Is There Any Fraud in Medicare ?  Here’s a Place to Start Looking

Elon Musk, of the Department of Government Efficiency, has asserted that his goal is to cut some $1 trillion of “waste and fraud” from annual federal spending. Skeptics of the effort say that that’s just not possible, mainly because almost half of federal spending constitutes the “entitlements” — Social Security, Medicare, Medicaid, and some smaller health insurance programs — and President Trump has pledged not to cut those. Add something close to $1 trillion for defense, and another close to $1 trillion for interest on the national debt, and the remainder (less than $2 trillion) doesn’t leave nearly enough room for a trillion of cuts.

But here’s the missing piece: What if there are large amounts of fraud in the entitlement programs? Trump hasn’t pledged not to go after that. Could the amounts of such fraud be significant in the context of the huge numbers at issue? I don’t fully know the answer to that question; but today I’ll look at one example involving very big numbers where obvious fraud is hiding in plain sight.

First, a look at the big picture numbers. The Center on Budget and Policy Priorities has on its website an overview of federal spending dated January 28, 2025, providing figures for fiscal year 2024 (which ended on September 30, 2024). The big categories:

– Federal spending for fiscal year 2024 was approximately $6.9 trillion.

– Health insurance entitlements (Medicare, Medicare, CHIP, and Obamacare subsidies totaled $1.7 trillion, or 24% of spending.

– Social Security totaled $1.5 trillion, or 21% of spending.

– Defense totaled $872 billion, or 15% of spending.

– Interest on the debt was about $892 million, or another 15% of spending.

– The remainder added up to $1.936 trillion.

And now, here’s a good place to start looking for fraud in the entitlements. In New York we have something called the Consumer Directed Personal Assistance Program. Bloomberg had a piece about it in July 2024, which is behind paywall, but Newsweek re-wrote the story here. The idea, supposedly, was that we could use Medicaid funds to pay relatives like spouses and children to take care of their infirm relatives, and thus save the costs of professional aides, let alone nursing homes. From Newsweek:

“Oftentimes, ideas that start with the best of intentions can be taken advantage of in the wrong hands,” Alex Beene, a financial literacy instructor at the University of Tennessee at Martin, told Newsweek. “With home health, some states like New York thought it would be a good idea to allow family members and friends to get paid for providing home health assistance to loved ones using Medicaid and Medicare dollars.

So what’s the problem?

[Beene]: “The problem is now you have individuals taking advantage of a pretty liberal, open-ended process for determining who qualifies.”

It seems that the program to let family members become the home health aides got going in 2015.

In 2015, the eligibility rules changed, and the number of people getting care skyrocketed from 20,000 to 250,000.

And that was just the start. Here’s what Newsweek says were the relevant stats for the period 2019-2024:

[T]he money going to this program triple[d] across the span of the last five years, and home health jobs are [in 2024] considered to make up 12 percent of New York City’s private sector jobs, Bloomberg reported.

The occasion for the Bloomberg and Newsweek pieces in 2024 was an interview given to Bloomberg by New York Governor Kathy Hochul in July of that year. In the interview, Hochul appeared to recognize that the home health care aide situation had gotten out of hand and needed to be reined in. From the Newsweek piece:

[Hochul said,] “The problem is now you have individuals taking advantage of a pretty liberal, open-ended process for determining who qualifies.” Hochul told Bloomberg that the program was being abused so much that it now makes up the majority of New York City’s job increases. . . . “I’m telling you right now, when you look on TikTok and you see ads of young people saying, ‘Guess what, you can make $37 an hour by sitting home with your Grandma. You know, here’s how you sign up,’ it has become a racket,” Hochul told Bloomberg.

So less than a year ago, Governor Hochul had recognized this as a “racket.” Surely then she did something to get it under control? Not at all. Instead, it appears that she has switched sides, and in ongoing budget negotiations this year is supporting a vast increase in Medicaid spending to continue funding this racket, among many other things. The New York Post had an editorial on April 6. Excerpt:

In a tale all too typical of Albany, Gov. Kathy Hochul a year or so ago was pushing to rein in out-of-control state Medicaid spending on home health aides, only to since switch sides with an eye on her re-election run next year. Now Medicaid outlays are set to soar at least 17% in the next budget, while the aide ranks are soaring and indeed are by far the single largest job category in all New York.

