Luke Rosiak

Hey, John.

Thanks for having me.

Yeah, this is Billions with a B. There's been a lot of focus on fraud in Minnesota lately for good reason, the great work of Nick Shirley and others.

It's important for people to understand the root of that is these Medicaid waivers.

that allow certain states to do things with U.S.

dollars that are far beyond what the medical program was ever intended to cover.

I found that another state with easily defrauded Medicaid expansions is actually Ohio, which will pay people to do homemaking and chores for the elderly, even just conversation and companionship.

And a lot of the people getting these checks are actually just the family members of the old people.

So they're getting paid to sit in their own houses and talk to their own family members.

Yeah.

And home health care in Ohio cost a billion dollars in 2024 alone.

That outpaces actual medical procedures, the kind with high paid doctors and expensive devices.

Well, originally the idea was that nursing homes are very expensive, so it might actually be cheaper to send people to their houses and help them out so that they could stay in their homes.

The problem is not a lot of people try to fake their way into nursing homes, but if you can pretend to be a little more infirm than you really are and it results in free government checks to your family members and you don't have to change anything about your life, suddenly a lot of people start feeling really infirm.

So that basically created this tinderbox.

And then what really lit the match is Ohio ran into the same toxic combination as Minnesota, which is generous government programs that rely on trust and then a massive infusion of immigrants from low-trust third-world societies.

Oh, yeah.

I mean, I toured hundreds of home health care offices and I barely saw a single American.

I mean, anybody who says they don't notice the pattern is kind of too blind to be involved in policy.

The home health care operators themselves will acknowledge that pattern by saying it's racist to question home health care itself.