Section 5164.421
(A) In addition to the electronic visit verification system described in section 5165.42 of the Revised Code, the department of medicaid shall establish requirements under which high risk in-home care service providers are required to verify data regarding the services provided to a medicaid recipient.
(B) The department shall establish criteria under which an in-home care service provider is considered to be a high-risk provider. The criteria shall at a minimum include all of the following:
(1) Repeated mismatches in check-in data;
(2) Data that indicates impossible travel times;
(3) Claims data that overlaps with a medicaid recipient's stay in a hospital for services that were not provided in accordance with an authorized individual service plan;
(4) Unusual outliers in billing data;
(5) Other data indicators that demonstrate a high risk of fraud.
(C) Each in-home care service provider classified by the department as a high risk provider shall satisfy the requirements established under this section, including that the high-risk provider utilize fingerprint scanning, facial recognition, vocal recognition, a secure personal identification number, or other approved verification method as a condition of receiving payment for services provided under the medicaid program.
(D) The department shall not sell or otherwise distribute any data transmitted or stored as part of a provider's use of electronic visit verification under this section. No such data shall be used for any purpose other than to verify medicaid payment claims submitted by a provider and reduce fraud within the medicaid program.
Last updated August 12, 2026 at 4:36 PM
Available Versions of this Section
- October 6, 2026 – Enacted by Senate Bill 315 - 136th General Assembly [ View October 6, 2026 Version ]