The Post collects some truly incredible statistics from a Report issued by the Empire Center think tank on April 3. The Empire Center Report is based on federal BLS data issued on April 2, although the data only go up to May 2024. From the Empire Center:

New York’s home health employment is continuing to soar, growing by 57,000 jobs or 10 percent from 2023 to 2024, according to newly released data from the U.S. Bureau of Labor Statistics. The state’s workforce of home health and personal care aides grew to an estimated 623,000 as of May 2024, according to BLS. . . .

From 20,000 in 2015 to 623,000 in 2024. Thanks, federal taxpayers, for picking up more than half of the tab. The Empire Center Report shows New York as by far the highest in the country in the number of these home health care aides per capita:

[New York has] 171 aides per 1,000 residents aged 65 or older, which was the highest rate in the U.S. – 153 percent higher than the national average and 24 percent ahead of the No. 2 state, California.

Over this period, the job category of home health aide has become far and away the largest job category in New York State. Here is a chart from the Empire Center Report, derived from BLS data, of the largest job categories in New York in 2024:

There are almost three times as many of these home health aides as all jobs in retail sales!

The Post attributes Governor Hochul’s switch of sides substantially to her buying the support of a health care union known as “Local 1199” (of the SEIU) in the run-up to her re-election campaign next year. Local 1199 hopes to unionize the home health aides to get hundreds of thousands of new dues-paying members, and then to engage in collusive wage negotiations where the bill will be paid substantially by the federal taxpayers.

I don’t know all the other examples of fraud in the entitlement programs. But if one this big and this obvious is just allowed to metastasize for years without any attempt at oversight, there are likely to be plenty of others.

Francis Menton, Manhattan Contrarian

NATO is a Corpse

NATO is a corpse. All that remains is the grotesque performance art of a diplomatic zombie stumbling from summit to summit, mouthing tired clichés about “shared values” and “burden sharing,” even as its core strategic logic lies rotting beneath the surface. The Atlantic Alliance, once the steel scaffolding of Western security, has become a hollow ritual. Its military readiness is an illusion. Its political cohesion is fraying. Its future, if it has one, lies not in revival—but in reinvention or replacement.

This is not a triumphalist declaration from the Kremlin or Beijing. It is a sober diagnosis, grounded in realism and restraint. And it should be a wake-up call in Washington, Ottawa, Berlin, and beyond.

NATO’s death was not caused by Donald Trump, though he may soon become its undertaker. Nor was it caused by Vladimir Putin’s invasion of Ukraine, though that war has exposed the Alliance’s hollowness in ways no war game or communique ever could. The real cause lies in decades of European free-riding, American strategic drift, and a foundational lie at the heart of the Alliance: the idea that an empire can masquerade as a collective defense pact without consequences.

Let’s start with the numbers. Most NATO members still do not meet the 2 percent of GDP defense spending benchmark, despite years of promises and performative panic. Canada, which has taken freeloading to an art form, has shown no serious intention of meeting its obligations. As I’ve written elsewhere, Trudeau’s empty pledges mask a decaying defense industrial base, a stagnant recruiting system, and an Arctic strategy made of snow and sentiment.

Germany—the economic motor of Europe—still can’t field a combat-ready army for more than a few weeks at a time. The Bundeswehr is a shell. Its special fund is already mostly spent, and its political class remains addicted to strategic ambiguity and military minimalism. France wants “strategic autonomy” but lacks the scale and will to lead Europe alone. Poland, despite its impressive rearmament, cannot carry the continent’s defense burden on its shoulders—certainly not while Berlin dithers and Washington increasingly looks west, not east.

Meanwhile, the United States—still NATO’s military backbone—faces a fiscal cliff, a recruitment crisis, and an overstretched force posture. The era of limitless resources is over. American global primacy has ended. Multipolarity has arrived. The U.S. must now prioritize. And that means making hard choices about where its forces are truly needed—and where others must finally step up or face the consequences.

