Medicaid Fraud & Billing Abuse
Recovery has become a business — but fraud should never be the business model.
Across Ohio, unethical providers are abusing Medicaid and insurance systems by prioritizing billing over care. These practices don’t just waste public dollars — they can cause real harm to people in recovery, delivering services that are unnecessary, incomplete, or unsafe.
According to the Ohio Attorney General’s Office, Medicaid fraud includes:
Billing for services that were never provided
Billing for more expensive services than were actually performed
Performing unnecessary services to increase billing
Falsifying diagnoses or documentation
Using unqualified staff to deliver and bill services
Paying or receiving kickbacks for referrals
This isn’t just unethical — it’s criminal.
Know Your Rights: You Can Request Your Billing Records
Whether you're covered by Medicaid, Medicare, or private insurance , you have the legal right to request and review your billing records at any time.
Under the HIPAA Privacy Rule §164.524(a)(1), individuals can access their designated record set, which includes:
Dates of service
What was billed
Which provider or clinician submitted the claim
Diagnosis and level of care used
Under the HIPAA Privacy Rule, specifically 45 CFR § 164.524, you have a legal right to access your billing and health records. This includes dates of service, charges, diagnosis codes, and provider names — because billing records are part of your “designated record set” as defined in 45 CFR § 164.501. Providers and insurers must respond to access requests within 30 days or face enforcement by the U.S. Department of Health & Human Services Office for Civil Rights (OCR).
This right applies across all payers — and it's enforceable by law.
Want to Check for Yourself?
Most Ohio Medicaid Managed Care Organizations (MCOs) offer online tools where you can check your claims, authorizations, and service history in real time.
If you're enrolled with CareSource , Buckeye Health Plan , Molina Healthcare , Paramount , Anthem , or UnitedHealthcare Community Plan , you can log into their member portals or mobile apps for access.
You can also call the number on the back of your insurance card and request a detailed billing statement or explanation of benefits (EOB).
This information belongs to you — and it’s one of the most powerful tools to protect yourself from fraud or unethical billing.
What RJNI Does
Recovery Justice Network Initiative (RJNI) is not a government agency or law firm. We do not investigate or prosecute fraud.
Instead, we:
Educate communities on what billing abuse looks like
Support individuals who suspect something isn’t right
Direct people to proper reporting channels
Advocate for transparency, oversight, and ethical care
Report Suspected Medicaid Fraud
Ohio Attorney General – Medicaid Fraud Control Unit
📞 1-800-282-0515
Report Medicaid Fraud Online
Disclaimer: Recovery Justice Network Initiative (RJNI) does not provide legal advice or conduct investigations. We provide education, resources, and advocacy to help protect people from systemic exploitation within the recovery and treatment pipeline.
How Recovery Justice Network Helps
We support people navigating the court-treatment pipeline by
Exposing unethical referral networks
Educating individuals and legal advocates on treatment rights
Connecting people to ethical, evidence-based care
Pushing for policy that protects treatment autonomy
Recovery begins with dignity — not coercion.
Disclaimer: Recovery Justice Network Initiative (RJNI) is not a law firm and does not provide legal advice or representation. We provide education, advocacy, and support to empower individuals to understand and assert their rights. If you need legal advice, please contact a licensed attorney or your local public defender’s office.
