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John Ʌ Konrad V @johnkonrad - LONG POST WARNING: How did this Somali fraud happen?
I have a close relative who works inside this system. She processes medicalcare claims for a large provider, we’ll call it SMH, in a deep-blue state (not Minnesota).
What people miss is that the biggest fraud isn’t the checks written to individuals. It’s the staggering cost of administering the programs.
My relative isn’t some paper-pusher. She’s a nurse with multiple degrees, managing a full team. Her entire day is spent chained to a computer: nonstop paperwork, Zoom calls, audits. There’s a fingerprint scanner and a camera on her desk. Family emergency? Too bad. Break down in tears from abuse? Still too bad.
Now, start with a real medical event: heart attack, cancer, stroke. The hospital treats you, then pushes you home quickly because long stays are crazy expensive and the hospital doesn’t have enough beds. Fine.
But home recovery requires ramps, grab bars, equipment. The state cuts checks to upgrade homes. Many recipients simply pocket the money. The state knows this, but doesn’t have enough inspectors, so it forces SMH to do “due diligence.”
That means more paperwork. More subcontractors. More verification. More zoom meetings for my relative. One claim can consume hundreds of man-hours.
Then there’s a shortage of visiting nurses. So patients must travel for bloodwork and follow-ups. Transportation services exist, but they’re heavily regulated and audited. That’s expensive.
Cheaper solution? Pay family members. Give them money to add a ramp to a minivan and drive the patient themselves.
Have an uncle who already has a van (because he’s scamming the system too), great we pay him monthly and you have to do nothing.
Now the real games begin.
How much help you get depends entirely on how you answer Zoom questions. Normal Americans say things like, “My son can help” or “A neighbor can drive me.” That caps benefits.
But there are cheat codes.
Say instead:
“I care for my autistic grandson.”
“I provide childcare for my niece.”