Medicaid corruption, now Ohio

[Newman]

The Babylon Bee had a headline a day or three ago, Theologians Struggling To Explain How Loving God Could Allow Ohio | Babylon Bee, but where my bad memories are based on Ohio's ridiculously cold winters during my college years, the Bee surveys the general landscape. Even so, they don't touch on unfolding revelations about corruption in the state, on a scale which may well rival Minnesota:

DW Investigates ‘Home Care’ Scheme Stealing Billions Of Your Hard-Earned Money (Luke Rosiak, Daily Wire)

Just before the Department of Government Efficiency closed its doors, it made a quiet move that may end up as its most lasting impact on the federal deficit.

DOGE published a massive trove of data in February that, for the first time, lets the public see what companies are billing Medicaid for. For decades, the payouts have been shrouded in secrecy. One of the largest government programs was a black box.

I’ve spent the past two months diving into the numbers. What I found was the most blatant waste of federal dollars that I have encountered in my two decades as an investigative reporter.

This is the first part of “Medicaid Millionaires,” a Daily Wire series exposing billions of dollars in dubious “personal services” payments where people are paid to spend time with their own family.

I set my sights on Ohio, which like Minnesota, has been granted waivers to expand Medicaid well beyond its original purpose. Under the guise of health care, 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 health care workers — and in many cases, are actually relatives of the Medicaid recipient.

As people have realized the United States government will pay them to hang out with their own families, northeast Columbus has seen its economy replaced by businesses that bill Medicaid. And Columbus, a city with the second largest Somali population in the country, has become, on the surface, the most unhealthy city on the planet.

We went down several of those rabbit holes. In the coming days, you’ll meet:

• A politician who founded an $11 million home health care company that he appeared to run part-time — without even mentioning it in his political biography — who funded his campaign with donations from other home health care owners.
• A woman who reinvented her janitorial LLC as a “health” provider, then billed Medicaid nearly $100,000 the first month.
• A landlord who bought airplanes after renting space to hundreds of home health care companies that billed Medicaid a quarter of a billion dollars.. . . .

etc.

Here we go again, staring at a level of theft that just boggles the mind.

[Celeste Chalfonte]

The Babylon Bee had a headline a day or three ago, Theologians Struggling To Explain How Loving God Could Allow Ohio | Babylon Bee, but where my bad memories are based on Ohio's ridiculously cold winters during my college years, the Bee surveys the general landscape. Even so, they don't touch on unfolding revelations about corruption in the state, on a scale which may well rival Minnesota:

DW Investigates ‘Home Care’ Scheme Stealing Billions Of Your Hard-Earned Money (Luke Rosiak, Daily Wire)
etc.

Here we go again, staring at a level of theft that just boggles the mind.

And once again, these started out as low-cost alternatives to institutionalization, but were abused.

CA has a program called "in-home support services." It's actually an excellent program. It allows people who would otherwise be in assisted living or even nursing homes paid for by Medi-Cal (Medicaid) to remain in their homes. If they would qualify for Medicaid-paid home health care (which uses certified home health aides and more costly certificated providers), but have a relative or other person who meets the criteria for providing unskilled or semi-skilled care related to the disability/medical condition, that person can be paid to provide the care that Medicaid would be paying for anyway. They are not paid to "hang out with" their disabled family member. The disability or medical condition is medically assessed, the number of hours the care ought to take is determined, and the provider files timesheets like any other employee.

Are there abuses? Almost certainly, just as there are abuses by hospitals, doctors' offices, physical therapists, etc. Oversight could definitely be improved in all aspects of health care.

A nursing home costs between $5000 and $15,000/month or more. A home health aide was $1500/month back when my grandmother started requiring full-time care; that was for 8 hours, and we took shifts along with our day jobs for the other 16 hours/day. She didn't qualify for any assistance. Nowadays, it's about $4800. HRH was the IHSS worker for a young woman (stroke victim) in the town where we lived before we moved here. With about 12 - 15 hours/week, her client could live in her own home instead of an assisted living facility. HRH did specific tasks for her that she couldn't manage, and it cost the state about $900/month. Without assistance, her client would have had to be in a residential facility, at the state's expense.

