Medicaid Fraud comes in many guises

"Zip codes" pop up in Ohio's breaking story, along with other similar features.

https://www.dailysignal.com/2026/05/08/mehek-cooke-massive-health-care-fraud-ignored-as-billions-drained-from-ohio-taxpayers/

Massive Health Care Fraud Ignored as Billions Drained From Ohio Taxpayers

Daily Signal Staff    |    May 8, 2026

Mehek Cooke, senior national security and legal analyst at The Daily Signal, warned that the growing fraud scandal in Ohio is not an isolated case but part of a systemic failure across welfare programs nationwide.

Appearing on “The Clay Travis & Buck Sexton Show” Thursday, Cooke said she discovered widespread health care fraud last December that is allegedly draining billions in taxpayer dollars. She brought this evidence to government officials, but many failed to take it seriously.

“This was the tip of the spear,” Cooke said of Ohio, pointing to similar fraud cases in other states. “Any time you have a welfare program, there’s going to be fraud because government is so complacent.”

Cooke described her firsthand efforts to investigate suspicious activity in Ohio’s home health care system, including making door-to-door inquiries in areas receiving significant taxpayer funding in Franklin County. Several whistleblowers alerted Cooke in December to alleged home health care fraud in Ohio, claiming that patients were entering doctors’ offices, claiming they needed home health care services. Upon evaluation, providers determined that they did not qualify for those services, but some of these individuals then threatened that if the paperwork was not rubber-stamped, they would return to providers who would approve it.

After receiving this information, Cooke said she brought the alleged fraud to the Ohio attorney general’s office and the Department of Medicaid.

Cooke also visited close to 100 home health care offices. What she found raised serious concerns about whether services were being legitimately provided.

“So, when you knock on doors, most of these people are in the Somalian community. They don’t speak English, so I’m wondering how they’re even providing services,” Cooke said. “It’s hidden behind closed doors.”

Cooke pointed to the concentration of funds in specific areas as a major red flag. Ohio has spent approximately $1 billion to $1.6 billion on home health care, she noted. Franklin County alone accounts for 38% of that spending, and within the county, roughly 40% is disproportionately concentrated in just two ZIP codes, amounting to about $243 million, based on statistics from Ohio Auditor Keith Faber.

“At some point, the state has to ask, what’s going on in these two ZIP codes?” she said. “But they didn’t. Our governor came out and said it’s the cost of doing business.”

Cooke criticized state leadership for failing to provide transparency, saying key agencies have not released basic funding data despite repeated public records requests.

She said the lack of enforcement is not due to a lack of authority but a lack of political will. “Prosecutors need evidence of fraud, and that responsibility starts with the governor’s office and the attorney general’s office,” Cooke said. “But if leadership won’t provide the information, cases can’t move forward.”

Cooke highlighted Faber as one of the few officials actively investigating potential fraud, but she warned that audits take significant time.

“People are complacent in the state of Ohio and in so many of these agencies,” Cooke added. “It’s not their tax dollars. It’s ours. They don’t care about Ohioans. They don’t care about Americans. They just want to keep funneling money out the door as long as they get paid.”

Without immediate accountability, Cooke warned, taxpayers will continue to fund a system vulnerable to exploitation.

Ohio Governor Candidate Vivek Ramaswamy Reveals 288 Companies At One Single Address Are Billing Medicaid!

Ohio is home to the second-largest Somali community in the United States, after fraud-wracked Minnesota.  An estimated 70,000 Somali residents are concentrated in Columbus, which just happens to be the state capitol!

https://nypost.com/2026/05/10/us-news/ohio-gov-candidate-vivek-ramaswamy-sounds-alarm-about-medicaid-fraud-after-288-companies-found-registered-to-same-address/

Ohio gov candidate Vivek Ramaswamy sounds alarm about Medicaid fraud — after 288 companies found registered to same address
By Chris Nesi - May 10, 2026

Ohio gubernatorial hopeful Vivek Ramaswamy is calling for a major crackdown on Medicaid fraud in the state after a probe allegedly uncovered millions of dollars in taxpayer funds being funneled to nonexistent home-healthcare companies.

