President Trump: Making America Great Again...

[myboynoah]

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[Bo Diddley]

The fraud mentioned in the report, versus going after political enemies via frivolous investigations.

That and maybe do a bit more auditing of money that gets paid out.

[myboynoah]

That and maybe do a bit more auditing of money that gets paid out.

You would think that would have been happening, but maybe those folks are part of the fraud as well. Hopefully the auditing dept didn't get DOGEed out of existence.

[dabrockster]

The DOJ and FBI would do well to focus on some real crimes.

This is a GOP state. Let’s see if the DOJ and FBI can be impartial in this and investigate.

Where there is smoke…

[Northwestcoug]

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Gerrymandering is a bipartisan issue. But unless I'm mistaken, ham-fisted political intimidation coming from the very top is a new low, and a very unique GOP thing. LMK if I'm wrong!

[BigFatMeanie]

That and maybe do a bit more auditing of money that gets paid out.

You would think that would have been happening, but maybe those folks are part of the fraud as well. Hopefully the auditing dept didn't get DOGEed out of existence.

In addition to auditing, we could always try shrinking and even eliminating <gasp!> the myriad government programs that are prime targets for fraud and abuse. Just sayin'...

[myboynoah]

In addition to auditing, we could always try shrinking and even eliminating <gasp!> the myriad government programs that are prime targets for fraud and abuse. Just sayin'...

Not against that. A real audit should be a first step. Maybe we outsource that to a private sector entity.

Still, this case seems ripe for DOJ and FBI action. Maybe we could take some of those FBI guys off of the ICE duty.

[BigFatMeanie]

Not against that. A real audit should be a first step. Maybe we outsource that to a private sector entity.

Still, this case seems ripe for DOJ and FBI action. Maybe we could take some of those FBI guys off of the ICE duty.

Not against that. They would still be going after Somalis so what's not to like?

[dabrockster]

In addition to auditing, we could always try shrinking and even eliminating <gasp!> the myriad government programs that are prime targets for fraud and abuse. Just sayin'...

Isn’t that what they are attempting to do right now and getting stone-walled by Dems?

Medicaid and the ACA is filled with fraud and no real compliance to address the issues. Believe me.

When For-profit and Nonprofits like the following are generating this amount of revenue (Per ChatGPT). It seems to be a problem..

Organization	2024 Revenue (Approx.)	Organization Type
UnitedHealth Group	~$400 billion	For-Profit (largest US insurer)Â
Centene Corporation	~$163 billion	For-Profit (insurer)Â
Molina Healthcare	~$40.65 billion	For-Profit (insurer)Â
Kaiser Permanente	~$115.8 billion	Nonprofit health system
CommonSpirit Health	~$37.5 billion	Nonprofit health system
Mayo Clinic	~$19.8 billion

[LVAllen]

FFS. THIS is what Fox is screaming about?

She explained that scammers in the community have been exploiting a loophole in Ohio’s Medicaid program that allows individuals to receive Medicaid payments, totaling as much as $91,000 per year per individual, for care they are supposedly providing to a family member.

It's not a loophole. It's a law (Section 1915(c) of the Social Security Act) that is intended to reduce Medicaid costs. In Ohio in particular, you need one of three levels of care: Nursing Facility, Developmental Disability, or Mental Illness. So, it's payment of services provided in the home or in the community which would otherwise be required to pay for these people's care in a full-time care facility like a nursing home. I assure you, that's far more expensive. Home and Community Based Services Waivers are very, very common, but the approvals aren't given out like candy. First the Medicaid recipient need to be qualified for Medicaid in the first place. And yes, that means US citizenship, no matter what your local conservative commentator insists. As of June 2025, there were 112k waivers in Ohio.

Also, the Medicaid recipient doesn't need to be "bedridden." Holy hell. Tell me you've never been inside a nursing home without telling me you've never been inside a nursing home. In a SNF or rehab center, they do their utter best to make sure those folks are up and mobile as much as possible.

After they get Medicaid-eligible, there is an intake process with Medicaid-approved agencies. Those agencies work with the Department of Aging. If the intake agencies aren't doing their job, report them to the AG Medicaid Fraud Unit.

This entire story is a load of crap. My guess is that once other people start to investigate this, you'll learn that the big story is that Suprise Surprise, Somalis tend to take care of the elderly in their community because they don't trust non-community members to do it. For more examples of this mentality, see the Filipino community, the Hmong community, etc. Meanwhile, foreign-born folks also tend to be massively overrepresented in the home health care / direct providers / nursing assistant categories, where they make up 1/3 of all providers.

[chrisrenrut]

Isn’t that what they are attempting to do right now and getting stone-walled by Dems?

Medicaid and the ACA is filled with fraud and no real compliance to address the issues. Believe me.

When For-profit and Nonprofits like the following are generating this amount of revenue (Per ChatGPT). It seems to be a problem..