I really hate that there are people who take advantage of good programs to enrich themselves, but that doesn't mean the program is intrinsically bad; it means it's badly managed.

[80zephyr]

I did some remodeling at an apartment complex 15 or 20 years ago. Was talking to a woman and her 20 something daughter. The daughter was an insomniac that qualified for welfare, and mom got paid to take care of her.

Wonder how she would have slept after working a full time job.

Mark

[Celeste Chalfonte]

I did some remodeling at an apartment complex 15 or 20 years ago. Was talking to a woman and her 20 something daughter. The daughter was an insomniac that qualified for welfare, and mom got paid to take care of her.

Wonder how she would have slept after working a full time job.

Mark

There will always be some.

Back in the 70s when I worked in social services, we had a standing joke that "low back pain" was some sort of doctors' code for "chronic alcoholism." There were, of course, people on disability and food stamps who had worked hard physical unskilled labor and genuinely could not work any more. And others who were alkies with a cooperative doctor.

Some fraud and/or abuse is inevitable. Rampant fraud and abuse is a major system failure or a policy.

[80zephyr]

There will always be some.

Back in the 70s when I worked in social services, we had a standing joke that "low back pain" was some sort of doctors' code for "chronic alcoholism." There were, of course, people on disability and food stamps who had worked hard physical unskilled labor and genuinely could not work any more. And others who were alkies with a cooperative doctor.

Some fraud and/or abuse is inevitable. Rampant fraud and abuse is a major system failure or a policy.

I don't believe this was a fraud situation. The girl couldn't sleep, and mom was paid to watch her. Not fraud, a stupid system.

Mar

[Newman]

Over the years of my adult life, the "shocking," regularly recurring scandals were pension/retirement benefit abuse by city union workers. We'd learn that almost all subway workers, say, (I'm making it up—to lazy to look it up this morning) were retiring with low back pain, etc. Video would be released of some "disabled" retiree doing heavy labor somewhere.

That's a pinprick compared to this wave of pillaging.

[scott]

And once again, these started out as low-cost alternatives to institutionalization, but were abused.

CA has a program called "in-home support services." It's actually an excellent program. It allows people who would otherwise be in assisted living or even nursing homes paid for by Medi-Cal (Medicaid) to remain in their homes. If they would qualify for Medicaid-paid home health care (which uses certified home health aides and more costly certificated providers), but have a relative or other person who meets the criteria for providing unskilled or semi-skilled care related to the disability/medical condition, that person can be paid to provide the care that Medicaid would be paying for anyway. They are not paid to "hang out with" their disabled family member. The disability or medical condition is medically assessed, the number of hours the care ought to take is determined, and the provider files timesheets like any other employee.

Are there abuses? Almost certainly, just as there are abuses by hospitals, doctors' offices, physical therapists, etc. Oversight could definitely be improved in all aspects of health care.

A nursing home costs between $5000 and $15,000/month or more. A home health aide was $1500/month back when my grandmother started requiring full-time care; that was for 8 hours, and we took shifts along with our day jobs for the other 16 hours/day. She didn't qualify for any assistance. Nowadays, it's about $4800. HRH was the IHSS worker for a young woman (stroke victim) in the town where we lived before we moved here. With about 12 - 15 hours/week, her client could live in her own home instead of an assisted living facility. HRH did specific tasks for her that she couldn't manage, and it cost the state about $900/month. Without assistance, her client would have had to be in a residential facility, at the state's expense.

I really hate that there are people who take advantage of good programs to enrich themselves, but that doesn't mean the program is intrinsically bad; it means it's badly managed.

The aid and attendance programs are excellent when they do just what you describe. The VA even includes it for most elderly disabled veterans. The lack of oversight is the problem and the almost exclusive Democrat resistance to any scrutiny, reform or oversight shows where much of that campaign funding came from.