The investigation found 288 separate Ohio home-healthcare companies with the same address — while listed locations for some of the supposed businesses appeared run-down or abandoned with no evidence any services were actually being provided.

“We’re going to have to take a deep, hard look at the way the $40-plus billion in state Medicaid dollars are being spent,” Ramaswamy told Fox News host Kayleigh McEnany during an appearance on “Saturday in America.”

“I think the right answer is any instance of waste, fraud, abuse … deserve[s] to be prosecuted, and we intend to investigate them aggressively, as well as to prosecute aggressively, to send a deterrent signal that our government is not a piggy bank, the taxpayer is not a piggy bank to be bilked,” he said.

The billionaire Republican candidate sounded the alarm after the recent Daily Wire report alleging widespread fraud reminiscent of what investigators found at dozens of purported childcare businesses operating in Minneapolis in recent months.

Republican Gov. Mike DeWine’s office fired back at Ramaswamy’s suggestion that social-services fraud is happening unchecked in the state.

In a statement to Fox News, DeWine’s office claimed Ohio has “extensive oversight mechanisms in place,” including “electronic visit verification for hourly care, requiring signed daily activity logs, conducting audits and surveys performing background checks on providers, and reassessing medical needs regularly.”

The term-limited governor’s office cited additional existing measures to root out would-be scammers, including “internal agency efforts to fight waste, fraud and abuse.”

In a statement to the outlet, the Ohio Department of Medicaid acknowledged the concerns the article raised, particularly in Franklin County, and said it has been “actively investigating these matters” even before the report was published.

“Upon initial review, some of the entities mentioned in the series are no longer Ohio Medicaid providers or have not billed Medicaid in several years. Some other providers are subject to ongoing investigation,” the statement said.

Ramaswamy chalked up the alleged rampant fraud as “downstream policies” of open borders and an “overgrown federal welfare state.

“That’s a big problem,” he said.

“We can’t fix the past. We can fix the future, and one of the things that I intend to do is to just take a dispassionate look at this,” he said.

“It’s not just responding to one news story or another as a game of whack-a-mole. The way I look at this is this is more of a broken-windows theory, which means that, if you have a broken window somewhere, it’s a reminder that we have to take a systematic look at the whole thing.”

Speaking of Medicaid fraud in Ohio, a profound money shot:

One big problem with Medicaid is that, because of the way it’s financed, fraud actually pays dividends to the states, which get federal matching dollars for every dollar spent on providing Medicaid benefits. So, if the state doles out hundreds of millions of dollars to phony day care, hospice, or “home health” companies, Washington kicks in hundreds of millions, which the state can then use to pay for legitimate healthcare.

https://issuesinsights.com/2026/05/08/which-state-is-next-in-the-medicaid-fraud-o-rama/

https://www.dailywire.com/news/medicaid-millionaires-how-the-feds-pay-immigrants-billions-to-hang-out-with-their-families

Which State Is Next In The Medicaid Fraud-O-Rama?
By I & I Editorial Board - May 8, 2026

When the scale of the Medicaid fraud in Minnesota started to emerge, our first thought was that, if it’s that easy to rip off Medicaid, the North Star State can’t be the only place where it’s happening.

Turns out we were right, as the Daily Wire’s exposé of massive fraud schemes in Ohio makes clear. Which means there are almost certainly still more to be uncovered. Which leads to the question of why we are learning about this only now.

Daily Wire is releasing a five-part series that alleges massive fraud in an Ohio Medicaid program – a state that obtained a waiver so it could reimburse “home healthcare.” The idea made sense. Care at home is cheaper than in skilled nursing facilities.

But it threw open the door to flagrant abuse.

As the Daily Wire’s Luke Rosiak explains, “Ohio pays people to go to Medicaid beneficiaries’ homes to perform ‘homemaking’ and ‘chores’ like cooking and cleaning. The people performing these ‘personal services’ tasks don’t even have to be healthcare workers — and in many cases, are actually relatives of the Medicaid recipient.”

