MedicaidAdministrativeMedium impact
5160:1-2-04 - Medicaid: consumer fraud and recoupments. (New/Final File)
Ohio Medicaid·OH·Program Integrity
Effective date
Mar 1, 2024
We identified it
Jun 20, 2026
Summary
Ohio Medicaid has implemented a new rule 5160:1-2-04 regarding consumer fraud and recoupments, effective March 1, 2024, replacing the previous rule on fraud and erroneous payments. This policy change affects how Medicaid handles fraud investigations and recovery procedures for improper payments.
Action Required
By March 1, 2024: Billing teams serving Ohio Medicaid patients must review and update compliance procedures to align with new fraud and recoupment requirements under rule 5160:1-2-04. Contact Ohio Department of Medicaid at 614-752-3877 for specific guidance on documentation and reporting requirements to avoid recoupment actions.