The Ohio Auditor of State conducts Medicaid compliance examinations (commonly referred to as audits), to identify improper payments and to ensure compliance with Medicaid reimbursement requirements. These audits are unique from other provider post-payment reviews — they follow a particular process, their findings are ultimately public and, therefore, can have significant financial and reputational effects on the provider. Providers who navigate alone do so at their peril.
This white paper focuses particularly on behavioral health providers, but the process is universally applicable to all Ohio Medicaid provider types
2025 Trends
2025 saw a continued focus on Medicaid providers, with the Auditor conducting 47 Medicaid provider compliance examinations, 14 of which involved behavioral health providers. The Ohio Auditor of State made overpayment findings in 93% of their behavioral health provider compliance examinations.
Overpayment findings ranged from zero to more than $1.75 million, with findings for nine of the 14 compliance examinations under $10,000. The average finding exceeded $250,000, not including interest.
We understand that the Auditor conducts intensive data mining to identify their subjects —providers of expensive services, high-volume providers or providers flagged for specific, perceived billing irregularities. We believe that AI tools have allowed for enhanced data analytics, and have permitted the Auditor to conduct more audits than in the past.
Fill out the form above to get access to our white paper and learn more.
Liam is a partner in the Vorys Columbus office. His practice focuses on advising health care industry clients on legal, regulatory and business issues impacting their operations. He brings in-house health care industry experience, which enables him to understand client expectations and apply a unique perspective to his practice.
He can be reached at jlgruzs@vorys.com.
Melissa is an associate in the Vorys Columbus office and a member of the health care group. Prior to joining Vorys, Melissa served as a judicial extern for the Honorable Magistrate Judge Gilbert S. Sison of the Southern District of Illinois and a legal extern with Legal Services of Eastern Missouri’s Microenterprise Program.
She can be reached at mmmoore@vorys.com.
Jordan Kulbarsh
Jordan has significant experience with Medicare, Medicaid and private payor investigation and audit defense, Medicare and Medicaid reimbursement, and overpayment audits and disputes. Jordan has experience representing adult and children’s hospitals, behavioral health providers, and recovery housing providers.
He can be reached at jzkulbarsh@vorys.com.