Rosiak dug into a treasure trove of Medicaid data released by DOGE and found the same thing being uncovered by independent journalists in Minnesota and in California. Obvious cases of fraud. Storefronts that don’t appear to be doing anything other than billing Medicaid. And, as it turns out, lots of immigrants are running these scams.

In the second part of his series, he reports finding 288 “home health” companies in just seven buildings in Columbus, Ohio, that collectively billed Medicaid $250 million.

So now, independent, muckraking journalists have uncovered massive child care fraud schemes in Minnesota, hospice fraud schemes in California, and a bustling “home health” care racket in Ohio.

And in each case, the governors have dismissed the allegations, claiming that their administration is aggressively rooting out fraud and that this is all just MAGA types causing trouble.

Even Ohio Gov. Mike DeWine’s initial statement – after the Daily Wire’s first article in the series was published – was dismissive of the report, saying that it “does not seem to allege any fraud in the details provided.”

One big problem with Medicaid is that, because of the way it’s financed, fraud actually pays dividends to the states, which get federal matching dollars for every dollar spent on providing Medicaid benefits. So, if the state doles out hundreds of millions of dollars to phony day care, hospice, or “home health” companies, Washington kicks in hundreds of millions, which the state can then use to pay for legitimate healthcare.

So, how many more Medicaid schemes are out there? How many schemes involve food stamps? Obamacare? Medicare?

If the journalism profession weren’t so hopelessly captured by the Democratic Party, every investigative journalist at every major news outlet in every state would be digging into to see if it’s happening in their hometowns.

But our guess is that zero are, because it would be seen as somehow helping Donald Trump.

Instead, reporters are filing stories about the “devastating,” “draconian,” and “deadly” Medicaid cuts Republicans approved as part of the One Big Beautiful Bill Act.

Typical is an NPR headline from last week: “It’s Day 1 of Medicaid work requirements in Nebraska. People are worried.” The Bulwark, which is so insanely anti-Trump that it now makes the Huffington Post look sensible, cried that “Trump’s Big Medicaid Cuts Are About to Get Very Real.”

You’d think Democrats would be as adamant as anyone about rooting out fraud. After all, every dollar that goes to a con artist is a dollar that isn’t being used to help the needy.

But as we’ve said before, for today’s Democrats, fraud isn’t a bug that needs to be stamped out. It’s a feature that enriches their friends and family — and gets them reelected.

— Written by the I&I Editorial Board

The history of the fraud-prone T1019 Medicaid personal-care billing code by Walter Curt, a Senior Fellow at Restoration of America and the founder of The W.C. Dispatch:

https://www.realclearinvestigations.com/articles/2026/05/14/unbridled_spending_billions_for_medicaid_program_congress_never_approved_1182576.html

Unbridled Spending: Billions for Medicaid Expansion Congress Never Approved
By Walter Curt, RealClearInvestigations - May 14, 2026

The Biden administration may have failed to convince Congress to double Medicaid spending on home healthcare in 2021, but the funding increase occurred anyway.

An RCI analysis of federal data has found that spending on the program, which pays health aides and family members to act as caregivers for elderly and disabled adults, nearly doubled between 2019 and 2024, to $46.4 billion a year – an amount nearly identical to the $50 billion per year Biden wanted. As a result, American taxpayers paid more than $217 billion for home-based care under the program during that five-year span.

Lacking congressional approval, policymakers simply moved the initiative out of Washington and down to the state Medicaid agencies.

Although the expansion was promoted as a way to reduce reliance on more expensive nursing homes, federal data show that did not happen. Medicaid spending on nursing facilities rose by nearly $5 billion in the same five years, to $46.3 billion. In addition, the sprawling home care program has become the subject of a growing set of fraud probes and prosecutions involving the billing codes at the center of the new spending.

The data suggest that the complex landscape of healthcare offers myriad ways for states and providers to access large amounts of federal funding.

