The state of Ohio has indicted six Medicaid providers on fraud charges for allegedly stealing $558,383 from the healthcare state-federal program for low-income residents.
One of those indicted is a business owner who “allegedly instructed employees to inflate claims,” Ohio Attorney General Andy Wilson said.
The defendants also include “providers who billed for services while working other jobs and individuals who billed when clients were hospitalized or deceased,” Wilson said.
Rasheedah Biles, 42, of Pickerington, is owner and operator of Reset Tomorrow, a Columbus behavioral-health program for children.
The state began investigating the program in 2025 after flagging…
PAYROLL & HR CONTROLS (PREVENTING “GHOST” SCHEMES)
Payroll fraud is often the hardest to detect because it “looks” like a normal business expense.
- Segregation of Duties (SoD): The person who adds new employees to the system must not be the same person who approves the monthly pay run.
- Mandatory Vacation Policy: Require all financial and HR staff to take 5–10 consecutive days of leave annually. Fraud often surfaces when the perpetrator isn’t there to “hide” the trail.
- Ghost Employee Audit: Perform a quarterly “Headcount Reconciliation” where managers must physically verify every name on their payroll list exists.
- Self-Pay Blocking: Ensure the payroll software has a hard-coded block preventing administrators from editing their own salary or bank details.