Does all of this recently uncovered fraud give you second thoughts about the system that was built?

[Celeste Chalfonte]

The aid and attendance programs are excellent when they do just what you describe. The VA even includes it for most elderly disabled veterans. The lack of oversight is the problem and the almost exclusive Democrat resistance to any scrutiny, reform or oversight shows where much of that campaign funding came from.

Does all of this recently uncovered fraud give you second thoughts about the system that was built?

Any system can be gamed of the people in it are not doing their jobs. X-reference the thread about staffing totalitarian governments or organizations with mediocre people.

The fraud doesn't give me second thoughts, because I already knew the system had had much of the necessary oversight stripped out of it, as has happened to virtually every "safety-net" program in CA and a number of other places.

We have a state program here (as do most states) to address industrial injuries that, in combination with pre-existing disabilities, result in total loss of earning capacity, much of which is otherwise uncompensated. It's a special state-operated trust fund variously called the "Subsequent Injuries Fund" or "Second Injuries Fund." It started out as a way to get employers to hire partially disabled veterans who otherwise qualified for the job, instead of refusing to hire them because they were at higher risk for work injuries and disability. The system was set up to be entirely funded by a small payroll tax. It worked well for nearly 70 years. Then some plaintiffs' lawyers, assisted by an ideology-driven administrative review board, started developing a body of case law that has resulted in CA's SIF becoming a money-hemorrhaging auxiliary retirement system for aging workers.

The original system was self-funding and highly functional. Currently, it's unsustainable. There's even a case holding unenforceable the statute that the legislature, in an unprecedented fit of rationality, enacted to prevent the funds being spent on illegal aliens. It has become nothing but another welfare program, and the surge in cases (average 1500 claims per adjuster these days) makes it impossible to enforce the few remaining safeguards against waste and fraud.

[Newman]

Any system can be gamed of the people in it are not doing their jobs. X-reference the thread about staffing totalitarian governments or organizations with mediocre people.

The fraud doesn't give me second thoughts, because I already knew the system had had much of the necessary oversight stripped out of it, as has happened to virtually every "safety-net" program in CA and a number of other places.

We have a state program here (as do most states) to address industrial injuries that, in combination with pre-existing disabilities, result in total loss of earning capacity, much of which is otherwise uncompensated. It's a special state-operated trust fund variously called the "Subsequent Injuries Fund" or "Second Injuries Fund." It started out as a way to get employers to hire partially disabled veterans who otherwise qualified for the job, instead of refusing to hire them because they were at higher risk for work injuries and disability. The system was set up to be entirely funded by a small payroll tax. It worked well for nearly 70 years. Then some plaintiffs' lawyers, assisted by an ideology-driven administrative review board, started developing a body of case law that has resulted in CA's SIF becoming a money-hemorrhaging auxiliary retirement system for aging workers.

The original system was self-funding and highly functional. Currently, it's unsustainable. There's even a case holding unenforceable the statute that the legislature, in an unprecedented fit of rationality, enacted to prevent the funds being spent on illegal aliens. It has become nothing but another welfare program, and the surge in cases (average 1500 claims per adjuster these days) makes it impossible to enforce the few remaining safeguards against waste and fraud.

Do you think that is by design?

I read long ago that massive government opens the door to massive fraud.

[Celeste Chalfonte]

Do you think that is by design?

I read long ago that massive government opens the door to massive fraud.

Which part?

Until fairly recently, it was a manageable little program designed to address a specific and limited need.

The case holding was absolutely by design. The Board (Workers' Compensation Appeals Board) is appointed by the Governor. It used to be somewhat balanced politically, since our governors are term-limited, but since CA became a one-party state, it has become ideologically skewed. To the extreme. Totally anti-employer and anti-insurer. All part of the war on business.

You'll seldom see me advocate for corporations, but in this, the game is rigged, and no employer - including the state itself - can comply with all the BS or afford to add jobs in this political climate.