The war in Ukraine has laid these contradictions bare. NATO as an institution is not fighting the war. The United States is. Some European countries are helping—but most are hedging. NATO has been bypassed in favor of bilateral and ad hoc coalitions. Article 5 hasn’t been tested, and it may never be. The idea that NATO is “more united than ever” is a comforting fiction, trotted out to conceal the fact that the Alliance can no longer mount a serious, conventional defense of Europe without massive and prolonged American escalation.

Even the so-called Nordic expansion—Sweden and Finland joining NATO—has not changed the equation. It’s a strategic sideshow. Unless Europe can build up a credible, conventional deterrent in the East, without expecting Washington to always bail it out, the Alliance will remain a Potemkin village: flags, acronyms, and summits without substance.

Trump’s likely return to the White House in 2025 should not be viewed as a cataclysm but as an overdue reckoning. He will not end NATO. He will force Europe to decide whether it is willing to pay for its own defense or not. He will not blow up the Alliance. He will make it answer for its contradictions. And that, frankly, is what a serious ally should do.

Some critics will scream that this is the death knell of the “rules-based international order.” But the order they mourn was already breaking down—long before Trump, long before Ukraine, long before Brexit or Crimea. What we are witnessing is not a collapse but a transition: from the illusion of Atlanticism to the reality of multipolarity. And NATO, if it is to matter at all in this new world, must either become a true European-led military alliance with American support—or fade into history like SEATO and CENTO before it.

This doesn’t mean abandoning Europe to Russian domination. It means telling uncomfortable truths. Europe is rich. Europe is populous. Europe is not helpless. The United States can and should support its European allies—but it should not subsidize their illusions indefinitely. A more self-reliant Europe is not a threat to American interests; it is a precondition for strategic focus on the North Pacific, the Arctic, and the Western Hemisphere—where the real contests of the 21st century will be 

In my writing here and elsewhere, I have repeatedly argued that Canada must stop pretending it is a global power and start acting like what it is: a North Pacific, Arctic, and North Atlantic state. That means prioritizing regional defense, rebuilding naval and aerospace capabilities, and getting serious about continental defense. NATO is not the vehicle for that anymore—if it ever was. For Canada, continuing to hide behind NATO rhetoric while failing to meet even the most basic obligations is not only cowardly—it is dangerous.

A dead NATO still carries risks. Strategic ambiguity, brittle expectations, and performative deterrence are a recipe for miscalculation. The Alliance’s political leadership must either acknowledge the need for transformation or risk a future crisis that reveals, in real time and in blood, what we already know: that the emperor has no tanks.

The solution is not sentimental nostalgia. It is clear-eyed realism. NATO in its current form is not worth saving. But its core idea—collective defense among likeminded powers—still has value. What’s needed is a reset: a reimagined Euro-Atlantic security framework led by capable European states, with American support but not American dominance. A NATO that deters by capability, not by assumption. A NATO that can say no as well as yes. A NATO, in short, that lives in the real world.

The alternative is strategic decay. A slow slide into irrelevance. More summits, more selfies, more hollow communiqués. Until, one day, NATO doesn’t die with a bang—but with a bureaucratic whimper.

That future is already here. NATO is dead. The only question now is what comes next—and whether we have the courage to build it.

Andrew Latham, Real Clear Wire

You Have No “Free Trade” With Mobsters

Why must President Trump get the Supreme Court’s permission to run the executive branch of government?

Trading and dealing with people in totalitarian countries is like dealing with mobsters. It’s not that the people in those countries are necessarily bad; but their rulers are. China is not a free country. China is a totalitarian government. Workers in China are borderline (if not actual) slaves. They work not for their own benefit, but for the welfare of their rulers. They operate only with the consent of the government. If you live in a free country, it’s an absurd delusion to claim you are “trading” with slaves. You are never trading with workers or business people in a Communist or fascist country, like China; it’s all an illusion perpetrated by the totalitarian government. The only appropriate policy of a free country toward a slave country’s government is to do everything possible (economically or even militarily) to undermine or destroy that government. At a minimum, you don’t trade with them, because it’s no different than doing business with mobsters. It WILL come back to bite you. Everything Trump is doing to the Chinese government at present is morally justified and long overdue.

