendors and providers to communicate expectations and support compliance.
The enhanced oversight of behavioral health providers comes not long after the state implemented initiatives to target and prevent Medicaid fraud after Ohio has faced national criticism. The right-wing news media site The Daily Wire mainly scrutinized personal home health aides, particularly those in Columbus, and the costs they were charging Ohio Medicaid for services and other billing practices.
Gov. Mike DeWine recently issued an executive order that requires more frequent revalidation of Medicaid providers being identified as higher-risk for committing fraud, in addition to other measures specifically targeting personal home health aides.
In January, Ohio Medicaid began the process of implementing new data analytics tools to help identify billing data anomalies that could better identify fraud.
Ohio Medicaid is also beginning a new policy of immediately removing and suspending payment to providers whose billing practices show “red flags” that indicate a high probability of fraud.