Organization	2024 Revenue (Approx.)	Organization Type
UnitedHealth Group	~$400 billion	For-Profit (largest US insurer)Â
Centene Corporation	~$163 billion	For-Profit (insurer)Â
Molina Healthcare	~$40.65 billion	For-Profit (insurer)Â
Kaiser Permanente	~$115.8 billion	Nonprofit health system
CommonSpirit Health	~$37.5 billion	Nonprofit health system
Mayo Clinic	~$19.8 billion

I agree with the premise that the fraud in Medicaid and ACA is mostly done by corporations.
I
t is incredibly hard for average people to defraud these programs, by design. I have a DIL on Medicaid and a son on ACA. I help them with their enrollments and documentation because it can be complicated and time consuming, especially for Medicaid.

So why aren’t we focusing on reforming the system to prevent corporations, PBMs, and providers. It’s much easier for politicians and pundits to make immigrants and poor people the bad guys instead of

[dabrockster]

FFS. THIS is what Fox is screaming about?



It's not a loophole. It's a law (Section 1915(c) of the Social Security Act) that is intended to reduce Medicaid costs. In Ohio in particular, you need one of three levels of care: Nursing Facility, Developmental Disability, or Mental Illness. So, it's payment of services provided in the home or in the community which would otherwise be required to pay for these people's care in a full-time care facility like a nursing home. I assure you, that's far more expensive. Home and Community Based Services Waivers are very, very common, but the approvals aren't given out like candy. First the Medicaid recipient need to be qualified for Medicaid in the first place. And yes, that means US citizenship, no matter what your local conservative commentator insists. As of June 2025, there were 112k waivers in Ohio.

Also, the Medicaid recipient doesn't need to be "bedridden." Holy hell. Tell me you've never been inside a nursing home without telling me you've never been inside a nursing home. In a SNF or rehab center, they do their utter best to make sure those folks are up and mobile as much as possible.

After they get Medicaid-eligible, there is an intake process with Medicaid-approved agencies. Those agencies work with the Department of Aging. If the intake agencies aren't doing their job, report them to the AG Medicaid Fraud Unit.

This entire story is a load of crap. My guess is that once other people start to investigate this, you'll learn that the big story is that Suprise Surprise, Somalis tend to take care of the elderly in their community because they don't trust non-community members to do it. For more examples of this mentality, see the Filipino community, the Hmong community, etc. Meanwhile, foreign-born folks also tend to be massively overrepresented in the home health care / direct providers / nursing assistant categories, where they make up 1/3 of all providers.

You have no clue what you are talking about..

[dabrockster]

I agree with the premise that the fraud in Medicaid and ACA is mostly done by corporations.
I
t is incredibly hard for average people to defraud these programs, by design. I have a DIL on Medicaid and a son on ACA. I help them with their enrollments and documentation because it can be complicated and time consuming, especially for Medicaid.

So why aren’t we focusing on reforming the system to prevent corporations, PBMs, and providers. It’s much easier for politicians and pundits to make immigrants and poor people the bad guys instead of

Because the Dems and GOP are all in bed with these major corporations. They hold all the cards and are the entities in the marketplace. They lobby for all fund to be funneled through them and the ACA as well as Medicaid.

Want to read up on the corruption that is our healthcare system, Check out Dutch Rojas n his LinkedIn and his website as he lays out the issues we see in our ACA and the state level.

https://www.linkedin.com/in/dutchrojas?utm_source=share&utm_campaign=share_via&utm_content=profile&utm_medium=ios_app

[Northwestcoug]

FFS. THIS is what Fox is screaming about?



It's not a loophole. It's a law (Section 1915(c) of the Social Security Act) that is intended to reduce Medicaid costs. In Ohio in particular, you need one of three levels of care: Nursing Facility, Developmental Disability, or Mental Illness. So, it's payment of services provided in the home or in the community which would otherwise be required to pay for these people's care in a full-time care facility like a nursing home. I assure you, that's far more expensive. Home and Community Based Services Waivers are very, very common, but the approvals aren't given out like candy. First the Medicaid recipient need to be qualified for Medicaid in the first place. And yes, that means US citizenship, no matter what your local conservative commentator insists. As of June 2025, there were 112k waivers in Ohio.

Also, the Medicaid recipient doesn't need to be "bedridden." Holy hell. Tell me you've never been inside a nursing home without telling me you've never been inside a nursing home. In a SNF or rehab center, they do their utter best to make sure those folks are up and mobile as much as possible.

After they get Medicaid-eligible, there is an intake process with Medicaid-approved agencies. Those agencies work with the Department of Aging. If the intake agencies aren't doing their job, report them to the AG Medicaid Fraud Unit.

This entire story is a load of crap. My guess is that once other people start to investigate this, you'll learn that the big story is that Suprise Surprise, Somalis tend to take care of the elderly in their community because they don't trust non-community members to do it. For more examples of this mentality, see the Filipino community, the Hmong community, etc. Meanwhile, foreign-born folks also tend to be massively overrepresented in the home health care / direct providers / nursing assistant categories, where they make up 1/3 of all providers.

Arizona has very similar plans. For years my Mom took care of my ailing grandparents in her home, and the state government gave her a relatively generous stipend to do it. There was no meaningful oversight. Later on she also got a state stipend for respite care for my autistic nephews. It was basically weekly grandma time, but the state dutifully paid her.

I'm sure there's fraud in the Somalia community. But I'm going to wait awhile and see if it's significantly worse than what is happening elsewhere.

[Bo Diddley]

Not against that. They would still be going after Somalis so what's not to like?