Before you get FREE TRADE you must first have FREE COUNTRIES. China is not free.

Michael J. Hurd, Daily Dose of Reason

What AYN RAND Really Thought of Totalitarian Regimes

At the height of the Cold War, Playboy magazine asked free market thinker and Russian author Ayn Rand, “Would you actively advocate that the United States invade Cuba or the Soviet Union?”

Rand replied, “Not at present. I don’t think it’s necessary. I would advocate that which the Soviet Union fears above all else: economic boycott, I would advocate a blockade of Cuba and an economic boycott of Soviet Russia; and you would see both of those regimes collapse without the loss of a single American life.”

I find it interesting that the globalist, pseudocapitalist Ayn Rand Institute denounces every aspect of Trump’s foreign and economic policy. And yet: Rand’s proposed economic boycott and blockade of Soviet Russia and Communist Cuba are more strenuous than Trump’s tariffs on China. The 21st Century Ayn Rand Institute, if consistent, would be forced to complain that Ayn Rand’s proposed economic boycott of Soviet Russia back in 1960 would be a violation of the economic individual rights of Americans to trade with the victims and slaves living under dictatorship.

More evidence that the Ayn Rand Institute and Ayn Rand have nothing whatsoever to do with each other.

Michael J. Hurd, Daily Dose of Reason

Secretary Marco Rubio: Student Visas not Some Sort of Birthright

Secretary of State Marco Rubio took aim at foreign students who come to the United States on a student visa only to do “crazy things” on campus, asserting that the administration continues to crack down on these “lunatics.”

Rubio said a student visa is not “some sort of birthright.”

Rubio made the remarks during President Donald Trump’s Cabinet meeting on Thursday.

“If you come to this country as a student, we expect you to go to class and study and get a degree. If you come here to, like, vandalize a library, take over a campus, and do all kinds of crazy things, you know, we’re going to get rid of these people,” Rubio said. “So when we identify lunatics like these, we take away their student visa.”

Rubio said late last month that the State Department had, at that point, revoked more than 300 student visas of foreign students who participate in actions such as “vandalizing universities, harassing students, taking over buildings, creating a ruckus,” among other things, like voicing support for Hamas terrorists in Gaza or antisemitic speech.

“No one’s entitled to a student visa. The press covers student visas like they’re some sort of birthright,” Rubio added. “No, a student visa is like me inviting you into my home. If you come into my home and put all kinds of crap on my couch, I’m going to kick you out of my house.”

Rubio’s remarks come amid reports that 300 foreign students in recent days alone have had their student visas revoked.

The White House defends the revocations under the 1952 Immigration and Nationality Act.

“It’s a section of the Immigration and Nationality Act that basically states that, for whatever reason, that if we think you’re not compliant, we can make you deportable,” immigration lawyer Jamie Barron told CBS News. “It could be, for example, an argument with a roommate, a fight, a DWI, a theft charge, or maybe they did a protest, which is freedom of speech, but they consider it may be harmful for the country.”

Newsmax

Rep. Byron Donalds : Protesters Don’t Even Know What They’re Mad About

Rep. Byron Donalds, R-Fla., told Newsmax about a protest in central Florida he crashed earlier this week to ask what the protesters were so mad about, only to find out they had no idea.

Donalds joined “Greg Kelly Reports” on Thursday and said the protesters had “no idea what they’re talking about.”

“Look, this is one of the reasons why I went to that Tesla protest, because I wanted to see firsthand what people were upset about. And when you ask them the question, they can’t answer,” Donalds told guest host Lidia Curanaj.

“It’s nothing new, especially when you’re dealing with people who are on the radical left,” he added about his experience in Kissimmee, Florida. “They can’t argue the facts. So what they try to do is bring out these crazy emotional arguments.”

Donalds also reacted to a clip of a woman trying to explain the evils of the Safeguard American Voter Eligibility Act, which passed in the House earlier Thursday, calling it “crazy” that the protester couldn’t enumerate basic facts about the measure she was protesting.

“They’re quick to tell you to do your research, and then when you try to go a couple levels down to figure out their research, you realize they have no idea what the hell they’re talking about,” Donalds said. “So when I see these clips — and I’m glad these clips are surfacing and that they’re out there for the American people to see — first I laugh, then I shake my head. Then I realize we still have a job to do.