[80zephyr]

Any system can be gamed of the people in it are not doing their jobs. X-reference the thread about staffing totalitarian governments or organizations with mediocre people.

The fraud doesn't give me second thoughts, because I already knew the system had had much of the necessary oversight stripped out of it, as has happened to virtually every "safety-net" program in CA and a number of other places.

We have a state program here (as do most states) to address industrial injuries that, in combination with pre-existing disabilities, result in total loss of earning capacity, much of which is otherwise uncompensated. It's a special state-operated trust fund variously called the "Subsequent Injuries Fund" or "Second Injuries Fund." It started out as a way to get employers to hire partially disabled veterans who otherwise qualified for the job, instead of refusing to hire them because they were at higher risk for work injuries and disability. The system was set up to be entirely funded by a small payroll tax. It worked well for nearly 70 years. Then some plaintiffs' lawyers, assisted by an ideology-driven administrative review board, started developing a body of case law that has resulted in CA's SIF becoming a money-hemorrhaging auxiliary retirement system for aging workers.

The original system was self-funding and highly functional. Currently, it's unsustainable. There's even a case holding unenforceable the statute that the legislature, in an unprecedented fit of rationality, enacted to prevent the funds being spent on illegal aliens. It has become nothing but another welfare program, and the surge in cases (average 1500 claims per adjuster these days) makes it impossible to enforce the few remaining safeguards against waste and fraud.

No good deed goes unpunished.

Mark

[scott]

Any system can be gamed of the people in it are not doing their jobs. X-reference the thread about staffing totalitarian governments or organizations with mediocre people.

The fraud doesn't give me second thoughts, because I already knew the system had had much of the necessary oversight stripped out of it, as has happened to virtually every "safety-net" program in CA and a number of other places.

We have a state program here (as do most states) to address industrial injuries that, in combination with pre-existing disabilities, result in total loss of earning capacity, much of which is otherwise uncompensated. It's a special state-operated trust fund variously called the "Subsequent Injuries Fund" or "Second Injuries Fund." It started out as a way to get employers to hire partially disabled veterans who otherwise qualified for the job, instead of refusing to hire them because they were at higher risk for work injuries and disability. The system was set up to be entirely funded by a small payroll tax. It worked well for nearly 70 years. Then some plaintiffs' lawyers, assisted by an ideology-driven administrative review board, started developing a body of case law that has resulted in CA's SIF becoming a money-hemorrhaging auxiliary retirement system for aging workers.

The original system was self-funding and highly functional. Currently, it's unsustainable. There's even a case holding unenforceable the statute that the legislature, in an unprecedented fit of rationality, enacted to prevent the funds being spent on illegal aliens. It has become nothing but another welfare program, and the surge in cases (average 1500 claims per adjuster these days) makes it impossible to enforce the few remaining safeguards against waste and fraud.

This supports my overall point that the government should not be in the business of redistributing income and that by providing better oversight instead of direct support the efficiencies gained will provide sustainability.

It's also why we should fix Social Security and the VA by means testing the benefits.

I'm friends with a couple who are retired at 45 and they each get:

Military pension: $3000
VA Disability: $4000
SSDI: $1800
Free healthcare for life as well.

That's over $17,000 per month, tax free, equivalent to a couple working and making $250K per year.

That's excessive and unsustainable.

The retirement pension is valid and fair. They both have combat deployments and served 22 years in the Army. The VA Disability and SSDI should be means tested.

[Newman]

This supports my overall point that the government should not be in the business of redistributing income and that by providing better oversight instead of direct support the efficiencies gained will provide sustainability.

It's also why we should fix Social Security and the VA by means testing the benefits.

I'm friends with a couple who are retired at 45 and they each get:

Military pension: $3000
VA Disability: $4000
SSDI: $1800
Free healthcare for life as well.

That's over $17,000 per month, tax free, equivalent to a couple working and making $250K per year.

That's excessive and unsustainable.

The retirement pension is valid and fair. They both have combat deployments and served 22 years in the Army. The VA Disability and SSDI should be means tested.

