Gov. Mike DeWine signed a bill into law that includes new regulations for certain Medicaid providers. AVERY KREEMER / STAFF
Gov. Mike DeWine signed a bill into law that includes new regulations for certain Medicaid providers, which follows lawmakers taking a closer look at alleged fraud and ways to prevent misuse for Ohio’s increasingly expensive Medicaid program.
Senate Bill 315, a bill that was first related to transitioning Supplemental Nutrition Assistance Program cards to chip-enabled cards, was passed by lawmakers in June right after the Ohio House Finance Committee added regulations to certain Medicaid providers to the bill.
Critics of the bill said it could cause delays in care, such as through the required prior authorization of services under the home- and community-based waivers, or make it more difficult to find providers of home healthcare services.
Proponents of the bill say it protects taxpayer dollars with the added regulations, such as requiring providers to verify certain visits and services through electronic visit verification software.
“Medicaid has long been ripe for abuse by bad actors who seek to rob taxpayers for their own gain,” said State Rep. Josh Williams, R-Sylvania Twp., who was a cosponsor on this bill. “With the passage of Sub SB 315, which expanded on the Medicaid Fraud Prevention Act (HB 795) that I introduced earlier this year, our state is finally standing up and saying no more. By passing Sub SB 315, we are placing fraudsters and criminals on notice that they will spend decades behind bars if they continue to rob our taxpayers through Medicaid fraud— they will be found, arrested, and convicted.”
State Rep. Josh Williams, R-Sylvania Twp., who was a cosponsor of Senate Bill 315, which Gov. Mike DeWine recently signed into law. The bill expanded on the Medicaid Fraud Prevention Act, introduced by Williams earlier this year. COURTESY OF THE OHIO HOUSE OF REPRESENTATIVES
House Bill 795, which included a number of the Medicaid provisions added to the senate bill, received numerous opponent testimonies, mostly regarding a controversial previous part of the legislation that banned payments to family caregivers. That provision was removed and not included in the regulations under SB 315.
“I oppose this bill because it approaches Medicaid waiver services primarily through suspicion, surveillance and fraud enforcement rather than through the purpose for which HCBS programs were created, which is allowing people to live in our homes and to participate in our community,” said Maria Matzik, a disability rights advocate from Fairborn, in testimony against HB 795. Matzik relies on Ohio Medicaid’s home and community-based services to live in her home.
‘A positive step towards reducing fraud’
State Sen. Willis E. Blackshear Jr., D-Dayton, a cosponsor of SB 315, said misinformation has spread around Medicaid fraud, but he was supportive of enhanced oversight in order to prevent fraud.
“There has been significant misinformation and exaggeration about Medicaid fraud. Medicaid is an essential program that millions of Ohioans rely on every day. However, as legislators, we do have a responsibility to prevent bad actors from taking advantage of the program,” Blackshear said. “The increased oversight measures added to Senate Bill 315 should be a positive step towards reducing fraud while making sure people receive the services they need.”
He also pointed to the original focus of the bill, transitioning to chip-enhanced SNAP cards, as another way to prevent fraud. Chip-enhanced cards have built-in microchips to process payments, which generate an encrypted code that is different for every transaction.
“The original provisions of the bill to add chips to SNAP cards will also help reduce scams and the loss of benefits for folks who rely on SNAP,” Blackshear said.
With the Medicaid provisions being added to the bill right before SB 315 passed, he said lawmakers will have to watch how this affects providers and patients.
“Due to the fast-tracked nature of the bill, we will need to continue to monitor the effects of this law on providers and recipients to ensure that the changes will not create unintended consequences. This is an ongoing effort as we look to ensure that people receive the healthcare they need,” Blackshear said.
Higher penalties for fraud to deter misuse
SB 315 also includes harsher penalties for Medicaid fraud as added deterrents, and there are also more resources for investigators to go after alleged perpetrators of fraud.
“That bill gives us a variety of tools that will allow us to better prosecute and investigate these cases,” Ohio Attorney General Andy Wilson previously told the Dayton Daily News.
The harsher penalties for Medicaid fraud includes:
- Medicaid fraud as a fifth-degree felony, and a $1,000 fine, rather than a first-degree misdemeanor.
- For amounts greater than $1,000 and less than $7,500, a fourth-degree felony and a $5,000 fine.
- For amounts greater than $7,500 and less than $75,000, a third-degree felony and a $25,000 fine.
- For amounts greater than $75,000 and less than $150,000, a third-degree felony with a presumption for a prison term and a $75,000 fine.
- For amounts greater than $75,000 and less than $150,000, a third-degree felony with a presumption for a prison term and a $75,000 fine.
- For amounts greater than $750,000, a first-degree felony and a $150,000 fine.
“The higher penalty ultimately can result in a prison sentence,” Wilson said.
Andy Wilson speaks to media in his office in Rhodes State Office Tower on Monday, June 15, 2026, in Columbus. He was sworn in as Ohio’s 52nd Attorney General on Friday, June 5, 2026, at the Clark County Court of Common Pleas in Springfield. JOSEPH COOKE/STAFF
The bill also specifies that Medicaid fraud constitutes corrupt activity under Ohio’s Corrupt Activities Law, which means law enforcement can prosecute connected networks of people committing Medicaid fraud as operating an ongoing criminal enterprise.
‘This is only the beginning’
This bill is only the beginning in tackling Medicaid fraud, said State Rep. Jennifer Gross, R-West Chester, chair of the Ohio House Medicaid Committee, who also commended Williams and State Rep. Tim Barhorst, R-Ft. Loramie, vice chair of the committee.
“While SB 315 and the Ohio Medicaid Program Integrity and Fraud Prevention Act represent a major step forward in delivering in-person provider inspections, strong electronic visit verification, tougher penalties for fraud, and critical oversight tools that will protect taxpayer dollars and safeguard services for those who truly need them, we know this is only the beginning,” Gross said.
“These bipartisan reforms make substantive change in the fight against waste, fraud, and abuse, but we still have work to do to ensure every dollar reaches the intended recipients and that our Medicaid program remains sustainable and accountable to all Ohioans,” she said.
State Rep. Desiree Tims, D-Dayton, who is on the Ohio House Medicaid Committee, was supportive of the passage of SB 315 and has also previously been involved in proposed legislation to address SNAP fraud.
“I support and am thrilled about the passage of this bill. I introduced legislation to combat SNAP fraud. And it takes too long for people to receive their benefits or quickly suspend benefits after being victims of theft,” Tims said.