“We have to communicate exactly what we’re doing to the American people. We have to be factual and demonstrate that our policies — the America First movement — is what’s going to put America on track to be successful for everybody,” he added.

Mark Swanson, Newsmax

How the Media is Killing Society

How the media is killing society:

1. People like good production value. They like good acting. Look at the popularity of The White Lotus. Or The Game of Thrones. To most people, the “news” seems credible, because it’s executed well. They’re liars, but they’re highly capable liars. Rachel Maddow is not a good person, but she’s good at what she does.

2. People were not trained to think critically. Government schools and most private schools condition you to be part of the pack. You are taught in groups, or classes, not individually. The goal is the average, or the norm, not achievement of your own potential. This leads, in adulthood, to a mentality of group think. In practice, this means replacing “What’s true?” with “What does everyone else seem to think?” I never knew how prevalent this was until COVID. It was shocking and staggering, even to me. 2020-2021 unmasked EVERYTHING.

3. The people in the media are the same as the people watching the “mainstream” media. They lack independence and critical thinking. Just like their audience. However, they, the members of the media, do have a leftist agenda. In fact, they are SO leftist they don’t even realize they’re leftist. To them, it’s a combination of virtue and objective truth. Their biases and outright lies seem self-evident, to them. They sneer at dissension, something they rarely encounter outside their elite blue states and cities. This results in the spectacle of sheep teaching sheep; sheep reinforcing sheep. Today’s establishment media: an elitism of ignorance and naivete masquerading as sophistication and truth. Most don’t see it. They just absorb it all, uncritically call it “news,” and go about the business of their lives.

It’s not hopeless. But the situation is daunting. More than most of us know. It’s incredibly uphill. Trump’s surprising victory in 2024 proved the media is not omnipotent. But it’s very, very present. And, because of those 3 points above, people will continue to default to whatever the media wants. Trump has an uphill battle, and his successors will have it even tougher. Ignorance has morphed into hatred, and it’s not letting go. It will not go down without a fight, and I am talking the fight of this century.

If the media stopped being leftist, it would have an impact. Indeed, we have more nonleftist media than ever before. It started with National Review and Ayn Rand’s Manhattan living room discussion groups in the 1950s and 1960s. It evolved into Rush Limbaugh, Fox News in the 1990s and 2000s. And today: alternate media (translation: nonleftist) is a force. It’s so much a force that Donald Trump got two terms (really, three terms) as President. Never underestimate the power of human potenial in the exercise of free will. We all have the capacity to think and know the truth, independently and against any odds. We all have this inner superhero, when we choose to activate it.

Good news: Critical, objective thinking is making a comeback. But we have a long tough road ahead for America, for truth and for civilization itself. I love Ayn Rand’s quote the most: Those who fight for the future live in it today. Thanks to the future we are creating today, the world has become a better place.

Follow Dr. Hurd on Facebook. Search under “Michael Hurd” (Charleston SC). Get up-to-the-minute postings, recommended articles and links, and engage in back-and-forth discussion with Dr. Hurd on topics of interest. Also follow Dr. Hurd on X at @MichaelJHurd1, drmichaelhurd on Instagram, @DrHurd on TruthSocial. Dr. Hurd is also now a Newsmax Insider!

Maximum Pressure: Trump Unleashes Fresh Sanctions on Iranian Nuclear Program

The Trump administration unleashed another round of sanctions on Iranian entities fueling the country’s illicit nuclear weapons program, ratcheting up pressure on the hardline regime ahead of major diplomatic talks this weekend.

The Wednesday sanctions primarily target “key entities managing and overseeing Iran’s nuclear program,” including the Atomic Energy Organization of Iran (AEOI) and a subordinate group, the Iran Centrifuge Technology Company (TESA), which manufactures the machines powering Tehran’s uranium enrichment program.

The fresh sanctions are the most biting to date and strike at the heart of Tehran’s nuclear industry, effectively choking off its ability to source the materials required for uranium enrichment and the construction of research facilities. They are certain to get the Iranian leadership’s attention ahead of negotiations with the United States on Saturday.