It does seem outrageous by the numbers, but I have to wonder about the disability part particularly. Genuine disability is not something I'd gladly trade for $4000/month. Seems odd, though, that they're both getting the same amount.

What is SSDI? (Stupid Shit; Don't Inquire?)

[scott]

It does seem outrageous by the numbers, but I have to wonder about the disability part particularly. Genuine disability is not something I'd gladly trade for $4000/month. Seems odd, though, that they're both getting the same amount.

What is SSDI? (Stupid Shit; Don't Inquire?)

It's not odd, they are both rated at 100% Permanent and Total, which is a designation that is fairly common for career military with combat deployments. Knee issues, back issues, ankle issues, PTSD, obesity, high blood pressure, tinnitus, hearing loss, and sleep apnea. That pays around $4000 per month which is why they both get the same amount. The ratings are now given out for diagnosed medical issues caused by something in their service (usually injuries documented while they were active duty) based on an uneven standard but generally how difficult working would be for the "average" person. I don't agree with that standard, but those are the rules we have now. One could say they earned it, but if that's the case just define a pension for certain events and deployments instead of only injuries - and fix the uneven application of those standards.

It should be needs based and not entitlement based. I know people who make $150K and run triathlons that are rated 100%. Meanwhile I met a guy last month who retired from the Army after 27 years, can barely hold down a job due to PTSD, doesn't have any friends, is very isolated, and just got denied VA disability even though he has a Purple Heart and two tours in Iraq and one in Afghanistan.

SSDI is Social Security Disability Income. It's a federal program that has the same problems as the VA - it's easily gamed, arbitrary, unevenly applies standards, and is not at all reflective of reality. People who should easily qualify for SSDI are denied due to the ability of their doctors in filling out paperwork while others seem to skate through because they hire expensive attorneys and have the means to hire consulting Physicians. SSDI should absolutely be needs based and it usually is, but since they don't work they don't have any taxable income - ergo, SSDI. This absolutely should be means tested for the entire financial situation. If you're disabled and can't work, you should demonstrate you actually need the money.

The couple above makes 50% more in retirement (and will for the rest of their lives) than they did on active duty - for 22 years of service, without investing a dime. That's unsustainable.

[80zephyr]

It's not odd, they are both rated at 100% Permanent and Total, which is a designation that is fairly common for career military with combat deployments. Knee issues, back issues, ankle issues, PTSD, obesity, high blood pressure, tinnitus, hearing loss, and sleep apnea. That pays around $4000 per month which is why they both get the same amount. The ratings are now given out for diagnosed medical issues caused by something in their service (usually injuries documented while they were active duty) based on an uneven standard but generally how difficult working would be for the "average" person. I don't agree with that standard, but those are the rules we have now. One could say they earned it, but if that's the case just define a pension for certain events and deployments instead of only injuries - and fix the uneven application of those standards.

It should be needs based and not entitlement based. I know people who make $150K and run triathlons that are rated 100%. Meanwhile I met a guy last month who retired from the Army after 27 years, can barely hold down a job due to PTSD, doesn't have any friends, is very isolated, and just got denied VA disability even though he has a Purple Heart and two tours in Iraq and one in Afghanistan.

SSDI is Social Security Disability Income. It's a federal program that has the same problems as the VA - it's easily gamed, arbitrary, unevenly applies standards, and is not at all reflective of reality. People who should easily qualify for SSDI are denied due to the ability of their doctors in filling out paperwork while others seem to skate through because they hire expensive attorneys and have the means to hire consulting Physicians. SSDI should absolutely be needs based and it usually is, but since they don't work they don't have any taxable income - ergo, SSDI. This absolutely should be means tested for the entire financial situation. If you're disabled and can't work, you should demonstrate you actually need the money.

The couple above makes 50% more in retirement (and will for the rest of their lives) than they did on active duty - for 22 years of service, without investing a dime. That's unsustainable.

Most disability payments are scams.

Mark