Ohio’s New Medicaid Fraud Law Could Freeze Provider Payments — Here’s How to Stay Cash-Flow Ready

On July 7, 2026, Governor Mike DeWine signed Senate Bill 315 — officially the Ohio Medicaid Program Integrity and Fraud Prevention Act — into law. The bill moved quickly through the legislature after a series of media reports alleged widespread fraud among home health providers in the Columbus area, and it passed with overwhelming bipartisan support: 85–10 in the House and a unanimous vote in the Senate.

For policymakers, SB 315 is a win. For the economists studying its real-world impact, the verdict is far less clear. And for the home health agencies, hospices, DME suppliers, and behavioral health providers who bill Ohio Medicaid every day, the law introduces a new financial risk that has nothing to do with whether they’ve done anything wrong: cash flow disruption.

What does SB 315 Actually Do?

The law significantly raises the stakes around Medicaid billing in Ohio. Key provisions include:

• Escalating criminal penalties. Medicaid fraud jumps from a first-degree misdemeanor to a felony, with charges scaling up to a first-degree felony and a $150,000 fine for fraud exceeding $750,000. Medicaid fraud is also now a predicate offense under Ohio’s corrupt-activity (RICO-style) statute.
• Payment suspensions on credible allegations. The Ohio Department of Medicaid (ODM) must suspend payments to a provider once the state Attorney General or Auditor submits a “credible allegation” of fraud — a much lower bar than a conviction, or even a formal charge.
• Mandatory electronic visit verification (EVV). In-home care providers must verify visits, often via GPS clock-in/clock-out, as a condition of payment.
• Prior authorization expansion. All therapeutic behavioral health services now require prior authorization.
• In-person site inspections before a provider can enroll to deliver home and community-based services.
• MCO enrollment caps, requiring managed care organizations to spread enrollment across providers rather than concentrating it.

These changes build on executive actions DeWine had already taken, including a moratorium on new home health and hospice enrollments and mandatory GPS-based EVV — measures that have already led ODM to suspend payments to nearly 60 “high-risk” providers this year.

Why are Economists Split?

According to a Scioto Analysis survey of 13 Ohio economists, opinion is nearly evenly divided on whether the law’s benefits will outweigh its costs. Asked whether Medicaid fraud prevention programs that add penalties, verification, and inspections will generate fiscal savings exceeding their administrative burden, five agreed, four disagreed, two were uncertain, and one declined to answer.

Supporters, like University of Cincinnati economist Michael Jones, argue that low-cost verification at the point of service should deliver a strong return on investment for the state. Skeptics point to a different risk: the same oversight measures designed to catch bad actors may also slow down or interrupt payments to legitimate providers — particularly smaller home health and behavioral health agencies that operate on thin margins and depend on predictable Medicaid reimbursement to make payroll.

The Overlooked Risk: Legitimate Providers Caught in the Middle

Here’s the part of the story that doesn’t always make the headlines: a “credible allegation” is not proof of wrongdoing, but under SB 315 it’s enough to trigger a payment freeze. Combine that with expanded prior authorization requirements, new EVV compliance hurdles, and mandatory site inspections before enrollment, and you get a system where honest, well-run provider organizations can face real cash flow gaps while they wait — sometimes for months — for reimbursement, an audit resolution, or a “high-risk” designation to clear.

For an agency covering nursing staff wages, vehicle costs, and rent every two weeks, a delayed reimbursement cycle isn’t a paperwork inconvenience. It’s an existential threat.

Where Does PRN Funding Come In?

This is exactly the kind of disruption PRN Funding was built to solve. We provide accounts receivable funding to healthcare providers — including homecare agencies and healthcare staffing agencies — who need working capital now, not in 60, 90, or 120 days when a claim finally clears.

When Medicaid payments are suspended pending a credible-allegation review, delayed by new prior authorization backlogs, or held up while a provider completes EVV compliance or a site inspection, PRN Funding can advance cash against outstanding receivables so operations don’t grind to a halt. Unlike a bank loan, invoice factoring isn’t based on your credit history or collateral beyond the receivables themselves — it’s based on the value of the claims you’ve already earned but haven’t been paid for yet.

As Ohio’s regulatory environment tightens under SB 315, providers who understand their financing options will be the ones best positioned to weather payment holds, audits, and compliance transitions without disrupting patient care or payroll. That’s the expertise PRN Funding brings to every client relationship: not just funding, but a deep understanding of how healthcare reimbursement cycles — and the regulations that shape them — actually work.

If your agency bills Ohio Medicaid and you’re concerned about how SB 315’s payment suspension and compliance provisions could affect your cash flow, talk to PRN Funding today about how accounts receivable funding can keep your operations running smoothly through the transition.