“The Iranian regime’s reckless pursuit of nuclear weapons remains a grave threat to the United States and a menace to regional stability and global security,” Treasury Secretary Scott Bessent said in a statement. “Treasury will continue to leverage our tools and authorities to disrupt any attempt by Iran to advance its nuclear program and its broader destabilizing agenda.”

Iran has spent years perfecting its ability to enrich uranium, the key component in an atomic bomb, through advanced centrifuges, which spin the fuel at high speeds to bring it towards weapons-grade levels. The latest sanctions aim to disrupt this activity by targeting the Iran-based Atbin Ista Technical and Engineering Company (AIT), which helps Tehran’s technology sector secure various components from foreign suppliers.

Iranian national Majid Mosallat, who serves as a managing director at AIT, was also hit with sanctions for his role in overseeing “the purchase and shipment of items to TESA on behalf of AIT,” according to information provided by the Treasury Department.

Another Iranian company, Pegah Aluminum Arak Company, was also designated for manufacturing aluminum products on TESA’s behalf. Additional sanctions target a constellation of companies that feed Iran’s Atomic Energy Organization, the main government body “responsible for research and development activities in the field of nuclear technology, including Iran’s centrifuge enrichment and experimental laser enrichment of uranium programs,” according to the Treasury Department.

Around July 2023, the AEOI formed Thorium Power Company and tasked it with developing “thorium-fueled reactor technologies,” which help breed a pivotal fissile material known as uranium-233. The company is now formally under U.S. sanctions and will face great difficulties trying to source weapons technology.

Two other Iranian companies—the Pars Reactors Construction and Development Company and Azarab Industries Co.—will also face sanctions. Pars acts as an “AEOI-subordinate” engaged in a “number of nuclear reactor projects.”

Azarab, the Treasury Department said, acts as a general contractor for the AEOI, helping it construct “power plant, refinery, petrochemical, and cement projects.” It also has a contract to produce “equipment for nuclear power plants.” The sanctions, like other similar measures, will stop Azarab from sourcing the materials it needs to complete these projects.

Nick Stewart, who served as chief of staff for the State Department’s Iran Action Group during Trump’s first term, said the latest sanctions send “a powerful and unmistakable message” to Tehran ahead of diplomatic talks this weekend.

“Beyond the practical impact of today’s designations, their timing—on the eve of potential talks in Oman—sends a powerful and unmistakable message: Iran’s nuclear ambitions will not be tolerated, and those who enable them will face severe consequences,” said Stewart, who is currently the senior director of government relations at FDD Action, an advocacy arm of the Foundation for Defense of Democracies think tank.

“With Iran at its weakest point in decades, the United States must recognize the tremendous leverage it holds and press that advantage,” Stewart said. “The complete and verifiable dismantlement of Iran’s nuclear program is the only viable path to protect U.S. national security and promote regional stability.”

The bevy of new punitive measures come ahead of what President Donald Trump described earlier this week as a “very big meeting” with Iran over its nuclear weapons program. Tehran’s enrichment activities went into overdrive during the Biden-Harris administration, which failed to enforce sanctions on Iran, helping it secure the cash needed to pursue nuclear technology and fund its regional terror proxies.

Trump entered office pledging to pursue diplomacy with Iran but promising to take military action if Iran balked at direct negotiations. The country’s hardline leadership still maintains that Saturday’s diplomatic détente will occur indirectly, with the two sides speaking through Oman as a mediator. The White House, meanwhile, insists the negotiations will take place directly with Tehran.

On Tuesday, shortly after Trump announced the talks, Iranian foreign minister Abbas Araqchi claimed that Washington had agreed to hold indirect negotiations.

“As long as ‘maximum pressure’ and threats exist, there is no ground for fair negotiations, and we will not hold direct negotiations,” Araqchi said. Trump, however, described the upcoming meeting differently during a Tuesday press conference with Israeli prime minister Benjamin Netanyahu.

“We have a very big meeting on Saturday, and we’re dealing with them directly,” Trump said. “We are meeting, very importantly, on Saturday at almost the h freshighest level.” Should the talks fail, “Iran is going to be in great danger.”

Free Beacon, Adam Kredo