Job & Family Services Ohio Medicaid

Medicaid Fraud Elements

Element Monitored General Rule Nursing Rule Daily Living Service Rule
Falsified provider application and/or records 5101:3-1-17.2 5101:3-12-06 (A)(9)(ii) 5101:3-12-06 (B)(6)(a)
Falsified kinship (Consumer) 5101:3-12-12 (A)(2) 5101:3-12-06 (A)(9) 5101:3-12-06 (B)(6)
Billing for multiple consumers in the same time period 5101:3-1-29 (D)    
Billing for services not provided 5101:3-1-29 (D)    
Billed hours greater than 24 hours per day 5101:3-1-29 (D)    
Kickback to the consumer 5101:3-1-29 (D)    
Billed Medicaid for the patient liability   5101:3-12-06 (A)(9) 5101:3-12-06 (B)(6)