Promises

The spending boom traces back to a March 2021 White House proposal. As part of its American Jobs Plan, the Biden administration called for $400 billion in new federal spending over eight years to expand home and community-based care under Medicaid. “President Biden believes more people should have the opportunity to receive care at home, in a supportive community, or from a loved one,” the White House said in its rollout.

Advocacy groups had long sought a vast expansion of home care. AARP told policymakers that home- and community-based services would “prevent or delay frail seniors and persons with disabilities from being admitted to nursing homes,” and that the cost would be a fraction of facility-based care – about $1,300 per person per year for community support against $25,000 to $37,000 per year for a Medicaid nursing-home bed. Justice in Aging, a national legal advocacy organization focused on older adults, said nursing home care was four times more expensive than community-based services and that older adults without home-care access were five times more likely to enter a nursing home.

The federal government put a number on the projected savings. The Department of Health and Human Services’ Office of the Assistant Secretary for Planning and Evaluation projected that for every additional dollar Medicaid spent on home care, nursing-home spending would drop by about 26 cents. Those were the figures used to make the case to Congress and to the public.

Justice for Aging and the Department of Health and Human Services did not respond to requests for comment.

Congress Unconvinced

President Joe Biden's proposal for a vast expansion of home care was never passed by Congress but the funding flowed anyway.

Congress was not convinced. The home-care expansion was cut to $150 billion in the Build Back Better Act, which did not win passage and then dropped entirely from the Inflation Reduction Act, which Biden signed into law in 2022.

Much of the money was spent anyway. When federal legislation stalled, the mechanism for delivering funding shifted from Congress to state Medicaid agencies. The Centers for Medicare and Medicaid Services worked with state programs to expand existing waivers, raise reimbursement rates paid to home-care providers, and build out programs that pay family members to act as caregivers. States that wanted to grow their spending pulled the regulatory levers they already had. States that hesitated were offered federal matching dollars, technical assistance, and a steady drumbeat of CMS guidance encouraging them to expand.

By 2024, Medicaid spending on the home-health bundle – personal-care services, home health aides, skilled nursing in the home, and the related billing codes that capture the bulk of the dollars – was $22 billion higher per year than in 2019. That increase amounted to roughly 44% of the annual expansion the Biden White House had originally sought from Congress, achieved without Congress ever approving the program.

Blue State Windfall

Most of the dollars were accessed by Democratic-controlled states. New York alone reached $15.67 billion in Medicaid home-health spending by 2024 – roughly a third of the national total – through its Consumer Directed Personal Assistance Program, which allows beneficiaries to hire a relative as the paid caregiver. Massachusetts, New Jersey, Illinois, California, and Pennsylvania all rank in the top tier of absolute spending growth. Pennsylvania’s home-health bill grew more than twelvefold over five years.

The fastest percentage growth between 2019 and 2024 came in Republican-controlled states with smaller base programs. Texas grew its Medicaid home-health spending by 330%. Arkansas grew by 352%. Alabama, 250%. Spending rose in every state in the union.

These numbers may grow due to lengthening waiting lists for people seeking home-care services. According to a Kaiser Family Foundation analysis of state Medicaid agency data, the number of Americans on waiting lists for Medicaid home- and community-based services has risen rather than fallen since 2019, despite the $217 billion expansion. Advocates say this is a reflection of the growing need for such services.

As the home-care proponents predicted, the number of Medicaid beneficiaries actually living in nursing homes did fall during the five-year period. Unique Medicaid nursing home users went from 1.57 million in 2019 to 1.29 million in 2023, a 17.7% decline. Most of the drop happened during the pandemic, when COVID-19 swept through nursing facilities and prompted admissions freezes at many homes in 2020 and 2021. Since 2021, the Medicaid nursing home population has been climbing again.

Rising Prices

But this did not produce savings, as states sharply increased the rates they paid to facilities. Medicaid spending on nursing homes grew from $41.4 billion in 2019 to $46.3 billion in 2024. The cost per resident per day at Medicaid-certified nursing facilities climbed from $313.66 in 2019 to $401.98 in 2024, a 28% increase.

The same dynamic occurred with reimbursements for home care. State Medicaid agencies raised home-care reimbursement rates sharply during and after the pandemic – 15% to 30% in many states – and most of those increases were never rolled back.

