As a Medicaid provider, you or your agency are responsible for knowing all the Ohio Administrative Code rules associated with the Ohio Home Care program. If there is an allegation that a rule has been violated, the Ohio Department of Job and Family Services (ODJFS) has a system to advise Medicaid providers of all alleged rule violations.

ODJFS sends a Notice of Operational Deficiency (NOD) to a provider to make them aware of an alleged violation. The NOD is sent after a preliminary investigation. The investigation may include copies of the consumer's record, timesheets or Medicaid billing reviews by the Case Management Agency and/or ODJFS staff.

The NOD will indicate which Ohio Administrative Code rule was violated and a brief statement of what happened. A copy of the rule will be included with the notice.

One of the purposes of the NOD is to correct an action or event. The NOD also teaches and/or informs the provider of an infraction that has occurred and been reported regarding their provision or lack of provision of services.

Some examples of when a NOD is issued:

• provider performance issues such as no timesheets or documentation, or lack of reporting to HSF regarding consumer status changes/service changes
• billing more service than is authorized on the All Services Plan.