{"data":{"id":"us-oh/ohio-rev.-code-5164.421","jurisdiction":"us-oh","citation":"Ohio Rev. Code § 5164.421","heading":"","body":"(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.\n(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:\n(1) Repeated mismatches in check-in data;\n(2) Data that indicates impossible travel times;\n(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;\n(4) Unusual outliers in billing data;\n(5) Other data indicators that demonstrate a high risk of fraud.\n(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.\n(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.","path":["Title 51 Public Welfare","Chapter 5164 Medicaid State Plan Services"],"source_url":"https://codes.ohio.gov/ohio-revised-code/section-5164.421","current_through":"2026-10-06 (Senate Bill 315 - 136th General Assembly)","vintage":"","retrieved_at":"2026-09-14T19:24:40Z","sha256":"3108c3530846a246517a82cf516aa867d033640b12337f924cf16854cfca203d","source_id":"us-oh","stale":false,"prev":"us-oh/ohio-rev.-code-5164.42","next":"us-oh/ohio-rev.-code-5164.43"},"notice":"GroundRules: Original legal text. Not legal advice."}