The official justification was a workforce shortage. The claims-level data show a different pattern. While Medicaid spending on home health grew 91% over five years, the number of providers billing Medicaid for these services barely grew, and the number of unique beneficiaries grew only modestly. What climbed each year was the price per claim and the price per beneficiary.

The larger share bought expanded eligibility – programs designed to enroll people who would not otherwise have entered a nursing home. The clearest example is New York’s Consumer Directed Personal Assistance Program, which allows the Medicaid beneficiary to hire a relative as the paid caregiver. According to a claims-level analysis of CMS Transformed Medicaid Statistical Information System (T-MSIS) data, the New York program grew from a niche state option into the single largest line item in Medicaid home-care spending nationally.

The total number of people involved in the program is hard to discern because federal claims data do not separate individual family caregivers from agency providers. In a self-directed Medicaid program such as home-care, the beneficiary – not an agency – picks and hires the caregiver, and the state pays that caregiver directly. The caregiver is most often a family member, a friend, or a neighbor. In states with large self-directed programs, the count of paid family caregivers is likely to be in the tens of thousands of individuals. State enrollment standards for self-directed and family caregivers were also relaxed during the pandemic, with documentation requirements reduced and licensing barriers lowered to expand the workforce.

Fraud Magnet

The expansion has become a documented vehicle for fraud. The U.S. Department of Justice and the HHS Office of Inspector General have brought a growing number of prosecutions involving the T1019 personal-care billing code – including fraudulent hours never worked, billing for deceased beneficiaries, and family-member billing schemes in which the care was either never delivered or was billed at a fraction of the claimed hours.

In December 2024, Pennsylvania Attorney General Michelle Henry announced charges against a suburban Philadelphia home-care agency, its owner, and 18 other people in a scheme that allegedly defrauded the state’s Medicaid program out of millions of dollars. The Department of Justice’s Health Care Fraud Unit listed multiple home-health prosecutions in its 2025 national case summaries.

Vice President JD Vance said he's directing the Federal Fraud Task Force to examine home-care spending.

The Daily Wire’s recent investigation of Ohio’s multi-billion-dollar home-care industry found a lack of oversight. “Since the services are performed inside private residences, there is no way to know whether the workers went at all, or what they’re actually doing in exchange for taxpayer funds,” Luke Rosiak reported. “An infinite number of small black boxes inside a black box. Multiple signs said the service provided, and billed to the government, was sometimes just ‘companionship & conversation.’”

Even as Ohio says it has ongoing probes into its home-care spending and Vice President JD Vance announced he’s directing the federal Fraud Task Force he heads to examine the Buckeye State, RCI’s analysis suggests a deeper problem – the extent to which massive federal dollars can flow without congressional approval.

Budget hawks say fraud must be addressed, but even that does not address the underlying mechanisms – massive funding with relatively little oversight – that invite runaway spending and abuse. The recent history of home-care funding also highlights the often false premises on which many government programs are sold to the American people.

Walter Curt is a Senior Fellow at Restoration of America and the founder of The W.C. Dispatch. Follow him on X at @wcdispatch and at wcdispatch.com.

@10x25mm Nursing home fraud was my entertainment this evening. Residents and their families commonly complain about absentee owners and off-site managers, but they're only the tip of an incredibly large iceberg.

This 80-minute expose from the Long Term Care Community Coalition (LTCCC) features guest Ernest Tosh, former prosecutor turned nursing home fraud specialist. He starts with the foundational legal structures that permit fraud. In his example, a typical 8 businesses run 3 facilities like a shell game. The fraud explodes from there into staffing, massaged payment reports, mortgage fraud, and financial fraud of all kinds.

Interestingly, Mr. Tosh is working the Dana Nessell, among other state AG's. He advises a state rather than federal approach to pin down fraudsters and make it stick. 

Tracking Nursing Home Dollars: Oversight and Insights

(May 12, 2026)

https://www.youtube.com/watch?v=q8GH1iQg8Kk